1. Oregon School Nursing Presentation
April 7, 2016
Ely Sanders, School Health Specialist
Oregon Department of Education
You may want to add your names
Oregon Department of Education
ODE. ES

2. School Nursing
Since last time we met at OSBA primary work has been to implement SB 698:
School Nurse Consultant! Jamie Smith!
School Nurse Task Force!
This has highlighted (even more) the need to:
Promote School nursing
Gather data
Tell our stories (What, Why, How)

3. A School Nurse
A school Nurse is a registered nurse who is certified by the Teacher Standards and Practices Commission and coordinate the health services programs of a school. (ORS )
A school nurse provides
health services for all students
free of charge.
Goal is to describe role of school nurses. Next slide is of SBHC
VERY IMPORTANT. Clarify importance of working under FERPA (nurses are indeed educational staff and as such work closely with teachers, counselors, and administration and are able to access and share medical/educational information with other school officials. IEP/504 meetings, accommodations in a classroom, and for training and care of the child.) They can not, however share in formation with SBHC as these are outside clinics operated under HIPPA.
(Reference School Nurse Document included in packet to committee:)
Oregon Department of Education
ODE. ES

4. A School Nurse
Must provide health care services for students who qualify for services under Individuals with Disabilities Education Act (IDEA) and Free and Appropriate Public Education (FAPE). IDEA Sec (c)(13).
Has an important role in interpreting a student’s health status, in explaining the impairment, and interpreting
medical and other health
information in relation to
an IEP and 504.
Oregon Department of Education
ODE. ES

5. What do you do?
ODE. ES

6. School Nurse Services (unique activities)
Train and delegate specific nursing tasks to other school personnel, drafts student health plans, and consult with IEP and 504 plans.
Provide mental health crisis intervention.
Works with student’s primary doctor.
May bill Medicaid.
Why is this important?? To be able to articulate
ODE. ES

7. School Nurse Services (unique activities)
Works under FERPA.
School Nurses are school district staff. (Regardless of employment status)
Governed by state and federal education rule and statute;
Provide case management for chronic and acute student health conditions.
Coordinate mandated screening.
school nurses are the individuals that are integrated into the school, in the classroom, training teachers, sitting in on IEP meetings, responding to crisis, and working under student’s primary doctors to improve individual student’s as well as overall school health.
Reference OHA School Nurse/SBHC document provided in packet.
ODE. ES

8. School Nurse Report
Oregon law (ORS )sets forth school nurse staffing ratios for the following:
Nurses and medically complex students (1:225)*
Nurses and medically fragile students (1:125)
Nurses and nursing-dependent students (1:1)
Encouraged: nurses and enrolled students (1:750)*
*Exceptions allowed
ODE. ES

9. State of Nursing in Oregon
Oregon ranks 51 out of 51 states for Nurse:Student ratio. 1:4664
Observed Nurse:Student ratio in Oregon range from 1:1500 to 1:9800. (Some districts report no school nurses.)
There has been a significant increase in the number of students
presenting with complex
and/or chronic medical
issues.
Ely Sanders, School Health and Sexual Health Specialist. Recently completed site visits with 12 school districts around the state. Common concerns and issues include:
• School Nurse salary/compensation. School nurses are most often compensated on teacher salary schedule. $35,000-40,000 starting salary.
• School Nurses report isolation with in their place of work. This includes lack of access to other medical professionals/supervision, professional development, and ability to consult with other nurses.
• Rising and complex caseloads that include complex and medically fragile children.
• Increase in Crisis management, counseling, and triage variety of physical, mental, emotional health needs of students.
• Increase in complex chronic conditions (Asthma, Diabetes, Allergies)
• Communication with school district staff and leadership.
• Lack of mental health services and resources
Oregon Department of Education
ODE. ES

10. Increase Student Need Students presenting with:
Obesity (includes related chronic disease including diabetes, high blood pressure etc.)
Asthma
Food allergies
Vision deficiencies
Mental health / Emotional health
Stress related illnesses
Limited or no access to Health Care
Sexual health/Teen pregnancy concerns
Small school district (Eugene area) reported a growth of insulin dependent diabetic students from 3 to 15 in just 4 years.
Incorrect insulin dosage can result in death. As such it is common hospital procedure/policy to require two nurses (one to test sugar levels and dose insulin and one to verify dosage prior to administration) to dose and administer Insulin.
Oregon Department of Education
ODE. ES

11. School Nurse Delegation
Nurse delegation to non-medical school staff has become the new norm in Oregon
Nurses and school officials report delegation of daily medical procedures such as:
Insulin dosing and injection
Urinary catheterization
Crisis response medical emergency
Adrenal Crisis
?!?!?!?!?
In most hospital and medical settings, policy insulin
This is significant for children and where I heard repeatedly that “we are waiting for a lawsuit as a result of a child’s death due to missed dosed medication or mistake by non-medical staff.
Nurses who are required to delegate live in constant worry since delegated activities are under their license.
Multiple nurses on tour discussed dilemma of delegating to school employees who often don’t want to (because of fear or capacity) but are appointed and not given a choice by their principle. Nurses, under the Nurse Practice Act, can only delegate to “willing, able, and capable” individuals. Difficult position when, as a nurse, you are provided the person to which to delegate a medical activity and you know they are not going to do a good job.
Oregon Department of Education
ODE. ES

12. School Nurse Awareness
Current/planned activities:
ODE/OHA Administrator Awareness Roadshow
Join and be active in OSNA
List Serve participation
ODE New school Nurse Orientation
Articulating importance of school nursing
Practice Elevator Speech (short, simple, positive)
Train your administrators/teachers
Participate in Federal, State, local policy
Make friends. Who out there gets school nursing and can support school health services?
ODE. ES

13. Updates! Progress Not there yet! New Orientation New Task Force
New Laws
New Orientation
New Guidance
Not there yet!
ODE. ES

14. Oregon School Nurse Updates
School Nurse Advisory Group (Fall 2015)
Updates to ODE Oregon Administrative Rules (OARs)
New and Updated to OARs, guidance and forms and (on going)
New School Nurse Orientation
SB 698 passes and signed by governor (Summer 2015)
Health consultant
Taskforce
School Nurse Advisory Group (Fall 2015)
New School Nurse Orientation
New and Updated to OARs, guidance and forms and (on going)
Dental, medication administration. . .
Oregon Department of Education
ODE. ES

15. School Nurse Advisory Group
Has met Monthly since October of 2015
Appointed, volunteer members representative of Oregon’s diverse school environments
Projects have included:
Serving as Rule Advisory committee for new and updated OARs.
Review of ODE/OHA guidance documents
Advised on creation of New School Nurse Orientation
ODE. ES

16. ODE Oregon Administrative Rules (OARs)
SB 698 (School Nursing)
Medication Administration
HB 3149 (Out of State Doctor Orders
SB 875 (Adrenal Insufficiency)
HB 3041 (Sun Screen)
HB 2972 (Dental Screening)
ODE. ES

17. OAR 581-021-0037 Medication Administration
(h) "Nonprescription medication" means only Federal Drug Administration approved, non-alcohol-based medication to be taken at school that is necessary for the child to remain in school. . . Nonprescription medication does not include dietary food supplements or nonprescription sunscreen;
ODE. ES

18. OAR 581-021-0037 Medication Administration
Adrenal Insufficiency
(i) “Notice of a diagnoses of adrenal insufficiency” means written notice to the school district from the parent or guardian of a student who has been diagnosed as adrenal insufficient with a copy of an order from the student’s physician that includes the student’s diagnosis, description of symptoms indicating the student is in crisis, prescription for medication to treat adrenal insufficiency crisis, and instructions for follow-up care after medication to treat adrenal insufficiency crisis has been administered.
ODE. ES

19. OAR 581-021-0037 Medication Administration
Adrenal Insufficiency (Cont)
Upon notification school administrator will designate school personnel to be responsible for administering medication for adrenal crisis.
Parent must provide medication
In event of adrenal crisis, identified trained staff will administer medication while
other staff call 911.
Oregon Health Authority
(OHA) finalizing training
protocols.
ODE. ES

20. OAR 581-021-0037 Medication Administration
Doctor’s Orders
A registered nurse who is employed by a public or private school may accept an order from a physician licensed to practice medicine or osteopathy in [ other state or territory] for not more than 90 days.
Will change to include: “or by an education service
district or a local
public health authority.
ODE. ES

21. OAR 581-021-XXXX Dental Screening
New OAR currently before State Board, expected adoption: May 2016
Schools must require new students, 7 years or younger, to provider a dental screening certificate or opt-out form.
Report data to the Oregon
Department of Education.
Schools are not required
to provide dental screenings
ODE. ES

22. New School Nurse Orientation
Held pilot NSNO on 3/27/2016
25 Participants
Very positive evaluations
Representation from around
Oregon
New to School Nursing
(all had prior nursing
experience)

23. New School Nurse Orientation
NSNO focused on role and context of school nursing practice
Legal foundation (OAR/Nurse Practice Act)
Privacy (HIPAA/FERPA)
Specific school nursing practice information
Relationship building/networking
ODE. ES

24. Questions? Ely Sanders, MPA School Health Specialist
Oregon Department of Education
Office of Learning | Student Services Unit
Office:
ODE. ES