2018 Summer Institute for School Nursing Diane Allen MSN RN NCSN CBIS School Health Program Coordinator Fairfax County Health Department ID: 760140
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Slide1
Fundamentals
of School Nursing2018 Summer Institute for School Nursing
Diane Allen MSN, RN, NCSN, CBIS School Health Program Coordinator, Fairfax County Health
Department
Rebecca T. Cooper BSN, RN School Nurse and Coordinator, Shenandoah County Public Schools
Robin Zophy MSN, RN, NCSN School Nurse and Coordinator, Gloucester County Public Schools
Slide2Disclosure Statement
Planner, Presenter and Author Disclosure
Diane Allen, Rebecca Cooper and Robin Zophy
I/We disclose the absence of personal financial relationships with commercial interests relevant to this educational activity within the past 12 months.
Slide3Objectives
.
At the conclusion of this session, the participant will be able to:
discuss at least three aspects of the role of the school nurse, and the advantages of involvement in the school community.
describe at least three school health entry requirements in Virginia Public Schools.
list at least four resources for school nurses.
identify at least five responsibilities of the school nurse, and will be able to discuss plans for the preparation of the school health clinic.
outline the process of identifying the student with Special Education needs
Slide4School Nursing
Definition of School Nursing
School nursing, a specialized practice of nursing, protects and promotes student health, facilitates optimal development, and advances academic success. School nurses, grounded in ethical and evidence-based practice, are the leaders who bridge health care and education, provide care coordination, advocate for quality student-centered care, and collaborate to design systems that allow individuals and communities to develop their full potential (National Association of School Nurses [NASN, 2017).
Slide5The History of School Nursing
Slide6Belgium 1873
Brussels—first city to employ a school physician
Regular city-wide system of school inspection
Slide7London 1892First employment of school nurse—Amy Hughes—to investigate nutrition of school childrenSix years later (1898) The London School Nurse Society was established
Slide81894-BostonFirst school health services in schoolsIdentifies and excludes from schools: students with serious communicable disease (scarlet fever, diphtheria, pertussis, chicken pox, measles, mumps, and impetigo; later—parasitic diseases such as scabies, ringworm)
Slide91902 – New YorkLina Rogers-First public health school nurse in New York City schools. Decreased the rate of absenteeism and spread of communicable disease.
Slide10Virginia History
1905 Norfolk, VA public health department employed nurses for the schools.
1913 Portsmouth Public Schools employed
a physician and school nurses.
Slide11Standards of
School Nursing Practice
Slide12Standards of School Nursing Practice
Consist of the
Standards of Practice and the Standards of Professional Performance
The Standards of Practice are the six steps of the nursing process
They represent the directive nature of the standards as the school nurse completes each component of the nursing process (continued)
Slide13Standards of School Nursing Practice
The Standards of Professional Performance relate to how the school nurse adheres to all of the standards of practice & addresses other nursing practice issues, concerns, & activities
Together, they provide authoritative statements that all school nurses perform competently
They provide evidence of a standard of care and do depend on context, especially in unusual situations (adapted from ANA, 2015b, p.3).
Slide14Standards of Practice
Standard 1: Assessment
The school nurse collects pertinent data and information relative to the student’s health or the situation.
Standard 2. Diagnosis
The school nurse analyzes the assessment data to determine actual or potential diagnoses, problems, and issues.
Slide15Standards of Practice
Standard 3. Outcomes Identification
The school nurse identifies expected outcomes for a plan individualized to the student or the situation.
Standard 4. Planning
The school nurse develops a plan that prescribes strategies to attain expected, measurable outcomes.
Standard 5. Implementation
The school nurse implements the identified plan.
Slide16Standards of Practice
Standard 5 a. Coordination of Care
The school nurse coordinates care delivery.
Standard 5 b. Health Teaching and Health Promotion
The school nurse employs strategies to promote health and a safe environment.
Slide17Standards of Practice
Standard 6. Evaluation
The school nurse evaluates progress toward
attainment of outcomes.
Slide18Standards of Professional Performance
Slide19Standards of Professional Performance
Standard 7. Ethics
The school nurse practices ethically.
Standard 8. Culturally Congruent Practice
The school nurse practices in a manner that is congruent with cultural diversity and inclusion principles.
Slide20Standards of Professional Performance
Standard 9. Communication
The school nurse communicates effectively in all areas of practice.
Standard 10. Collaboration
The school nurse collaborates with key stakeholders in the conduct of nursing practice.
Slide21Standards of Professional Performance
Standard 11. Leadership
The school nurse leads within the professional practice setting and the profession.
Standard 12. Education
The school nurse seeks knowledge and competence that reflects current nursing practice and promotes futuristic thinking.
Slide22Standards of Professional Performance
Standard 13. Evidence-Based Practice and Research
The school nurse integrates evidence and research findings into practice.
Standard 14. Quality of Practice
The school nurse contributes to quality nursing practice.
Slide23Standards of Professional Performance
Standard 15. Professional Practice Evaluation
The school nurse evaluates one’s own and others’ nursing practice
Standard 16. Resource Utilization
The school nurse utilizes appropriate resources to plan, provide, and sustain evidence-based nursing services that are safe, effective, and fiscally responsible.
Slide24Standards of Professional Performance
Standard 17. Environmental Health
The school nurse practices in an environmentally safe and healthy manner.
Standard 18. Program Management
The school nurse directs the health services program within the school and community that includes evidence-based practice and accountability measures for quality, student health and learning outcomes.
Slide25Slide26Delegation
The authorization by a registered nurse to an unlicensed person to perform selected nursing tasks and procedures in accordance with
18VAC90-20-(420-460).
Slide27Delegation
Criteria for Delegation- 18VAC90-20-430
Assessment required prior to delegation- 18VAC90-20-440
Tasks that may
NOT
be delegated- 18VAC90-20-450
Tasks requiring a nursing assessment
Triage
Administration of medications
Slide28Delegation
Do not require the exercise of independent nursing judgment;
Do not require complex observations or critical decisions with respect to the nursing task or procedure;
Frequently recur in the routine care of the client or group of clients;
Do not require repeated performance of nursing assessments;
Slide29Delegation
Utilize a standard procedure in which the tasks or procedures can be performed according to exact, unchanging directions; and
Have predictable results and for which the consequences of performing the task or procedures improperly are minimal and not life threatening.
In the absence of delegation or training, the school system remains accountable to ensure the student’s needs are met in accordance with both federal and state laws
Slide30The 5 Rights of Delegation
“The Registered Nurse is not required to delegate an unlicensed person to perform a nursing task if it does not meet the criteria from the Virginia Board of Nursing. Delegation shall be made only if all of the following criteria are met: “
Slide31The 5 Rights of Delegation
1. In the judgment of the delegating nurse, the task or procedure can be properly and safely performed by the unlicensed person and the delegation does not jeopardize the health, safety, and welfare of the client.
2. The delegating nurse retains responsibility and accountability for nursing care of the client, including nursing assessment, planning, evaluation, documentation and supervision.
Slide32The 5 Rights of Delegation
3. Delegated tasks and procedures are within the knowledge, area of responsibility and skills of the delegating nurse.
4. Delegated tasks and procedures are communicated on a client-specific basis to an unlicensed person with clear, specific instructions for performance of activities, potential complications, and expected results.
Slide33The 5 Rights of Delegation
5. The person to whom a nursing task has been delegated is clearly identified to the client as an unlicensed person by a name tag worn while giving client care and by personal communication by the delegating nurse when necessary.
Slide34RN/LPN Scope of Practice
Taken directly from definitions
Virginia Board of Nursing Guidance Document #90-23: Decision Making Model for Determining RN/LPN Scope of Practice
Slide35Professional Nursing Insurance
Professional Liability and Malpractice Insurance
Rider for consultation – you talk to kids, parents and staff
Slide36Nursing Tidbits
You Are a Nurse and a Leader
A Nursing Professional in an Educational Environment
Independent Practitioner
See students with a “different set of eyes” than a teacher/administrator
A nursing specialty
Slide37Nursing Tidbits
Develop a Strong Relationship with Administration – they can make or break you
Update your School Board on nursing activities in your schools – nursing services volume of visits, % absences vs return to class
Participate in School Activities
Faculty meetings and activities
PTA meetings and activities – Bingo, family nights…
School Sponsored events – mother daughter dance…
Slide38Nursing Tidbits
Offer extras
Learn the educational lingo
Maintain a monthly bulletin board
Sponsor a student club
Offer a faculty wellness activity – arrange to become a Weight Watchers site, BP screenings
Slide39Nursing Tidbits
Be involved in your community
Chair or attend the School Health Advisory Board
Join a nursing coalition in your area
Get involved in County events
Join the Medical Reserve Corps
Slide40Nursing Tidbits
Professional Development
Become active om a professional organization – NASN, VASN, ANA, VEA, NEA…
Keep Learning!!!
Attend professional conferences – VASN Fall Conference, NASN Annual Conference
Take a Class
Earn an Advanced Degree and/or National Certification
Slide41ALWAYS REMEMBER…
BE PROUD OF YOUR SPECIALTY
YOU ARE NOT “
JUST
“
A SCHOOL NURSE
YOU ARE
the
HEALTH PROFESSIONAL IN YOUR BUILDING!!!
Slide42Slide43Student Enrollment Requirements
Slide44Student Enrollment Requirements
Virginia Department of Education VDOE) Superintendent’s Memo
Annually published on the VDOE website in
JULY.
Subject Line : “Student Enrollment Requirements – School Year ___-___
http://www.doe.virginia.gov/administrators/superintendents_memos/2018/index.shtml
MUST READ EVERY YEAR, CHECK FOR UPDATES
Slide45Physical Examination
Slide46School Entrance Physical Form
The school entrance physical form and immunization record shall be a standardized form provided by the State Department of Health, which shall be a part of the mandatory permanent student record.
To access the form visit:
http://www.doe.virginia.gov/support/health_medical/index.shtml
Slide47Physical Examination
“No pupil shall be admitted for the first time to any public kindergarten or elementary school in a school division unless such pupil shall furnish, prior to admission…. A comprehensive physical examination… within 12 months prior to the date such pupil first enters such public kindergarten or elementary school…”
Code of Virginia
§ 22.1-270
Slide48Which Means…
There is
no
grace period for obtaining a physical. A student entering VA public school for the first time in kindergarten or elementary school must have a comprehensive physical
before
they can enter the building.
There is no legal requirement for a physical exam for students entering grades 6-12. Some school divisions have established policies requiring a physical for these students. Check your school division policy for guidance.
Slide49Exemptions
The
Code of Virginia
§
22.1-270 (D)
Allows for parents who object to a physical examination on religious grounds to provide a written letter stating that the child is in good health and free from any communicable or contagious disease.
Slide50Preschool Enrollment Requirements
Preschool children fall into 2 categories: those that are officially enrolled in the school (preschool handicapped and special education) and those that merely rent space from your school division (most Head Start programs).
There is no document that outlines the responsibilities of the healthcare provider or specifically states the enrollment requirements for preschoolers.
Slide51Preschool Enrollment Requirements (cont.)
The preschool specialist at the Department of Education states that all preschool
Special Education
students must have a physical and
age appropriate
immunizations in order to attend school.
Slide52Preschool Enrollment Requirements (cont.)
All
students participating in a preschool program must provide a physical and proof of immunizations, that conform to the Code of Virginia,
upon entering kindergarten
. Regardless of the fact that they may have provided these documents when they entered a preschool program previously.
Slide53Middle School and High School Enrollment
No requirement for Physical exam
Must have up-to-date immunizations
Slide54Unique Considerations
HomelessFoster ChildrenMilitary CompactSpecial Education
Slide55Required Immunizations
Slide56Immunization Requirements
For specific immunization requirements, access the Virginia Department of Health website:
http://www.vdh.virginia.gov/content/uploads/sites/11/2016/04/Min-Requirements.pdf
Also available in Spanish.
Slide57Diphtheria, Tetanus & Pertussis(DTaP)
4 doses of
DTaP
– one must be
on or after
the first birthday
Slide58Tetanus, Diphtheria & Pertussis(Tdap)
One dose required for entry into 6
th
grade
Slide59Hepatitis B
3 doses
All minimum age & interval
Requirements must be met
Slide60Human Papilloma Virus(HPV)
A 3-dose series for
males and females
entering 6
th
grade
Slide61Measles, Mumps & Rubella(MMR)
2 doses of measles and 2 doses of mumps; 1 dose of rubella.
First dose
MUST
be administered on or after the first birthday.
Second dose given prior to starting kindergarten.
Slide62Polio
4 doses- one on or after the 4
th
birthday*
Slide63Varicella(Chickenpox)
2 doses – one dose
on or after the first birthday.
Second dose prior to entering kindergarten
Slide64Haemophilus Influenza Type b(Hib)
Required ONLY for children up to 60 months of age (IPOP and VPI preschool classes)
.
Series of 2-3 doses.
Current age, not number or prior doses governs number of doses required.
Unvaccinated children between 15 and 60 months are only required to have one dose.
Slide65Pneumoccocal (PVC)
Required ONLY for children up to 60 months of age (IPOP and VPI preschool classes)
.
1 to 4 doses, dependent on age at first dose, are required
Slide66Conditional Enrollment
Any student whose immunizations are incomplete may be conditionally enrolled if that student provides documentary proof at the time of enrollment of having received at least one dose of the required immunizations accompanied by a schedule for completion of the required doses within 90 calendar days.
Slide67Immunization Exemptions:Religious Exemptions
No certificate of immunization shall be required for the admission to school of any student if the student or his parent submits an affidavit to the admitting official stating that the administration of immunizing agents conflicts with the student's religious tenets or practices.
Code of Virginia
§ 22.1-271.2
Slide68Immunization Exemptions:Religious Exemptions
The certificate of religious exemption form may be downloaded from:
http://www.doe.virginia.gov/support/health_medical/certificate_religious_exemption.pdf
Slide69Immunization Exemptions:Medical Exemption
No certificate of immunization shall be required for the admission to school of any student if the school has written certification from a licensed physician or a local health department that one or more of the required immunizations may be detrimental to the student's health, indicating the specific nature and probable duration of the medical condition or circumstance that contraindicates immunization.
Slide70Virginia Immunization Information System (VIIS)
District can enroll in program free of charge
Can look up immunization records for students instead of calling doctor’s office; not all doctors offices participate I VIIS
School Nurse can sign the “shot record” printout as an official document for school record
POC: Rochelle Green
Phone: 804-864-8190
Email: Rochelle.Green@vdh.virginia.gov
Slide71Virginia High School League (VHSL) Physicals
https://drive.google.com/file/d/0B_7KGbWzA0LxcFRrOXZqQVNjdm8/view
Many schools do Sports Physical Clinics
You may be asked to assess “pre-exam” data – ht., wt., BP,…
Slide72School Nursing Resources
Slide73State School Nurse Consultants
Virginia Department of Education
Tracy White, RN
Phone: 804-786-8671
Email:
Tracy.white@doe.virginia.gov
Website:
http://www.doe.virginia.gov/support/health_medical/index.shtml
Slide74State School Nurse Consultants (Cont.)
School Health Service Specialist – Virginia Department of Health
Position Vacancy
Phone: (O)804-864-7689 (F)804-864-7722
Email:
Website:
http://www.vdh.virginia.gov/ofhs/childandfamily/childhealth/schoolhealth/
Slide75Professional Organizations
Virginia Association of School Nurses –
www.vasn.us
National Association of School Nurses –
www.nasn.org
Slide76Publications
VA School Health Guidelines Manual
Guidelines for Specialized Health Care Procedure
School Nursing Scope and Standards of Practice
Code of Ethics for School Nurses
School Nursing: A Comprehensive Text, 2
nd
Edition
First Aid Guide for Child Care and School Emergencies
Online Resources on VDOE School Health website
Slide77Day Two New School Nurse Orientation
Slide78New Nurse Orientation
You should receive a nursing orientation from your supervisor
If your supervisor is not a nurse, seek the advice of a nurse from a neighboring county
Contact School Nurse Consultants with questions
See Sample Orientation Packets in Notebook
Slide79Setting Up Your Clinic
View the NASN website for suggestions
Questions and Answers?
Slide80School Nurse Calendar
May have to enter school days, holidays, work days into computer program
See Sample School Nurse Calendars – Some Ideas
Student Days vs. Non-Student Days – do you have to work Non-Student days?
Slide81Medication and Insulin/Glucagon Training for Unlicensed Staff
Training Manuals and Slide Presentation with Notes are accessible on the VDOE School Health Website
http://www.doe.virginia.gov/support/health_medical/office/index.shtml
Requirements for Schools
Who can Refuse to Administer meds
Who can train staff?
Slide82Staff Training
Food and
Beesting
Allergies, Anaphylaxis and
EpiPen
use
Life-Threatening Allergy Action Plan, Food Allergy Action Plan
Asthma – Asthma Action Plan
Seizures – Seizure Action Plan
Diabetes – Diabetes Medical Management Plan
Slide83IEP, IHP, EAP… Oh My!!
IEP
Individual Health Care Plan
Emergency Action Plan
What’s the difference!!!
Slide84Annual Health History Forms
Staff
Students
Slide85Substitute Nurse Plans
Welcome your sub
Log On to computer information
Map of School/ Location of supplies/ Teacher Names/Room & Phone numbers
School Schedule/ Lunch Schedule
Current Health Problem List – Info on kids to know well; Special Procedures/Protocols for them/emergencies
Slide86Substitute Nurse Plans
Current Medication and Special Procedure Schedule
List of Food Allergies
Workman’s Compensation Reporting Information
Parents restricted from access to students
School Emergency Information – Fire Drill/Lockdown/… procedures
Paper documents in case computers go down
Slide87Emergencies
Fire
Emergencies
Lockdown/ Active Shooter
Tornado
Emergency Drills
Emergency Go Kit
Calling For EMS services
Slide88Health Alerts for Teachers
Confidentiality
How to report to staff
Maintaining Confidentiality on Electronic Record Systems
Slide89Sick Day Guidelines
Review Samples in the Notebook
Slide90Child Abuse Reporting
Mandated Reporter
Who calls
How do you interact with the student/what do you ask
Slide91Concussion Protocol
Pretesting Students
Concussion /Protocol
Return to Learn
Return to Play
Slide92Head Lice
Protocol
Treatment
Follow up
Slide93Medications
Prescription Meds vs. Controlled Substances
Over the Counter Medications
Medication Forms
Administration of Medications
Documentation of Medications
Accountability of Medications
Wasting a Medication
Medication Error Reporting
Consent to
Release Information
Slide94Documentation
Office Visits
Concussion Visits
Accidents/ Incident Reports
If you don’t write it, it wasn’t done!
Slide95Workman’s Compensation
Injury Reporting
Follow-up
Who is responsible for maintaining records
Slide96Heath Records
Protected by FERPA
Part of the Cumulative Record, NOT a separate entity
Some schools chose to separate Health Record and house in clinic
Return Health Record to Cumulative Record when a student leaves your school
Transferring Records – See handout in notebook
Records Retention
Slide97Medicaid Billing
Brief Introduction
Random Moment Time Studies
Slide98Monthly/Weekly Checklists
AED – Epinephrine – Equipment Checklists
Refrigerator Temperature Checklists
Slide99QUESTIONS AND ANSWERS
Slide100Slide101What’s Next?
Exceptional Caring: Role of the School Nurse in Special Education
Mandated Health Screenings