*To FASN members-*Here is a PowerPoint presentation that you can

use when you have an opportunity to speak to influential groups- like School Boards, PTA groups, or other local community groups*Make it personal- use statistics from your district

or school, tell personal stories – they often are what really grabs someone’s attention! And we know that school nurses have LOTS of stories!*After personalizing the presentation- delete this

slide*Good Luck! *Rita Becchetti, Advocacy Chair, FASN

Place your name here

*Why do we need School Health Services

*History of School Health

Physicians and nurses hired to exclude the potentially contagious students (Boston & NYC)

-School health services spread-First full-service schools

-Conflict between public health and private medicine- AMA opposition to all publicly-funded treatment services in schools

School health = health ed, immunization documentation, screenings, tx for minor injuries, referrals for problem dx & tx

-New provider types: nurse practitioners, SBHCs. -New emphasis on health care to poor children.-Federal law mandates health-related services for students with disabilities

-Spread of SBHCs-Influence of changes in education (accountability, testing, success for all) and health systems (accountability, managed care, outcomes focus)

Protect the school environmentMultiple possibilities; protect the

studentsSchool health content fixed by external issuesSchool health contained

Focus on individual student health, incorporation of mandated servicesImportance of external education and health policies for shaping

school health

Early 1900s

1920s

1950s

1960s

1980s

1990s

1970s

1910

1880s

SCHOOL HEALTH – THE 100 YEARS

*School Nursing- Who is your

school nurse?

*School nursing is a specialized practice of professional nursing that advances the well-being, academic success and life-long achievement and health of students. To that end, school nurses facilitate positive student responses to normal development; promote health and safety including a healthy environment; intervene with actual and potential health problems; provide case management services; and actively collaborate with others to build student and family capacity for adaptation, self-management, self advocacy, and learning.

* (NASN 2010)

*It is the position of the National Association of School Nurses that school districts should provide a full-time professionally prepared registered nurse all day, every day in each building (NASN, 2003).

*“Every student deserves a school

nurse.”

*School Health Challenges Today

*Today-*Sicker kids in the hospital sicker kids getting out of hospital earlier (i.e. in schools)*Youths high risk behavior starting at an earlier age (as early as 8th grade)*Era of resistant infections (MRSA, VRE…)*Age of natural and man-made disasters*Violence*School shooting*Terrorism*Hurricanes

*School Health Today

*The percentage of children and adolescents in the United States with chronic health conditions (CHC) increased from 1.8% in the 1960s to more than 25% in 2007 (Halfon & Newacheck, 2010). *Asthma: Over 10 million U.S. children aged 17 years and under (14%) have ever been diagnosed with asthma; 7 million children still have asthma (10%). *13 million school days are missed each year due to

asthma.*About 1 in 10 children (10%) had asthma.

(Centers for Disease Control and Prevention, Vital Signs, May 2011).

*School Health Today

*Allergies: *Number has doubled from 1997-2002 (Study

from Mount Sinai school of Med and the Food Allergy and Anaphylaxis network)*Centers for Disease Control and Prevention

reports that one out of every 25 children has a food allergy, representing about a 20% increase between 1997 to 2007.*Approximately 6 million children have a life-

threatening allergy-peanuts being the most common

*School Health Today

*More medications given during the day at school*More than 3.5 million school children take

medication at school every day*Includes 200 types of prescription drugs,

about 3x the number taken in 1980s (Iowa Univ)

*Where are We Now?

*Poor nurse to student ratio:*Estimates 56,000 nurses FT at schools 1:950 students (2004 Census)*Real estimate 1:1,461 students (NASN)*Some communities 1:7,200 (Tuolumne County, CA)

*Federal guidelines: 1:750 students*Almost 47% of schools fall short of the federally recommended nurse-to-student ratio (CDC)

*NASN recommends minimum ratios of nurses to students depending on the needs of the student populations:*1:750 for students in the general population, *1:225 in the student populations that may require daily professional school nursing services or interventions, *1:125 in student populations with complex health care needs, and *1:1 may be necessary for individual students who require daily and continuous professional nursing services.

*  *“Every student deserves a school

nurse.”

*Schools Without a Nurse Have more

medication errors

*More Medication errors*University of Iowa research:*600 school nurses surveyed in year 2000*50% of respondents reported medication errors at the schools

they worked at, mistakes made by teachers, secretaries, health aides

*LA school district - 86% of med doses administered last year came from unlicensed staff members

*Schools Without a Nurse Have

*More lost days from school*CDC Study in 2002 school year*Students across the nation lost roughly 14.7 million school

days to asthma*A 2003 study from 16 elementary schools in Toledo, OH*Asthmatic students who attended schools with a full time

nurse averaged 3 more school days than asthmatic students at schools with part-time nurses.

*Healthy People 2020

*The percent of students in federally supported special education program increased from 8% to 14% from 1977 – 2006 (NCES, 2007).*Within this group, the rates of children with

health conditions have doubled since 2001 (NCES, 2007).*As rate of NICU survival has risen, so do the

numbers of children with neurodevelopmental problems.

*“Schools without nurses are putting children in

harm’s way. If we cannot afford school nurses,

we’ve got our priorities skewed”.

Dr. William Sears; Physician and Author

*Every Student Deserves a

School Nurse

*The national average of nurse to student ratios is abysmal right now:*Only 13 states met the

recommended 1:750- The state with the healthiest ratio was Vermont, at 1:311- The state with the worst ratio was Michigan, at 1:4,836 *Florida – now at #47

*Where are We Now?

*Inconsistent laws between States:*NASBE, NASN: *Only in one State (DE) a nurse is required in every

school*Only in 15 states, District MUST offer nursing services

*Poor Pay:*Median salary $36,000 (2004 survey of > 4,000 school nurses) –that is$20,000 less than the median salary for a clinical nurse*School district budget cuts

*The Issues Today

*Main issues surrounding health management of students with chronic health conditions in schools are as follows:

• Health care services must be provided for students who qualify for services under IDEA or Section 504 to meet requirements of federal laws. The school nurse has an important role in interpreting a student’s health status, in explaining the impairment, and in interpreting medical and other health information in relation to the expanded e standards for eligibility under Section 504 (Zirkel, 2009).

*The Issues Today

• Development of individualized health care plans (IHP) is a nursing responsibility and is based on standards of care that are regulated by State Nurse Practice Acts and cannot be delegated to unlicensed individuals (National Council of State Boards of Nursing [NCSBN], 2005).

• Effective and safe management of chronic health conditions is complex, requires careful planning by a school nurse, and may involve delegation of nursing tasks to both licensed and unlicensed assistive personnel (UAP).

*The Issues Today

• A full-time school nurse is essential to achieve quality student health services and to meet student health needs.

• Dependable funding is required to ensure quality student health services.

*Schools Need a Nurse

*More risk taking:*1999 US Supreme court ruling:* Public school districts to provide medical care short of a

doctor to students with disabilities (Devices e.g. trachs, G-tubes, feeding pumps)

*Dealing with Emergencies: * In Florida 6,007 calls made to 911 in 2003-2004 school year

according to FL DOH

*Advocate

*The Student-to-School Nurse Ratio Improvement Bill has been introduced in both the House and Senate.  *Ask your Representative to support H.R. 2730

and your Senators to support S. 2750.

*Healthy People 2020

*Among toddlers and infants in this group who show no or mild disability, a significant number of them have moderate – severe disabilities at school age (Marlow, Wolke,& Bracewell,2005;Hoestra,Ferrara,Coeser,Payne Connet, 2004)*Each year, as these survivors enter early

intervention services and Kindergarten, the need for school health services increases. *Medically fragile children in school require

ventilators, tube feedings, medication, and other complex nursing cares (Clement, Barfield, Ayadi, & Wilber, 2007).

*Future planning

*Reducing Health Disparities and increasing access to care:*Children are 25% of the population, but 35% of the

population living in poverty (US Census, 2005)*40.9% of the nation’s K–12 students are low

income and receive free- and reduced price-lunch (National Center for Education Statistics, 2006)*Almost 12% of children do not have health

insurance, but 19% of children in poverty lack insurance (US Census, 2007)

*Future planning

*Foreign-born immigrant children are now 5.7% of high school population and 3.3% of the primary school population (National Governors Association, 2008).*Over 900,000 children are homeless

(National Coalition for the Homeless, 2007)*All of these factors affect access to care. *The school nurse may be the only health

care the children have available

*Healthy People 2020

*The predominant funding of school health services through education budgets needs to be reexamined. *School nurses are extensions of the public

health system and a vital component of the care of children with disabilities. *Investigation of adequate funding models

(such as a combination of health and education funding) that do not impinge local education instructional budgets is needed.

*Coordinated School Health

*Health of young people is strongly linked to their academic success- and academic success of youth is strongly linked with their health.

• Helping students stay healthy is a fundamental part of the mission of schools.

• Health-related factors, such as hunger, chronic illness, or physical and emotional abuse, can lead to poor school performance.1

• Health-risk behaviors such as substance use, violence, and physical inactivity are consistently linked to academic failure and often affect students' school attendance, grades, test scores, and ability to pay attention in class

*Coordinated School Health

*School Health Services*Health Education*Physical Education*Nutrition Services*Psychology, Social Services, Counseling*Healthy and Safe School Environment*Health Promotion for Staff*Family and Community Environment

*It is the position of the National Association of School Nurses that school districts should provide a full-time professionally prepared registered nurse all day, every day in each building (NASN, 2003).

*“Every student deserves a school

nurse.”

*How can you help our children?

*Thank you

*For more information, contact:

*Put your contact info here