NPS Health Services Report Karen Rufo MS, PPCNP-BC, RN Nurse Leader Natick Public Schools October 7, 2014

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 of students. To that end, school nurses facilitate positive student responses to normal development; promote health and safety; 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.

There are 14 Registered Nurses One Nurse Leader One School Physician Health Services Staff There are 14 Registered Nurses One Nurse Leader One School Physician One want to be Therapy Dog

Facts Combined the NPS nurses have an average of 27.6 years of nursing experiences (ER, OR, Critical Care, Pediatrics, Psychiatry, Oncology, Enterostomal RN, IV Therapy, Wound Care, Administration, Community Health, and Med Surg Nursing) They have over 143 years of school nursing experience They all have a minimum of a BSN Five of them are Master’s prepared and one holds a graduate certificate in Nursing Education

Certifications They are all DESE Certified They have all completed the ICS course for Emergency Preparedness (Incident Command Systems) and NIMS (National Incident Management System) 700 Training They are all CPR Certified and ready to work as First Responders Two Nurses have Advanced Cardiac Life Support Certification Five of them hold Advanced National Certifications in School Nursing or as a Pediatric Nurse Practitioner Eight of the current Nursing Staff has been trained in Smallpox Vaccination

Primary Responsibilities Injury Prevention, Triage and Treatment Illness Assessment and Care Medication Administration and Monitoring Health Counseling and Health Promotion Communicable Disease prevention and Control Individualized Health Care Planning Case Management for Students with Special Health Care Needs Communication with everyone!

Additional Responsibilities 1.IEP Consults 2.Medical 504 Coordinator 3.Education to parents and students about their medications, policies and illnesses 4.Physician consults for medical, social, behavioral, and emotional issues 5. Education to staff regarding Epinephrine Autoinjector Administration, Life Threatening Food Allergies and Blood Borne Pathogens, First Immunizations, policies, communicable disease and general health and wellness Students with special medical conditions About medications and the impact upon the students performance and what they need to know to about the medication for various field trips

Committees School Level: Case Management, ACT, Crisis Teams and Smoking Cessation, Medical 504 Coordinators, Leadership Team District Level: School Health Advisory Committee, STARS, Special Olympics, EAN, and SEPAC Town wide: Natick Together for Youth, Medical Reserve Corps Volunteers State wide: Essential School Health Grant, Massachusetts School Nurse Organization, National School Nurses Association, Metro West Childhood Obesity Task Force, Massachusetts Association of School Research Nurses, Massachusetts Department of Public Health Evaluation Team

Mandated Massachusetts DPH Screenings Vision Grades K-4, 5th, 7th and 9th Hearing Grades K-3, 7th and 9th Postural/Scoliosis Grades 5th thru 9th Height/Weight and BMI Grades 1st, 4th, 7th and 10th SBIRT Grade 7 and 9

Number of Nurse Visits by School 2011-2012 2012-13 2013-14 PreSchool 79 232 270 BenHem 6211 7329 7574 Brown 3115 3572 4410 Johnson 3965 4022 4077 Lilja 4016 4383 4286 Memorial 4740 5703 7448 KMS 4923 6571 7986 WMS 10,892 12,021 12,700 NHS 9791 7523 9037 TOTALS 47,732 51,356 57,788

RTC =94%

Number of Nurse Visits September 2013 vs September 2014

# visits September 2013 # visits September 2014 PreSchool 23 66 BenHem 775 926 Brown 426 728 Johnson 361 376 Lilja 460 367 Memorial 517 491 KMS 823 895 WMS 1314 1708 NHS 1013 1302

Factors to Consider for Nurse: Student Ratios Number of Students Enrolled Number of Medically Fragile Students Number of Students with Developmental/Communication Needs Number of Clinic Visits Number of Procedures/Treatments Role of the Nurse in the School

WMS 27 831 7,950 (132 hours) 81% NHS 15 351 4,374 (73 hours) 45% KMS # of students # of visits so far this year (23 days) data collected as of 9/29/14 time of those visits in minutes Percentage of nurses time WMS 27 831 7,950 (132 hours) 81% NHS 15 351 4,374 (73 hours) 45% KMS 290 2,853 (48 hours) 30%

Consistent with 1998 legislative report, Options for Developing School Health Services in Massachusetts, the recommended school nurse to student ratio is 1.0 fulltime equivalent (FTE) certified nurse in each building with 250 to 500 students. In buildings with more than 500 students, there should be 0.1 FTE for each additional 50 students. For buildings with fewer than 250 students, the ratio is calculated at 0.1 FTE: 25 students.

Natick Numbers Minimum recommended FTE= 10.8 Average: 16.1 FTE Optimal situation: 21.48 FTE

Recommended Nurse FTE to meet student needs SCHOOL # students enrolled Nurse FTE 2014-15 Recommended Nurse FTE to meet student needs PreSchool 103 0.4 BenHem 622 1.4 0.1 Brown 486 1 1.5 Johnson 235 Lilja 406 Memorial 434 KMS 660 1.2 2 WMS 927 3 NHS 1499 TOTALS 5372 10.8 13