The Awty International School Houston Texas Gina Sharman RN School Nurse

1. The Awty International SchoolHouston TexasGina Sharman RN School Nurse

2. OBJECTIVES • Discuss the history of School Nursing • Identify challenges for nurses in private and public schools • Identify resources to support school nurses in private and parochial schools • Identify mentors and means to network to connect private and parochial school nurses.

3. History of School Nursing • 1893 Opened the Henry Street Settlement which delivered home care nursing to the poor immigrant families on the Lower East Side of New York. • 1903 Ward went to insurance companies to sell them on the idea of providing free visiting public health nurses to their policy holders. Metropolitan Life Insurance Company was the first to sign on. Lillian Wald 1867-1940

4. History of School Nursing Wald recognized after observing classrooms in the Lower East Side of New York that “healthy children learn better”. Sick children should be at home and not spreading diseases. 1913 Persuaded the New York Board of Education to hire nurses in their schools. Lillian Wald 1867-1940

5. History of School Nursing • By the 20th century the role of the school nurse was expanded to provide first aid, health screening, health education and immunization tracking. • Unlike Lillian Ward in the 1900’s, school nurses today face many challenges as nurses practice in both public and private schools. 1 Lillian Wald 867-1940

6. Challenges for Nurses in Private and Parochial Schools • Isolation • Immunization Compliance • Advocating for Standards of Practices and Best Practices

7. Isolation As a school nurse…do you ever feel isolated and alone on the job? Allnurses.com by Praiser Feb 3, '06 School Nurses Do you ever feel as I do ? Isolated. Alone. Different. Misunderstood. Taken advantage of. No respect. I am just curious. Let's hear from you all ! • School Nurses practicing in an private educational setting are isolated from traditional professional networks. We can miss the opportunity to exchange information, discuss policy and stay abreast of the latest health information.

8. Isolation School Nurses practice in a non-health care setting so our position with-in the school can be ambiguous in terms of role and identity. Private School Nurses often straddle the divide between education and health care. Nurses must answer to licensing boards, and professional associations for the quality of care. Nurses must also comply with the Nurse Practice Act of their state.

9. Isolation Educators are accountable to parents who are paying high tuition costs while expecting high academic standards. School Nurses working in a private and parochial schools often feel like the Lone Ranger.

10. Challenges of Immunization Compliance • National Studies indicate that almost 1 in 4 children in the United States are not appropriately immunized and that children who live in poverty and in urban areas are more likely to be under-immunized. • The State of Texas in 2009 was ranked 47th out of the fifty states for overall immunization compliance.

11. Immunization Data CDC 2011

12. Immunization Data CDC 2011

13. Challenges of Immunization Compliance In larger public inner-city schools many obstacles exist making immunization compliance a daunting task for the school nurse. Challenges can include: Working parents Lack of access to primary care Lack of transpiration Cost of immunizations The impact of HIPAA legislation

14. Challenges of Immunization Compliance In Private and Parochial schools the obstacles for immunization compliance are slightly different. Think about your own school(s) Can you identify some reasons for non-compliance?

15. Challenges of Immunization Compliance Challenges might include: a) Misinformation on the risks and benefits of the vaccine b) Trust issues related to government assigned vaccines c) Families traveling to many countries must adopt a new vaccine schedule for compliance d) Vaccine cost e) Vaccines are supplied and administered in a doctors office f) Time lost away from school in order to obtain vaccinations g) Parents and administrators assume Private schools don’t have to follow the same guidelines

16. Challenges of Immunization Compliance Successful vaccine compliance is dependent on parental, patient and provider awareness towards the vaccine. Immunization compliance is based on whether or not parents are abiding by heath provider recommendations to vaccinate patients eligible to receive the vaccine. School Nurses working in a private and parochial must come up with strategies to improve immunization compliance in their schools.

17. Determining Factors

18. Strategies to Improve Compliance Accurately Document Immunizations Implement a immunization reminder Increase Awareness About the Importance of Immunizations Place educational posters in your office Target parents who do not believe in vaccinations to inform them about the benefits of immunizations and risks of their decision Accommodate and Motivate Parents

19. Advocating for Standards of Practice and Best Practices • The school nurse must maintains a high level of competency: a) Continuing education classes (CEU’s) b) Collaborating with peers, other health professionals and community agencies • Understanding the standards of school nursing practice • Stock your clinic with a copy for School Nursing: Scope and Standards of Practice 2nd Edition (located at the bookstore of the NASN) website www.nasn.org • There isn’t a shortage of nurses there is a shortage of funded positions in our school systems

20. Advocating for Standards of Practice and Best Practices • School nurses must defend standards and best practices especially when their supervisor is not a nurse • Balance state laws and BNE policies when developing school policies and procedures • Don’t be afraid to say “no” then develop a solution that works for your school

21. Resources for School Nurses • National Association of School Nurses (NASN) Website: www.nasn.org • NASN-PPSN Private/Parochial School Nurse) Listserve How to find it: www.nasn.org • on the left, under “Members and Membership”, click on “Special Interest Groups” • then click on Private and Parochial School Nurses • then click on PPSN Electronic Discussion List

22. Resources for School Nurses • Texas School Nurses Organization (TSNO) • Website: www.txsno.org

23. Resources for School Nurses • Texas Dept. of State Health Services (DSHS) • School Health Division, including School Health Manual • Website: www.dshs.state.tx.us/schoolhealth/default.shtm

24. Resources for School Nurses • Center for Disease Control • Website: www.cdc.gov • Immunization Information, including translating foreign immunization records • ww.cdc.gov/vaccines/pubs/pinkbook/downloads/appendices/B/foreign-products-tables.pdf

25. Resources for School Nurses Center for Disease Control Website: www.cdc.gov Immunization Information, including translating foreign immunization records ww.cdc.gov/vaccines/pubs/pinkbook/downloads/appendices/B/foreign-products-tables.pdf

26. Identify mentors and means to network to connect private and parochial school nurses Your Thoughts Ideas?

27. Identify mentors and means to network to connect private and parochial school nurses • Set up a e-mail network with other school nurses in your area • Get involved by joining local and state nursing organizations (NASN and TSNO) • Ask another school nurse actively involved in nursing organizations to be your mentor

28. Identify mentors and means to network to connect private and parochial school nurses • Subscribe to school nursing magazines and journals then meet with another group of school nurses to discuss issues • Call on a neighboring school and ask the clinic nurse if you can help in anyway • When in doubt pick up the phone

29. THANK YOU FOR ATTENDING Bound by paperwork, short on hands, sleep, and energy... nurses are rarely short on caring.  ~Sharon Hudacek, "A Daybook for Nurses"