Transforming Michigan and the Nations Schools

Through Appropriate School Nurse Staffing

 Presented by Kathleen Wiejaczka RN BSN

Ferris State University

March 25, 2009

 Objectives

 To understand the variety of roles of the school nurse.

 To gain knowledge of key issues related to school nurse-to-student

ratios.

 To understand key statistics related to school nurses and children in

school.

 To understand negative impact of less school nurse-to-student ratios.

 To gain knowledge of current legislation related to school nurse-to-

student ratios.

 To be able to identify political strategies to effect change.

 immunizations

Policy
Development School Nursing Roles Student
Health

Scoliosis Staff
Screening CPR

Individual
Health care
report Participate
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decompressor Individualized
are needed to see this picture.
Education
Emergenc Planning
y Committee
Care
Plan
Sex Health record
Education

Crisis medications Communicable

Protective Vision & Staff
intervention disease control
Service Dental Hearing Health
Reporting Screening Screening
Student &
Staff
Counseling
CSNO website at:
http://www.csno.org/docs/2-23-09 SNOR Legal Aspects-Dale-Revised.pdf
 Key Issues Related to School Nurse-to-Student
Ratios
 School administrators are delegating nursing functions to unlicensed assistive
personnel (UAP), endorsed by the Michigan Department of Education.

 The Public Health Code of Michigan and the Nurse Practice Act state that only a
Registered Nurse can delegate nursing acts, functions or tasks.

 When a school nurse delegates a nursing function, that nurse must supervise the
UAP on a regular basis.

 The recommended ratio of school nurse-to-student is 1:750 in general education

and 1:125 in special education per NASN, CDC and AAP.
 Key Statistics
 There are 73 million children in the US and 97% attend school.

 11% of children under the age of 18 do not have health insurance

 19% of children live in poverty in US

 17% of all students attending public schools receive special education

 13% of children receive medication at school

 15% to 31% of children under age 18 have chronic health conditions

 More Statistics
 Less than 25% of schools provide necessary services for
children with chronic illnesses.

 Only 19 states and D.C. have laws mandating school nursing

 More than 50% of public schools do not meet the

recommended ratio of school nurses-to-students.
 Negative Impact

 Mistakes are 3 times as likely to happen with UAP being responsible

for health needs of students.

 Only 25% of UAP received training and half of these were only a two
hour training, one time.

 Michigan is the second worst in the nation for school nurse-to-student

ratios. One nurse for every 4,204 children.

 5% of students seen by RN are sent home compared to 18% seen by

UAP

 Parents are managing their child’s health needs at the school.

 Current Legislation with School Nursing

 Representative Carolyn McCarthy and Lois Capps introduced new bill June
5, 2008.

 Called Student to School Nurse Ratio Improvement Act of 2008 or HR 6201

 Will authorize Secretary of Health and Human Services to give grants to

eligible States to reduce student-to-school nurse ratio

 Status: Referred to House Committee on Energy and Commerce

 Will require a report to the CDC evaluating the effectiveness of the program
in improving ratios and evaluate increased health benefits on the students
ability to learn.
 HR 6201 continued

 Eligible States are those who have a ratio greater than 1:1,000
of school nurses-to-students

 Mary Louise Embrey, Director of Government Affairs through NASN

believes this bill will be an amendment on a larger health care reform
bill.

 Mary Louise states that evidence-based data from this study will
prove that school nurses make a difference on student health and
learning.
 Political Strategies to Effect Change

 School nurses should speak to:

~~~ the public
~~~ administrators
~~~ legislators
~~~ Board meetings
~~~ PTO

 School nurses should:

~~~ join professional organizations and become active
~~~ invite legislators into their schools and give them a tour
~~~ write editorials or offer to be an expert for newspapers

 Become politically active and support HR 6201.

 Believe in the power of many to make a difference!
 Summary
 Through the passage of HR 6201, safe levels of school nurses will
occur nationally. I support this bill and encourage you to also.

 Through the data from this study, it will validate the contribution
school nurses make to the health of students.

 Improvement of school nurse-to-student ratios.

 Nursing procedures, tasks and functions will be supervised by

registered nurses and keep our children medically safe while at
school.
 References
 Annie E. Casey Foundation (2008). Growing up in America: child safety in
Canada, United States and Mexico. Retrieved from http://www.aecf.org
 Broussard, L. (2207). Empowerment in school nursing practice: a grounded
theory approach. The Journal of School Nursing, 23 (6), 322-328.
 California School Nurses Association (2008). School nursing services.
http://www.csno.org/docs/2-23-09 SNOR Legal Aspects-Dale- Revised.pdf
 Canham, DE., Bauer, l., Concepcion, M., Luong, J., Peter, J., & Wilde, C.
(2007). An audit of mediction administration: a glimpse into school health
offices. The Journal of School Nursing, 23 (1), 21-27.
 Hillemeier, M. M., Gusic, M. E., & Bai, Y. (2006). Rural and urban children
with asthma: are school health services meeting their needs? Pediatrics,118
(3), 1097-1103. doi:10.1542/peds.2005-2239
 House of Representatives, Student to school nurse ratio improvement act of
2008: H.R. 6201. Retrieved from http://thomas.loc.gov/
 McCarthy, A. M., Kelly, M. W., Johnson, S., Roman, J., & Zimmerman, M. B. (2006).
Changes in medications administered in schools. The Journal of School Nursing, 22 (2),
102-107.
 Michigan Association of School Nurses (2006). Position papers. Retrieved
from http://www.michiganshcoolnurses.org/extras/contact_us.php
 References
 Michigan Department of Education (2002). Medication policy and guidelines
for administering medications to pupils. State of Michigan official website.
Retrieved from
http://www.michigan.gov/documents/Medications_Policy_Nov_25,_2002_51010_7.pdf
 Murphy, J. & Lechtenberg, J. (2008). Michigan school nurse-to-student
ratio:second worst in nation. National Association of School Nurses.
Retrieved from http://www.nasn.org/default.aspx?taabid=523
 Nwabuzor, O. M. (2007). Legislative:shortage of nurses: the school nursing experience.
The Online Journal of Issues in Nursing: A Scholarly Journal of the American Nurses
Association. Retrieved on March 8, 2009 from Pub Med Database.
 Pennington, N. & Delaney, E. (2008). The number of students sent home by school
nurses compared to unlicensed personnel. The Journal of School Nursing, 24 (5),
290-297. doi:101177/1059840508322382
 Rodewald, A. (2009). Ranks of school nurses dwindling despite need. School Nurse
News, 26 (2), 31.