1. What Story Does Your Data Tell?
Janice Selekman DNSc, RN, NCSN, FNASN
Professor
University of Delaware

2. Data: Teen Pregnancy and Births
National
Missouri
1991: 100/1000 pregnant
2011: Pregnant
51/1000 females 15-19
140 under 15
1991: 63 births/1000
2016: Teen births
25/1000 females 15-19
1991: Pregnant
116/1000 females 15-19
2011 Pregnant 52.4
1991: Teen births
61.8/1000 females 15-19
2016: Teen births
22.3/1000 females 15-19

3. Missouri 8% of your children are in immigrant families (no change)
Children who missed 11 or more school days due to illness or injury
% (2003)  5.8% ( )
% (2003)  6.8% ( )
19% of 4th graders chronically absent (no change)
16% of births (848) to teens are repeat births
16% of children have 1 or more emotional, behavioral, or developmental condition

4. Data: Overweight and Obesity
Missouri
1980 vs. 2014
1980: obese
7% 6-11 years
5% years
2014: obese
8.9% 2-5 years
17.5% 6-11 years
20.5% years
2015
13.5% obese children; 13.1% obese high school students
28.4% of year olds overweight and obese
(national 31.3%)

5. Youth Risk Behavior Survey 2016
National (% 15-18)
Missouri (% 15-18)
Did not go to school because felt unsafe
5.6
6.1
Carried a weapon on school property
4.1
5.9
Ever smoked
32.3
34.5
Smoked before age 13
6.6 (average age 13.94)
8 (average age 12.71)
Drank alcohol before age 13
17.2 (average age 14.52)
17.3 (average age 13.43)
Currently use marijuana
21.7
16.3
Ever had intercourse
41.2
37.7
Had intercourse before age 13
3.9
Currently sexually active
30.1
27.5
No pregnancy prevention used
13.8
12.1

6. Youth Risk Behavior Survey
National
Missouri
Were electronically bullied
15.5
16.6
Were bullied on school property
20.2
21.4

7. Where is the data on school nurses?
How many of you have saved a life?
How many of you have identified a child/staff who needed immediate attention/diagnosis

8. Characteristics of a Profession
Provides essential services
Possesses a body of specialized knowledge and skills needed to practice the profession NORMALLY NOT POSSESSED BY THE NONPROFESSIONAL
Requires a specified period of specialized education
Has a professional association that regulates the work of the profession and has an ethical code of conduct

9. Characteristics of a Profession
Members are involved in decision-making in the service of clients
Strong service motivation and commitment to competence
Committed to quality comprehensive care, safety and interdisciplinary collaboration
Serves as role models and mentors
Presenting/ teaching/ publishing
“What the pediatric staff nurse and APN can learn from the school nurse and what we need from you”

10. Characteristics of a Profession
High level of public trust, based on profession’s demonstrated capacity to provide service markedly beyond that which would otherwise be available
Accepts responsibility and is accountable to society
Demonstrates efficacy
CONTINUOUSLY EVALUATES THE EFFECTIVENESS OF YOUR PRACTICE
This is different from competence
OUTCOMES

11. Data collection by State School Nurse Consultants: 2014
32 states collect information on 855 data points
Range = 3 (Michigan) to 297 (Pennsylvania) data points (WV = 171)
Info on number of RNs
Children with chronic health conditions
Health screenings

12. Missouri 0 questions on school demographics
9 questions about staff (# hours RN & LPN provide services, LPNs, UAPs)
57 questions on students (# with DNR orders, immunizations screened, numbers screened, nursing procedures done, medications given, mental health and other chronic conditions addressed, pregnant teens, and 504 plans)

13. You have a tremendous amount of data in the state
WHO SEES IT?
WHO ANALYZES IT?
WHAT ACTIONS ARE TAKEN BECAUSE OF IT?
WHAT OUTCOME MEASURES DEMONSTRATE THE DIFFERENCE THAT YOU MADE?

14. We must be able to show that WE made a difference
We MUST go beyond the number of children we see
And the number of tasks we do
We must be able to show that WE made a difference

15. Definition of School Nursing (NASN, 2017)
School nursing, a specialized practice of nursing, protects and promotes student health,  facilitates optimal development, and advances academic success. School nurses, grounded in evidence-based, ethical practice, are the leaders who bridge healthcare and education, provide care coordination, advocate for quality student-centered care, and collaborate to design systems that allow individuals and communities to develop their full potential. 

16. Outcomes Component of the end result of the nursing process
Demonstrates effectiveness of the nursing interventions
Measureable
Reflect the nursing goals
A form of accountability
Reflects the quality of care

17. Where are the outcomes?
For weight, vision, hearing, posture, BP and dental
Number screened and referred
Number receiving treatment
AND THEN WHAT?????
WHAT IS IMPACT ON ACADEMIC PERFORMANCE?

18. North Carolina Outcomes
For life-threatening allergies, Type 1 Diabetes, obesity, seizure disorder, and asthma
Student can verbalize accurate knowledge of condition
Student has improved grades
Student has decreased absences
Recognize and avoid allergic, asthma, or seizure triggers
Identify appropriate portion sizes; improve food choices
Demonstrate skill in administering epinephrine, using inhalers/spacers, counting carbs, testing blood sugars, and calculating and delivering insulin
Increasing physical activity
Reducing episodes of allergy or seizures
Remaining within peak flow goals; improving HgA1c or BMI
Reducing side effect of medications and avoiding complications of seizure activity

19. Possible outcomes Children who got glasses and their grades improved
# teens who return to school after delivery
# pregnant teens who stay in school
Increasing attendance rates of children with chronic conditions
$ brought into the school (or in-kind services)
Letters of satisfaction from parents and staff

20. Unique questions
“What is #1 health issue that consumed a large amount of time and resources?”
“List the 3 most common reasons individual health counseling is provided”

21. Covering too many schools
May result in fewer programs/initiatives
You know fewer of the students and families well
You know fewer of the staff well – to meet their needs
Less satisfaction from everyone
Fewer outcomes
# hours/week you are paid to be in your car driving from 1 school to another

22. How can Missouri school nurses USE the data?
Let me tell you the difference I make in the lives of children!

23. No School Nurse Here
Let parents and staff know when there is no school nurse in the building
Empower parents to complain
Start support group for parents of children with chronic conditions and empower them first
Engage parents in the school
North Carolina has Parents Advocating for School Health
Engage staff as your advocates, and you be theirs
NOTICE: It is the Health Office if no school nurse is there – not the Nurse’s Office

24. How do we know we have a problem?
School nurses being laid off
Districts hiring LPNs or aides instead of SN
Disturbing Examples:
2 schools in California refused to follow the IEP for a student with severe autism and diabetes. They offered the family $86,000 to sign away the child’s right to an education and keep the child out of school
Mercedes Mears, 5th grader from Washington died of asthma attack in arms of aide trying to get her to use her inhaler rather than give the EpiPen just feet away

25. Philadelphia: 1/3 of school nurses laid off 2012 (now totaling 100 school nurses)
Laporshia Massey died of asthma.
School called at end of day that child did not feel well
Child came home in respiratory distress
Died on the way to the hospital
Did school nurse cuts kill this child?

26. New Bedford CT, 6 year old with Type I DM was told by school district to find another school because budget cuts precluded them from having a full time school nurse
Family went to ABC News, city council, the school board
Request was rescinded and school nurse was hired
One win………MANY losses

27. No one cares that we have Standards of Practice
No one cares that we try to promote Evidence-based Practice
No one cares that some of you have advanced education in school health
No one cares that many of you are nationally certified school nurses
No one cares that you also promote health and prevent disease

28. There is NO School Nurse Shortage!!!
No school nurse will work for LPN wages
No school nurse will call her work part time and agree to work without benefits
No school nurse will take the legal responsibility for thousands of children
There is NO shortage of school nurses; there is a shortage of schools willing to pay for qualified school nurses, so that every school and every child has a school nurse

29. And then there is the damage done by the American Diabetes Association
Forced states to change Nurse Practice Acts allowing non-nurses to give glucagon and insulin
Focused only on diabetes and not on other chronic conditions
Worked against us rather than with us
Said they are “helping kids be safe at school”
But is allowing teachers and coaches to give insulin safe

30. The bottom line MONEY Quality does not matter Science does not matter
The health of the child does not matter

31. Snoop Around the Building
Look for ways the school can save money even if other positions will be cut
This is not the time to be Mr. Nice Guy

32. WE MUST HAVE OUTCOMES Health care is NOT a priority for the school
Most schools are unaware of the impact of school nursing on the bottom line
Schools don’t care that school nurses decrease ER visits by children by 80%
Schools don’t care that school nurses send home only 5% of the children, compared to secretaries and other UAPs who send home 18%

33. Hillel Quote
If I am not for myself, then who will be for me? And if I am only for myself, then what am I? And if not now, when?

34. A Current Quote
IF YOU ARE NOT AT THE TABLE….. YOU ARE ON THE MENU “If the forces within us don’t move us, the forces outside us will” (Dan O’Neal, ANA)

35. Show that you make a difference
Have outcome data that shows that absence of a school nurse and your programs hurts them financially
Fewer kids in their seats
Fewer healthy kids
All resulting in lower test scores and decreased money coming to the school
Find out what is important to the principal, superintendent, school board and make this a priority
WE CAN HELP YOU!!!

36. Community Involvement
Community Advisory Groups
Include someone from the media
Joint venture with local children’s hospital or pediatric group
Get stories out to the media
“What do school nurses do?”
We had x children with diabetes, y with asthma, z with … In addition, x children had accidents that required assessment and first aid. The school nurse made a difference by…..

37. Articles in the newspaper on changing health care in the schools…
Articles in the newspaper on changing health care in the schools….looking like they support what the principal and superintendant are trying to do….but look at what is happening to Johnny
Article on ‘how is Tyrone’s health?’ and what a great job the school nurse is doing to make it happen. Hooray for your school!

38. Children are 25% of the population, but they are 100% of the future
“If you want to predict the future, create it” (Bill Gates)

39. Your challenge Identify the problem
Decide what data needs to be collected to document that you have a problem
Ask questions, get a team, make a plan
Act
And then measure your results (outcomes)
AND THEN SPREAD THE WORD
Put it on your website
Brag to the principal and school board
On your bulletin board on meet the teacher night

40. School nurses must have the data…
To show the nation why they need highly educated school nurses
To show that we make a difference in the lives of children
To assure that we have one educated and certified school nurse in every school in Missouri