Brunswick County Schools School Nurse Program

1. Brunswick County Schools School Nurse Program Wanda J. Willis, RN, ADN, B.Ed., NCSN School Nurse Supervisor

2. What is school nursing? School Nursing is a specialized practice of professional nursing that advances the well-being, academic success and life-long achievement of students. School Nurses facilitate normal development and positive response to interventions; 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. (National Association of School Nurses, 2010). ****The Brunswick County Schools nursing team strives daily to achieve these factors for all of our students to support improved access to the educational environment.****

3. Brunswick County Schools-Nursing Team 12 school nurses and one Nursing Supervisor provide health services to over 12,500 students in 19 schools throughout our county. Presently, our lowest nurse to student ratio is 1:1005 and our highest is 1:2366. The American Academy of Pediatrics recommends one nurse to every school or a minimum of one nurse for every 750 students. School nursing services are assigned to schools based on data collected on health needs and medical procedures for ALL students.

4. Why are school nurses important? School nurses…. Play an essential role in keeping ALL children healthy, safe, and ready to learn. Address rising health issues and chronic medical conditions that must be managed and can’t be delegated during the school day so the students can access school. Have the knowledge, skills and expertise to assess, plan, and evaluate the health needs of students. Practice independently as the only health care provider in the education setting. Manage and care for students with acute illnesses and chronic conditions in schools on a daily basis. Work to decrease student absences and advance the academic success of students.

5. Roles and Responsibilities of School Nurses • Medication administration including proper training, handling, and storage • Manage chronic health conditions such as asthma, diabetes, seizure disorders, gastrointestinal diseases (e.g., Crohn's disease), and cardiac disorders • Severe allergy protocols and anaphylaxis management • Lice checks and rechecks and document each • Special procedures—catheterizations, G-tube feeds, transfers for toiletry needs, diabetic pumps—carb counting and calculations, insulin injections • Respond to health-related emergencies, including first aid and CPR • Individualized Health Care Plans/Emergency Action Plans • Disaster preparedness • Recognition of signs and symptoms of child abuse and neglect and mandated reporting responsibilities • Blood borne pathogen awareness • Maintain confidentiality of health information • Communicable diseases • Nutrition and food safety • Mental health and substance abuse screening and referral • Environmental safety issues • Injury prevention • Yearly mandatory staff trainings (including bus drivers)

6. Roles and Responsibilities, cont. • Participate in IEP and 504 Plan processes • Identify all at risks students • Document all health room visits • Review all student cumulative folders for state required documents—immunizations, health assessments, certified birth certificates • Notify parents of missing enrollment documents by the 30th day of the initial start of school • Perform vision screenings, document results and follow up on referrals • Coordinate and assist with flu clinics, adolescent immunization month clinics, T-dap clinics, health assessment clinics • Complete state immunization and health assessment reports • Complete state school health services reports (twice per year) • Educate students and staff on various health topics • Prepare students and staff for accommodations on field trips • Identify community resources needed to meet student needs • Serve as a liaison between school personnel, family, community and health care providers

7. School Nursing-Dispel the Myth Myth: School nurses primarily administering aspirin, checking a temperature, applying a band aid or ice pack and offering hugs are rooted in nostalgia. Truth: Schools have become mini-clinics. Presently in the 21 Century school nurses are increasingly handling an astronomical number of students with chronic or serious health issues. Health conditions span across ALL of our student population. Many medications are administered in schools... But one that is shockingly surprising is Versed (midazolam). Now used for managing acute seizure activity Administration can not delegated-requires a nurse Do we have students who require this prescribed medication? Yes! Typically use: in intensive care units in hospitals, sedation of patients undergoing surgery

8. Times have changed... Significant changes in recent years have dramatically impacted the delivery of school health services. For example there are: • Significant increases in the number and severity of illnesses in students who attend school; • Marked increases of social morbidities such as substance abuse, homicide, suicide, child abuse and neglect, and violence • Increases in psychosocial and developmental problems, such as Attention Deficit/Hyperactivity Disorder (ADHD), depression, eating disorders • Changes in the family structure (divorce, remarriage, working parents);and • Threats of bioterrorism • Increases in complicated social factors such as homelessness

9. Changing with the times...Celebrations • BCS is fortunate to have a dedicated group of school nurses!!! • Our School Nursing Team does whatever it takes to keep our students healthy and safe. • The nursing team is a collaborative team that supports our students, each other, and our schools. • For the 2019-2020 school year we have incorporated electronic documentation in Power School to improve communication and efficiency. • All school nurses participated in training for emergency management and pediatric mental health. • For the first time ever, two of our SNFI nurses worked in the shelters with BCHS during Hurricane Dorian and had a very positive outcome.