Transcript School Nurse Bill

School Nurse Bill
Organized Groups Pro
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National Association of School Nurses (NASN)
CDC
Healthy People 2020
American Nurses Association
American Academy of Pediatrics
American Dental Association
American Lung Association
Food Allergy and Anaphylaxis Network
PRO
• NASN believes
 every child deserves a school nurse, every school day.
 NASN recommends ratio based on student health needs.
• Healthy People 2020 objective
 student-to-school nurse ratio of 1:750 well students
 Baseline in 2006 was 40.6%
 Target improvement 44.7% with 10% improvement.
PRO
• CDC: Reported
 8.9% of children in 2008 without health insurance
 1,300,000 homeless children in U.S.
 Schools have become the only source of health care for many
children and adolescents.
 Communicable and infections diseases account for millions of
school days lost each year
 Students with health problem attended by school nurse were
able to return to class 95% of time.
 School nurses have a positive impact on immunization rates.
 Using a formula based approach offers a reasonable means
for achieving better student outcome.
PRO
• American Academy of Pediatrics: Students today
face increase social issues as well as the need for preventative
services and interventions for acute and chronic health issues.
• American Nurses Association: When there is no
nurse on the school premises, the responsibility to administer
the necessary medication and treatments falls on
administrators, educators and staff that are ill-prepared to
perform these tasks.
• Statistics from the National Center for Educational Statistics
indicate that of the 52,000,000 children who currently spend
their day in schools, 16% have chronic physical, emotional, or
other health problems.
PRO
• American Lung Association:
 Severe asthma is one of the greatest threats to
student health
 Affects 1 in 10 students
 About 2 students in every classroom
 According to CDC, students in the US lost approx.
14.7 million school days to asthma.
 More school nurses might help keep those
students in the class room.
Organized Group Con
School districts facing economic constraints
• Many states do not follow the Federally
recommended nurse-to student ratio which is
1:750 students in the general school
population 1:225 students in the
mainstreamed population
• School Administrators do not want to lose one
of their teachers. Losing the school nurses
verses losing a teacher. Difficult choice!
Problem
• School nurses lack of documentation of the
benefits or outcomes of school nursing services.
• Leads to efforts going unrecognized &
undervalued.
• School nurses must educate school
administrators, teachers, and parents about the
services they provide and the positive impact
they have on children.
• Need evidence that full-time school nurses are
needed in schools so that health needs of
students can be met.
Evidence
• For example a study done in 2004,
investigating difference between student
access to full-time and part-time school
nurses found that, a full time nurse might
attend to 74 visits related to asthma
compared to a part-time nurse who might
attend to only 6.4 visits per 100 students
enrolled in the school. (Telljohann, 2004).
Economic Impact
• http://www.youtube.com/watch?v=tUH9Cjos6wM
• School nurses make approximately $ 40,000 to $
60,000 nationwide. May be different depending on the
geographic location.
• According to the Health Resources and Service
Administration (HRSA), there were 73,697 RNs working
as school nurses in 2010.
• There is no shortage of school nurses.
• There is a shortage of funded school nurse positions!!!
• If every state follows the federal guideline for studentto-school nurse ratio, more local school district and
state budget will be spent on salaries.
Economic Impact
• If more budget is utilized to fund school nurse
positions then probably some other area
suffers- may be one less teacher or a physical
education personnel, arts, music….
• School districts reduce funding for school
nurses to help close a state deficit
• While the funding for school nurses decline
the need stays the same or grows.
Related Policies
• S 2047: Student-to-school nurse ratio
improvement act of 2012 introduced on 1-302012.
• HR 2730
• HR 2750
• Similar bill in 2009
• Senator Charles Schumer proposed a companion
bill in the Senate.
• Neither bills came out of committee.
National Law Mandates
• IDEA (Individuals with Disabilities Education Act)
of 1975.
• Americans with Disabilities Act of 1990.
• Rehabilitation Act of 1973
 Although these laws require school districts to
provide services to students with special needs,
they do not mandate that such services be
provided by school nurses.
 School districts therefore are not obliged to hire
school nurses. Instead they may hire unlicensed
assistive personnel.
Legal and Ethical Concerns
• Compromising child safety- life threatening situations and even death in
some instances.
• According to ANA- mistakes are more than three times as likely to occur
• Growing number of chronic illnesses
• Nurses cover multiple schools and may not be available when a child is in
distress
• May develop into something more serious while waiting for the school
nurse to arrive.
• Depending on secretaries, non-medical personnel, teachers or principal to
administer medications and treatments.
• Non-medical personnel not qualified to handle emergencies, food allergies,
medication allergies etc.
• U.S supreme court ruling requires public school district to provide medical
care for students with disabilities including handling devices such as
tracheostomy tubes, ventilators, and feeding pumps- requires trained
personnel to handle…
Ethical Concerns
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Every day 3.5 million school children take medication at school.
The includes 200 types of prescription drugs about 3 times the number taken in
the late 1980’s
The number of children allergic to peanuts and tree nuts has doubled since 1997.
HIPPA regulations. STDs, TEEN pregnancies, Sexual behavior
Reporting specific communicable diseases as required by state laws
Student demands not to share information, protect privacy & confidentiality
DNR orders for children attending schools with chronic condition such as kidney
failure, cardiac issues etc.
IDEA and ADA mandates to include ill students in regular schools
More school nurses might help keep those students in the classroom.
If we cannot afford school nurses we’ve got our priorities skewed!
It is like not putting in a traffic light until there is a serious accident.
Girl in Tacoma died in school because of peanut allergy and acute asthma attack –
school nurse wasn’t there school staff failed to deliver a shot of epinephrine.
Result – Death of a child in school.
Ethical Framework
The Utilitarian Approach
Ethical Framework
• Conceived in the 19th century
• By Jeremy Bentham and John S. Mill
• Help legislators determine which laws were
morally best
• Ethical actions are those that provide the greatest
good for the greatest number
Limitations
 Assumes that one can measure harm and benefit
 Conflict with traditional nursing goals of individual patient
advocacy
Impact on Healthcare and Nursing
• Decreasing the student-to-school nurse ratio will help
 Effective/efficient management of chronic illnesses
 Effective/timely management of emergencies
 Increasing attendance
 Improved attendance = academic success
 Keeps students at school and parents at work
 Allows teachers to teach instead of providing
healthcare to children
 Reducing the number of 911 calls
 School nurses may be the only health provider a child
sees (ANA, 2005).
Impact on Healthcare
• Currently, more than 50% of public schools in the US do not have a
full time RN.
• Wide ration disparities exist from state to state, within states and
school districts, and between urban and rural schools.
• Students today have increasingly complex needs for nursing care.
• School nurses facilitate learning for all students, especially those
with asthma, food allergies, obesity, vision and hearing difficulties,
dental problems, mental and behavioral problems, and those who
need prescribed medicine for either acute or chronic conditions.
• With 98% of school-age children in the US spending their days at
school, the role of the school nurse is critical to the implementation
of quality school health services.
• For many children, contact with a school nurse is often the only
consistent access to a health care professional.
Nursing
• School nurses will be able to provide better care to
their student patients
• Be available in the school building when needed
• Administer medications and vaccines
• Reduce medication errors
• Assess health status and make referrals
• Prepare for disaster
• Provide health counseling and wellness programs
• Foster healthy habits among school children
• School nurse is seen as less of a threat that educators
and other school personnel
How many school nurses are needed
• NASN recommends
 1:750 for well students
 1: 225 for students who require daily
professional school nursing services
 1: 125 for student population with complex
health needs
 1:1 for students with multiple disabilities
Where do we stand
• As of August 2011
 34 states failed to meet a minimum standards
 16 states and District of Columbia met the
recommendations
 Vermont topped the list with 1:396 students
 Michigan bottom of the list 1:4411 students
 Ohio ranked 32nd with 1:1,328
How to achieve the target
• States require funding
• Bill HR 2229 (2011) introduced by Carolyn
McCarthy to make demonstration grants to
eligible local educational agencies for the
purpose of reducing the student-to-school
nurse ratio in public elementary and
secondary schools
• Student-to-Student Nurse Ratio Improvement
Act of 2011 is currently in committee.
• http://www.youtube.com/watch?v=_Mf0tVnG
fqY&feature=fvwrel