School Nurse Orientation What is school nursing?

1. School Nurse OrientationWhat is school nursing? Sandi Clark, RN KDPH Pediatric Section Supervisor/ School Health Nurse Consultant July, 2014

2. School Nursing • The National Association of School Nurses (NASN) defines school nursing as a specialized practice of professional nursing that advances the well-being, academic success and lifelong achievement and health of students.

3. School Nurses • Facilitate normal development & positive student response to interventions • Promote health & safety, including a healthy environment • Intervene with actual & potential health problems

4. Provide case management services • Actively collaborate with others to build student & family capacity for adaptation, self-management, self advocacy & learning (NASN 2010)

5. NASN Nurse-to-Student Ratio • 1:750 for students in the general population • 1:225 in the student populations requiring daily professional school nursing services or interventions • 1:125 in student populations with complex health care needs • 1:1 may be necessary for individual students who require daily & continuous professional nursing services

6. Kentucky School Nurse Services • Provided by: 1. Advance Practice Registered Nurse (APRN) 2. Registered Nurse (RN) 3. Licensed Practical Nurse (LPN) • Hold a current Kentucky license from the Kentucky Board of Nursing (KBN) • Must know the their individual scope of practice (defined in KRS 314.011)

7. Licensed Practical Nurse • LPN is not licensed for independent practice • LPN practices under the supervision of a RN, APRN, physician, or dentist • Supervision of the LPN does not have to be physically on sight

8. Licensed Practical Nurse • KRS 156.502 (2) and 2014 KBN AOS # 15 does not allow the LPN in the school setting to delegate, train or supervise unlicensed school personnel on school health services

9. School Nurses Impact School Achievement/Attendance • Improve School Performance/Attendance • Serve as the vital link to better care • Provide essential services • Bridge Education and Health • Actively improve the lives of students, families & staff

10. Key School Personnel • Education School Nurse Consultant – provides leadership, consultation & technical assistance to local school districts r/t school health services (KRS 156.501) • KDPH School Health Nurse Consultant – provides leadership, consultation, & technical assistance to local health departments school nurse programs • School Health Coordinator – works with all school personnel, the local BOE, school council, KDE, LHD, Family/Youth Resource Centers (FRYSC), & parents (702 KAR 1:160, Section 5) • School Nurses – must have a current KY license • Unlicensed school personnel may be delegated to perform school health services when trained according to KRS 156.502 & 702 KAR 1:260, Section 4 (g)

11. Models of Delivery • Delivered by local school district employed RN, APRN, LPN, or unlicensed school personnel who have been trained according to KRS 156.502 • Local health department personnel contracted by the local school districts • Local school district may contract with a hospital or health care provider for a school based center (SBHC)

12. Specialized Services • School nurses work to create access to health care for students and families • School nurses coordinate & conducts assessment, planning and implementation of individualized health care plans (IHP) • School nurses determine if health services can be delegated to Unlicensed Assistive Personnel (UAP) • School nurses coordinate evaluation and intervention services • School nurses assist students to learn to manage their chronic illness

13. Communicable Disease Control and Prevention • Student absences due to infectious diseases cause a loss of millions of school days each year (CDC 2010) • School nurse can offer guidance, infection control strategies and disease management techniques • Parents role to communicate with schools and local officials r/t possible communicable diseases

14. Communicable Disease Control and Prevention • KRS 158.160: Notification to school by parent or guardian of child’s medical condition threatening school safety—Exclusion of child with communicable disease from school—closing of school during epidemic • MRSA is not a reportable disease • Reportable Disease Form (HSRG: link to DPH form)

15. Communicable Diseases • Bloodborne Pathogen Training for School Personnel 1. Required by OSHA 2. Must be reviewed yearly 3. Training must be “interactive – ability to ask questions and receive answers during training session • KSBA has OSHA training for school district each year – ask who is responsible for Exposure Control Plan in your district • Some school districts have this training online @ KY TRAIN

16. Health Services Medication administration • Includes over-the-counter (OTC),daily scheduled, PRN, or emergency (glucagon, diastat, or epinephrine) • Insulin administration and carb counting Clinical Procedures • Tube feedings and catherizations • Trach care and suctioning • Ventilators or oxygen therapy

17. Chronic Health Conditions Intervention Overweight/Obesity – one in three children, ages 2 to 19 are overweight • Overweight – having excess body weight for a particular height from fat, muscle, bone, water or combination of these • Obesity – excess body fat • Immediate health effects- Cardiovascular disease (high B/P or cholesterol),pre-diabetes, bone/joint problems

18. Asthma – more than 7 million children have & is one of the biggest contributors to school absences (over 10 million days annually) Schools should 1. Identify & monitor all asthma students 2. Obtain individualized Asthma Action Plans 3. Established standard ER protocols 4. Educate all school personnel 5. Ensure students know policies & procedures for self-carry, administer & quick relief meds

19. Diabetes – Type 1 or 2 is on the rise in children & youth under age 20, 0.26% • Care includes monitoring blood glucose several times a day, calculating carbohydrate content of meals, dosing insulin via syringe, pen or pump • Each student must have a Diabetes Medical Management Plan (DMMP), Individual Health Plan (IHP) , & Emergency Care Plan (ECP)

20. Epilepsy (Seizures) - brain disorder characterized by two or more unprovoked seizures • Approximately 70% those diagnosed , the seizures can be controlled with medicine or surgical techniques or devices • Can be a life threatening condition • May increase the risk of learning, psychosocial & behavioral problems

21. Seizures types include- simple partial , absence, complex partial & generalized tonic-clonic • A student should have a seizure action plan for emergency care • Plan should include: assess students needs; customize as to treatment, first aid, & accommodations; teach & tailor interventions needed to relevant school personnel & students

22. Allergy and Anaphylaxis • Potentially life-threatening allergic reaction that can occur very quickly • Causes- allergies to bee stings, insects bites, shellfish, nuts, egg whites, dairy, medications (i.e. antibiotics), mold, latex & other allergens • Symptoms will vary, most common- hives, itching flushing, swelling of lips, tongue & roof of mouth • Airway often affected, may result in chest & throat tightness, difficulty breathing & swallowing

23. Epinephrine by injection is the prescribed recommended choice of treatment given in the outer thigh • Administer at the first signs of anaphylaxis • Call EMS for emergency follow-up care • Students with known allergies should have an anaphylaxis action plan

24. School Nurse School Year Calendar August 1. Finalize a written school health plan for the year 2. Determine the data need to document for nursing services 3. Prepare health office & supplies 4. Review/update ER care plans & procedures 5. Identify & post list of current personnel trained in CPR & recertification dates

25. School Nurse School Year Calendar August 6. Check records for current Immunizations, physical forms, vision & dental screening forms 7. Plan in-service training with staff – BBP, CPR, Medication Administration, special procedures*(i.e. catherization & tube feeding) * Training only good for current school year (July1-June 30)

26. September • Update health records • Schedule classroom health presentations • Establish a procedure for advance field trip • Establish dates for required vision & hearing screening notifications October • Complete state immunization report • Continue follow-up immunization compliance • Review absentee records to identify health problems, requiring nursing intervention • Maintain/update IHP and emergency action plans

27. November • Continue surveillance of immunization records • Review absentee records to identify health problems requiring nursing intervention • Conduct classroom presentations on prevention of cold-flu; sore throats; positive health practices • Schedule and conduct vision and hearing re-screenings

28. December • Review absentee records to identify health problems requiring nursing intervention • Continue surveillance of immunization records • Review student health records for vision exam and dental screening/exam compliance (must complete before Jan 1) January • Review absentee records to identify health problems requiring nursing intervention

29. February-March • Review absentee records to identify health problems requiring nursing intervention • Complete re-screening for vision and hearing, • Review immunization records • Review KDE health reports for accuracy

30. April-June • Review follow-up referrals on screenings • Review care plans & ER actions plans • End of the year report due to KDE • Submit request to attend a school health related educational program • Develop tentative plan for next school year

31. Contact Information • Sandi Clark, KDPH School Health Nurse Consultant SandiK.Clark@ky.gov • Karen.Erwin, KDE School Nurse Consultant Karen.Erwin@education.ky.gov