THE SCHOOL NURSE Roles and Responsibilities

1. THE SCHOOL NURSERoles and Responsibilities THE OFFICE OF SCHOOL HEALTH Department of Education/Department of Health and Mental Hygiene

2. OFFICE OF SCHOOL HEALTH • Created in 2003 • Joint program of DOE and DOHMH • Provides nurses, physicians, and other services to schools • Assures compliance with laws and regulations • Office of School Health

3. SCHOOL HEALTHOUR MISSION • The Office of School Health provides public health services for New York City’s >1.4 million school children. • The Office of School Health promotes the physical, emotional, social and environmental health of every child enrolled in the City’s 1,500 public and nonpublic schools. • School Health Nurses provide preventive health teaching, health education, case management, and direct services.

4. HEALTH SERVICES: MEDICATION & PROCEDURES School Nurses perform these commonly requested direct services: • Administration of oral medications. • Administration of medication through an inhaler or nebulizer • Application of ear, eye or nose drops. • Application of topical creams or ointments to the skin for a chronic condition. • Injections (SC and IM), generally insulin, glucagon, and epi-pens (note NYSED exceptions).

5. Health Servicescontinued • Blood glucose monitoring. • Medical management of an insulin pump. • Rectal medications. • Tracheostomy care. • Nasogastric tube care and feedings. • Catheterization (urinary).

6. NURSING • DOHMH provides a nurse to elementary schools (without an SBHC) and a public health advisor to middle schools • DOE provides a nurse for students with IEP and Section 504 mandated nursing services • Single integrated work force

7. DOHMH Nurses • 36% of the funding from the State to meet public health objectives • Public health priorities: immunization, obesity, asthma, vision problems, diabetes • DOHMH and DOE nurses belong to different unions and have different working conditions (e.g. lunch) • Electronic medical record installed using homeland security funds

8. THE NURSING SHORTAGE • About 100/650 DOHMH positions and 130/390 DOE positions are vacant • 10 contracted Nursing Agencies fill the majority of these vacancies • 10 Borough Nursing Directors 7 DOHMH 3 DOE • 42 Nursing Supervisors 32 DOHMH, 10 DOE

9. Nurses and Principals • The program works best when there is a strong and effective relationship between the nurse and the principal or designee • Nurses are expected to contribute their time and expertise to the school community • Principals are encouraged to participate in the selection of the nurse and the non-clinical aspects of the nurse’s evaluation

10. MEDICAL ROOMS • To ensure student safety and privacy School Health has set minimum standards for these rooms Adequate size – generally 200 square feet Sink with hot and cold water Floor to ceiling walls No through traffic Computer hook-up (for ASHR electronic record)

11. ASTHMA • Average student with asthma misses three extra days of school • Nurses are making special efforts to identify these students and improve their treatment • Principal support needed for: Open Airways Program – 3rd to 5th grade.Nurse conducted sessions

12. COMMUNICABLE DISEASES • School Health will provide advice and meet with staff and parents • Standard letters are available in multiple languages • Most of the time it is better to wait until there is a definite diagnosis (e.g. type of meningitis)

13. CONCERNS • EMERGENCIES Nurses must work closely with principals when these arise In life threatening emergencies a nurse may have to call 911 without consulting the principal In general, the nurse should not be asked to go to the hospital with a student

14. MINOR TRAUMA • In some schools every student with a minor injury (e.g. a paper cut) is sent to the medical room • This is not medically (or legally) necessary • Students lose instruction time • The nurse cannot perform other important functions

15. SUMMARY • It is vital for School Health staff to have effective working relationships with principals • We need to balance the school support public health and the provision of skilled nursing services roles of the nurses • Many of our responsibilities are determined by State law, NYC health code and Chancellor’s regulations