1. Carol MacDougall RN, BScN, MA Erin Maughan PhD, MS, RN, APHN-BC, FAAN Yvette Laforêt-Fliesser RN, BScN, MScN, CCHN (C)

2. Participants will have: 1. An increased understanding of the contribution school nurses can make in their school and community. 2. A greater awareness of current Ontario and US efforts to ensure the presence of nurses in schools. 3. An opportunity to identify strategies for advocating and securing local access to a school nurse.

7. https://gayecrispin.wordpress.com/tag/horse-2/

8.  United States: Education, PH and Hospital Employed  England: School Nurses  Ireland: PHN screenings only  Scandinavia: District nurses provide services in schools  Europe: 5 models (Baltag & Levi, 2013)

10. Up to 500 % 500-1000 % 1001-2000 % 2001-3000 % Over 3000 % Canada 19.314.3 24.5 Australia 12.520.858.44.20 Europe 40.020.0016.04.0 Far East 40.030.020.005.0 New Zealand 42.90 14.30

12. Education Employed School Nurses Public/Community Health Nurse 1.Treating Acute Injuries or Illnesses (73.4%) 1.Immunization Tracking, Compliance and Clinics (50.0%) 2. Informatics, Health Records, Data Management (71.1%) 2. Administrative Paperwork, Committee, Reports, Summaries, Meeting (48.0%) 3. Communication with Parents/Staff or Others About Specific Student Issues (66.7%) 3. Informatics, Health Records, Data Management (41.2%) 4. Medication Administration (56.5%) 4. Classroom Education/Health Promotion (37.3%) 5. Consultation Services to Students, Families and Staff (44.6%) 5. Referral of Students, Families and Staff to Community Resources (30.0%)

13. Nutrition % Reproductive Health % Hand Washing % Personal Hygiene % Smoking Tobacco % Canada67.358.241.830.649.0 Australia54.229.233.337.512.5 Europe76.060.044.0 36.0 Far East65.030.050.055.015.0 New Zealand 10085.7 57.171.4

14.  Misunderstanding of Role of School Nurse  Potential to do much more  Budget constraints resulting in:  One nurse or nursing team covering many schools  High nurse: student ratios  Limitations on access to care Seigart, D., Dietsch, E. and Parent, M. (2013). Barriers to providing school-based health care: International case comparisons. Collegian: 20, 43–50.

15. FamilySchool Health Care School Nurse

17.  Public health has an official health promotion mandate with schools [see Ontario Public Health Standards and School Health Guidance Document]  Settings-based health promotion  Multi-disciplinary  PHNs in Ontario schools up until the mid 1990’s  April 2015 CHNIG of RNAO Policy Paper and Evidence Paper to substantiate school public health nursing as a specialized area of practice 17

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19.  Importance of the school-age years  Description of public health nursing in Ontario  Proposed scope of practice of School-Based PHNs  System level recommendations 19

20.  Community Development  Health Promotion  Chronic Disease & Injury Prevention  Community Participation  Youth Engagement and Empowerment  Collaborative Nursing  Social Determinants of Health, Social Justice, Equity 20

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22. Assessment, supportive counseling, referral Health education and skill development Clinical services Communication, consultation and coordination with school staff (including case conferences), families, service providers  Format: designated time in schools; school-based health or wellness clinics

23. Small group programming and/or classroom education, e.g., healthy relationships, self-esteem, communication, social skills, anger management Staff education (including on youth engagement and curriculum materials) Parent education Training groups of peer leaders, e.g., Playground Activity Leaders, Nutrition, Mental Health Leaders, Healthy School Committees

24. Assessment, surveillance, and data analysis to identify priority strengths and needs Support a Health Action Team (that includes youth) to create comprehensive action plans, i.e., the plans should include the components of Curriculum, Teaching and Learning School and Classroom Leadership Student Engagement Social and Physical Environments Home, School and Community Partnerships) Work with school staff, students and communities to develop and implement healthy school policies and to create supportive school environments Ensure equitable access to health and social services for the school population

25. Contribute on school board working groups, e.g. health policy development Participate on board/inter-agency committees to ensure equitable access Engage young people in health-related communications/campaigns Acknowledge school successes at board or community events Collect statistics to identify trends and prevailing issues Conduct evaluations as indicated

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27.  Foundational documents  RNAO BPGs that inform school PHN practice  Other jurisdictions and school nurses  Journals publishing evidence on school nursing  Environmental scans in Ontario  Grey literature  Literature review  Logic Model 27

28. 28  Immunization  Mental health  Nutrition  Parent support  School-based health centres  Self-injury  Sexual health  Academic achievement  Barriers to school nursing practice  Bullying  Comprehensive school health  Evaluation, program planning and research  Family violence Literature Topics

29.  To Ministry of Health ◦ “Child and Youth Health” ◦ “Mental health promotion for children and youth” ◦ Research on health and academic outcomes ◦ Phase in school public health nurses ◦ Ontario School Health Management in Public Health Network  To Ministries of Education and Child and Youth Services ◦ participation in community, school board and school-level planning  To Public Health Ontario ◦ continuing education to build capacity ◦ strengthen curriculum in Schools of Nursing

30.  Pro-active education regarding role of school nurse in 21 st Century  Return on Investment ◦ School Nursing:US$1=US$2.20 ◦ Immunizations: $9.9 million direct care ◦ 1 hour Principal time; 20 min teacher (per day)

31.  Should PHN be returned to schools? ◦ If so, should it be a full scope of practice?  Do you have any suggestions on how we can move school nursing forward?

32. “The world is full of stories but the stories are all one.” - M. Albom: The Five People You Meet in Heaven

33.  Yvette Lafor ê t-Fliesser yvettelaforetfliesser@gmail.com yvettelaforetfliesser@gmail.com  Erin Maughan emaughan@nasn.org emaughan@nasn.org  Carol MacDougall cmacdougall@pdhu.on.ca cmacdougall@pdhu.on.ca