Perhaps the health and welfare of students and staff is not on your professional or personal radar. I wanted to share with you one school nurse's perspective on her job responsibilities... read them and be amazed at what school nurses really do in the course of a day:

NURSING SERVICES PLAN

Manasquan School District

2008-2009

The certified school nurses in the Manasquan Public Schools have a multitude of roles within the scope of professional practice. In an ongoing effort to ensure children remain healthy and ready to learn, the school nurses take on the roles of nursing care provider, investigator, communicator, counselor, educator, child advocate, community liaison, recorder and manager.

Nursing Care Provider

Within the role of nursing care provider, the school nurses use the nursing process, which includes assessing, planning, implementing, and evaluating the nursing care in an ongoing manner. The development of individualized health care plans and/or emergency care plans are carried out by the school nurses for each student with acute or chronic health concerns. The school nurses also provide health care and advice to faculty members.

Investigator

As the investigators, the school nurses seek information regarding health histories, health practices, environmental concerns, safety issues, communicable disease patterns and current health information relevant to the practice of school nursing. Consultations with parents and guardians, pediatricians, specialists, health agencies, administrators, classroom teachers, guidance counselors, student assistance counselors, learning disability counselors, school psychologists, cafeteria staff, custodial and maintenance staff, mobile crisis units, suicide prevention coalitions and grief counselors are sought in order to gather information.

Communicator

As communicators, the school nurses use varied approaches to share important information with students, parents, staff members, physicians, health care agencies, administration and government entities. Telephone conferences, personal letters, newsletters, flyers, bulletin board postings, e-mail communications, website updates, personal conferences, departmental meetings, Intervention and Referral Services meetings and Child Study Team meetings represent some of the methods and forums in which health information is communicated.

Counselor

School nurses serve in the role of counselor to students, parents and staff alike regarding health issues and personal concerns. Referrals are made to the school psychologist, student assistance counselor, school guidance counselor and private physicians, or community health resources as needed.

Educator

The role of educator is a vital role for the certified school nurses. Informal teaching takes place continuously on a one-on-one basis during the delivery of nursing care to students, faculty and parents. Staff education on pertinent health topics such as asthma, allergies, diabetes, child abuse and relationship abuse, seizure disorders, eating disorders, disabilities, etc.) is provided at building meetings, faculty in-services or in small groups as appropriate. Parent education is provided through written materials, presentations, discussions and special programs.

Child Advocate

As childcare advocates, school nurses work closely with staff and families to facilitate that health care needs and accommodations are identified and met. Advocacy can extend beyond these areas to include referrals for health services and counseling, community programs, camps, or even DYFS.

Community Liaison

In the role of community liaison, the school nurses work with many , in the past from the Central Jersey Blood Bank, Monmouth County VNA Flu Vaccine Program, Visiting Nurse Association of Monmouth County, Monmouth County Board of Health Department programs, Monmouth County Prosecutors Office programs Jersey Shore Family Health Center, Community Health Center of Asbury Park, 180 Turning Around Lives Program, district food drives and wish trees, PTO, coordination with the Elks and Manasquan Police Department for Christmas and Thanksgiving gift baskets and certificates for needy families, Seek 911 Program (1st grade) through the Monmouth County Sheriff's Department, NJ Transit Railroad Safety Program, Dental Health Program K-3 (Dr. Paperth), New Jersey Family Care, consultation and services provided by the school doctor (Dr. Go), local pediatricians and dentists in addition to free vision care by local physicians. Most recently, Healthy Heart Day events encouraged community senior citizens involvement with the districts students and faculty and a Diabetes Walk involving students, faculty and community members as well.

Recorder

An extremely time consuming role for the school nurses is the role of recorder. A legal record must be maintained for each student and documentation for each incident of nursing care is required. Each entry must include the date, time, major complaint, nursing assessment, plan of care, implementation, evaluation and any referrals to outside professionals and/or agencies. This documentation provides a detailed history of each student's visits to the health office. Individual health room visits are recorded in the Genesis computer software program. This accurate account of student visits to the health office can at times verify the existence of ongoing physical and emotional issues. Excel worksheets are developed for items not included in Genesis such as diabetic worksheets, health awareness lists and physical education excuses. Information from parents and health care providers must also be incorporated into the student records through the use of the State of New Jersey Health History and Appraisal form otherwise referred to as the A-45 card. Every student must have a hard copy of the A-45 in their health file per the New Jersey State Department of Education and Department of Health. These cards can only be handwritten and contain important data on the individual student such as health history including allergies, immunization history, special health current problems, important injuries and illnesses that prevent the student from partaking of gym, routine and sports physical examinations, vision, hearing and scoliosis screenings, findings and recommendations of physicians, modifications of health program, referrals and follow ups and conferences with parents. Data must also be collected and recorded with submission of corresponding reports for state and county agencies relating to immunizations, communicable diseases such as MRSA, tuberculosis testing on students and faculty, waste management (proper disposal of syringes) and employee injuries. Accident reports are also hand written and submitted on a case by case basis for school injuries involving students and faculty and visitors. Physical Education excuses are emailed to the gymnasium teachers on a need be basis according to exit from and entry into gym classes for injuries, illnesses and surgeries. Another time consuming task is the Health Awareness List that is a running account of all grade levels and addresses individual student health issues and current treatments as well as health history. This list is constantly updated. It is shared with the each faculty member having that particular child in their classroom at the beginning of each new school year and as needed throughout that school year for changes in care and/or condition and also for any students transferring into the district.

Manager

With the variety of roles the school nurses take on and the variety of needs that must be balanced at any given point in time, the school nurses take on the role of manager. In the school setting, it is essential to aggressively manage any health problems that are likely to compromise learning. For this reason, school health care providers must prioritize concerns and assign health services staff in a way that achieves this goal.

The assignment of school nurses in the Manasquan Public Schools must not be based solely on the student population. Consideration must be given for the special education population and the severity of health concerns present within each building. Severity coding can be broken down into four levels: Nursing Dependent, Medically Fragile, Medically Complex, and Health Concerns.

Level I: Nursing Dependent

Nursing dependent students require 24 hours/day, frequently one-to-one, skilled nursing care for survival. Many are dependent on technological devices for breathing, for example, a student on a ventilator, and/or requiring continuous nursing assessment and nursing assessment and intervention. Without the use of the correct medical technology and nursing care, the student will experience irreversible damage or death.

Level II: Medically Fragile

Students with complicated health care needs in this category face each day with the possibility of a life-threatening emergency requiring the skill and judgment of a professional nurse. Examples may include, but are not limited to: severe seizure disorder requiring medication, severe asthma, sterile procedures, and tracheostomy care with suctioning, unstable or newly diagnosed diabetic with unscheduled blood sugar monitoring and insulin injections, diabetics with insulin pumps requiring monitoring and asthmatics requiring nebulizer treatments.

Level III: Medically Complex

Students with medically complex concerns require daily treatments or close monitoring by a professional nurse. They may have unstable physical and/or social-emotional conditions and the potential for a life-threatening event may exist. Examples include, but are not limited to: ADHD and on medication, anaphylactic event, cancer, immune disorders, moderate to severe asthma (inhaler, peak flow meter), preteen or teenage pregnancy, carefully timed medications, medications with major side effects, unstable metabolic conditions, continuous or intermittent oxygen and complex mental or emotional disorders.

Level IV: Health Concerns

In the category of health concerns, the student's physical and/or social-emotional condition is currently uncomplicated and predictable. Occasionally, the student requires monitoring, varying from biweekly to annually. Examples include, but are not limited to: dental disease, headaches, migraines, sensory impairments, diabetes self-managed by the student, dietary restrictions, eating disorders, orthopedic conditions requiring accommodations and encopresis.

MANASQUAN ELEMENTARY SCHOOL - STATISTICS (October 2008)

Grade Levels:  Pre-School through 8th Grade

Student Elementary Population: 696

General Education Enrollment: 631

Pre-School Enrollment: 6

Special Education Enrollment: 59

504 Accommodation Plans: 17

Students with medical involvement: 301

(This number includes three Diabetic students, two students with Celiac Disease, one student with Cystic Fibrosis, one student with Sickle Cell Anemia, one student with severe unstable Epilepsy, one student with supraventricular Tachycardia and one student with Vasovagal Syncope, many students with Asthma and life threatening nut allergies among many other serious conditions)

Levels of Care:

Level I: Nursing Dependent 0

Level II: Medically Fragile 11

Level III: Medically Complex 82

Level IV: Health Concerns 208

51

Students transferring into elementary school: ('07-08):

30

Students transferring out of elementary school: ('07-08):

School Year 2007-2008 Statistics

Description

Total Student health office visits: 3,368*

*This number does not include medications, phone calls, faculty visits, parent conferences as well as other miscellaneous daily routine occurrences too numerous to document in the GENESIS software.

It is important to note that Manasquan made a software conversion in 2007-2008 on or about November 1, 2007 to the GENESIS program. The numbers reported herein reflect the difficulty of that transition rather than the actual number of office visits, which were recorded in the past on an excel spreadsheet.

REVISE this section BEFORE SENDING to BOE (Get from Cheryl)

SCHOOL HEALTH SERVICES - MANASQUAN ELEMENTARY SCHOOL

Laurie Cosgrove RN

Physical Examinations:

• Coordinates and assists Dr. Go with physical exams for transfer students not having a medical home or requested by the Child Study Team.
• Assists with summer athletic physicals given by the Jersey Shore Medical Center Team under the direction of Dr. Rice at the high school for athletes from the elementary school as well as from the high school.

Sports Program:

• Oversees review of all sports packets which includes securing of any missing information and placing eligible students on a clearance list for tryouts for all seasons.
• Notes any unknown health concerns, charts scoliosis, vital signs, vision and physical exam date on health card and health awareness list.

Working Papers:

• Prepares medical portion of working papers for qualified students as needed.

State Mandates:

• Confers with Dr.Go regarding health concerns as they arise throughout the school year. Discuss any changes in school policy and or state mandates as they relate to student health.

Emergency Cards:

• Distributes cards to every student and faculty member, track incoming cards for return as well as for pertinent information and proper signatures.
• Any new information is added to current health awareness list.

Workman's Compensation:

• Sends letter to all staff at start of school year regarding district policy.
• Disseminate information to staff members who are hurt on the job.

Immunizations:

• Updates immunization records as needed.
• Compiles data and prepares yearly report as required.
• Hepatitis B Series mandate: Reviews all 5th grade charts for compliance with law and notify parents of any non-compliant situations. Chart all incoming related immunizations of either the three-dose or Recombivax (two-dose) type on permanent health card.
• Reviewed all Pre-School records for compliance in receiving new state mandated vaccines for September through December of 2008. Contact parents for non-compliance and record vaccines on permanent state health cards.
• Review all sixth grade records for compliance in receiving 2 new State mandated vaccines required this September and record these vaccines on permanent state health cards.
• Completes County and State Immunization Report yearly.
• Writes and distributes any new state vaccine mandates in letter form to parents via mailing and tracks compliance in receiving those vaccines.

Thanksgiving/Christmas Baskets:

(Laurie Cosgrove)

• Baskets and food gift certificates for needy families with Manasquan Police Department/Elks.
• Distributes letter to needy families regarding specific needs for each family member according to age and size.
• Gathered information given to PTO for purchase of needed items for the wish tree as well as to Student Counsel for wrapping purposes. All information is strictly confidential.
• Nurse hand delivers bags filled with gifts to needy families.

Health Awareness List:

(Laurie Cosgrove)

• Compiles and lists all medical problems of students in kindergarten through eighth grade.
• Update Health Awareness List regarding transfer students as needed.
• Reviews with all faculty members including paraprofessionals working directly with students in a teaching or non-teaching capacity as well as with the administration and guidance counselor.
• Faculty updated with medical information as needed.

Physical Education Excuses:

• Compiles a computerized list of students that are excluded from PE due to injury, illness or surgery.
• Removes students from computer list when cleared for gym.
• E-mails gym excuse list to PE staff daily.
• Charts all PE excuses on health cards.

Pre-School Special Education:

(Laurie Cosgrove)

• Reviews immunizations and physicals for entrance and creates health card for each student.

Kindergarten:

(Laurie Cosgrove)

• Attends and disseminates information to all incoming kindergarten parents during registration process at both the prearranged registration time and prior to the opening day of school.
• Reviews immunizations and physicals for entrance and creates health card for each student.
• Attends kindergarten orientation prior to the opening day of school and reviews health office procedures in a group setting with parents.

Transfer Students:

(Laurie Cosgrove)

• Review all incoming physicals as well as immunizations for compliance prior to the first day of school and charts all immunizations and physicals on health card. This process must be repeated for the pre-school students as well.
• Attends transfer student orientation prior to opening day of school and reviews health office procedures in a group setting. Reviews, evaluates and discusses any compliance issues with parents on a need-be basis.

Heights and Weights:

• Reviews and records on heath card.
• Follow-up with parents on obvious deviations according to normal growth and development patterns and/or BMI (Body Mass Index).

Individual Health Care Plans (IHCP):

(Laurie Cosgrove)

• Write, distribute and explain Emergency and IHCP's for students requiring such to faculty and paraprofessionals on a case to case basis.

Tuberculosis Screening:

• Administers test, reads and records Mantoux tests on new faculty members as well as on transfer students per state requirements.
• Refers positive reactors to Monmouth County Health Department for chest x-ray and treatment if indicated.
• Follows up on all positive results.
• Completes yearly TB Report.
• Order and arranges for pickup of all needed supplies from Monmouth County Health Department.

Audiological Screening:

• Students screened in accordance with NJ State Guidelines.
• Recording of such on NJ Health Card (A45), referrals to parents as needed with subsequent follow-up. This includes grades K through 4, 6 and 8 as well as transfer students.

Vision Screening:

• Students screened in accordance with NJ State Guidelines.
• Recording of such on NJ Health Card (A45), referrals to parents as needed wit subsequent follow-up.
• Arrange for eye exam/glasses if indicated through Lion's Club for families without insurance in community. (This includes grades K, 2, 4, 6 and 8 as well as transfer students)

Scoliosis Screening:

• Performs screening every other year according to state statutes on all students age 10-18.
• Referrals forwarded to parents and follow-ups on physician visit outcomes.

Health Room Supplies:

• Submits yearly order according to projected needs and budget.
• Organize all deliveries and confirm all items against packing slips and original orders.
• Storage of new and existing supplies.

Accident Reports:

• Prepares reports for staff/students as necessary and distributes to principal and Board Office.
• Follow-up on any injuries.

Health Room Visits:

• Daily assessment, evaluation and treatment of both student and staff emotional/physical health concerns on both an emergency and non-emergency basis and the recording of such on the Genesis software program.
• Frequent parental contact by telephone and/or conferencing accomplished on a case-to-case basis. Increased contact due to age of population.
• Utilization of local first aid squad/paramedics as required.
• Referrals to Division of Family and Youth Services as indicated after conferring with team members.

Medication:

• All daily and as needed medication orders are data entered into the GENESIS Medical program and logged in per student visit.
• Obtains proper physician/parent authorization on a yearly and as needed basis for all meds kept in health office and administrators according to physician's specific orders.
• Asthma Action Plan for asthmatics obtained from physician/parent on all students requiring possible use of inhalant/nebulizer medications as per NJ State Mandate.
• Secures Emergency Allergy Action Plan of all students requiring an Epi-Pen.
• Charts all meds on individual permanent health cards (A-45).
• End of the year mailing to all parents whose child/children had medication in the nurse's office, including proper forms for the following school year as well as pick-up and drop-off procedures for medications.

EpiPen Delegates:

• Chairs, coordinates and trains team members.
• Updates delegates as needed.

AED Response Team:

(Laurie Cosgrove)

• Chairs and coordinates; sets up training sessions and mock trials as needed.
• Arranges for team recertification for CPR/AED every other year as required.

First Aid Orders:

• Reviews and updates standing orders as needed with school physician.

Substitute Nurses:

(Laurie Cosgrove)

• Reviews resumes, conducts personal interviews and recommends candidates for addition to our sub-nurse list for board approval.
• Orients sub nurses to office policy and procedures.
• Secures substitute nurse for all required field trips.

Field Trips:

(Laurie Cosgrove)

• Prepares first aid boxes, medications including inhalers/nebulizer treatments with accompanying equipment and corresponding physician's orders.
• Copy of Health Awareness List for the specified group included.
• Accompany 8th grade students on overnight field trip annually as well as other field trips as specified by the school principal.

Policy Development:

(Laurie Cosgrove)

• Develops policy or changes existing policy as need arises according to Manasquan District Policy and/or State Mandates issued.
• Keeps administration and staff fully updated on any upcoming changes as necessary.

Continuing Education:

• Attends district in-services as well as outside workshops and in-services that relate directly to field of elementary school nursing in order to grow professionally as well as to meet the 100 hour/5 year mandate required of all teachers.

NJ Family Care Coordinator:

(Laurie Cosgrove)

• Packets are distributed to all incoming transfer students.
• Assists families with problems encountered during enrollment process.

Flu/Pneumonia Vaccine Clinic:

• Assists in coordinating yearly clinic with the VNA of Central Jersey. Newsletter shared with staff with pre-registration in nurse's offices.
• Also share information regarding spring Blood Bank run by high school nurse and offer pre-registration for faculty.

Intervention & Referral Services Team:

(Laurie Cosgrove)

• Active member of team at weekly group meetings as well as individual student meetings held with parent(s).
• Medical screening process performed and recorded on all new referrals.
• Individual findings discussed at meetings and appropriate referrals made at that time.

Special programs:

Laurie Cosgrove)

• Coordinates and schedules SEEK 911 Program for all 1st graders yearly through the Monmouth County Sheriff's Department.
• Coordinates and schedules a Railroad Safety Program through New Jersey Transit on railroad safety for grades K-8 as needed.
• Coordinates and schedules a year Dental Health Program for students in grades K-3 with Fred Paperth, local pediatric dentist.

Membership:

• Maintains current membership in the County, State, and National School Nurse's Associations.

Staff In-service:

• In-services staff as required by mandates and/or needs, by principal's request.

Wellness Committee:

• Chairs (Laurie Cosgrove) and coordinates committee meetings in direct correlation to the Child Nutrition and WIC Authorization Act of 2004.
• Coordinated a diabetes fundraiser (Susan McCoy) for Fall 2008.

Float Nurse Training: (Laurie Cosgrove)

• Continually updates and trains part-time nurse (Susan McCoy) and paraprofessional (Ann Marie Fernandez) on continually changing office procedures, State and county mandates and oversees individual daily projects.
• Provides feedback as needed.

MANASQUAN HIGH SCHOOL

Grade Levels: 9 - 12

Student Population: 1028

General Education Enrollment: 866

Special Education Enrollment: 162

Students with medical involvement: 424

Level I: Nursing Dependent 4

Level II: Medically Fragile 22

Level III: Medically Complex 160

Level IV: Health Concerns 238

The certified school nurse fulfills her duties and both develop and implements health services in accordance with the New Jersey Nurse Practice Act, ANA/NASN Standards of School Nursing, NJ Department of Education Health Services Guidelines, and the New Jersey Interscholastic Athletic Association.

SCHOOL HEALTH SERVICES - MANASQUAN HIGH SCHOOL PROJECTION 2008-2009 SCHOOL YEAR - Cheryl Bontales RN

Physical Examinations:

• Coordinates and assists Dr. Go with physical exams for transfer students not having a medical home or requested by the Child Study Team.
• Coordinate the summer athletic physicals conducted by the Jersey Shore Medical Center Team under the direction of Dr. Stephen Rice at the high school for Manasquan School District student/athletes grades 6-12.

Sports Program:

• Reviews all sports packets in entirety, secures any missing information and places eligible students on a clearance list for tryouts for all seasons.
• Meet with Athletic Director, coaches and Athletic Trainer regularly to discuss student/athlete injuries, recovery, and compliance with NJIAAC Rules and Regulations.
• Notes any unknown health concerns, charts scoliosis, vital signs, vision and physical exam date on health card and health awareness list.

Working Papers:

• Prepares medical portion of working papers for qualified students as needed.

State Mandates:

• Confer with Dr. Go regarding health concerns as they arise throughout the school year. Discuss any changes in school policy and or state mandates as they relate to student health.

Emergency Cards:

• Distributes cards to every student and faculty member, track incoming cards for return as well as for pertinent information and proper signatures.
• Any new information is added to current health awareness list.

Workman's Compensation:

• Sends letter to all staff at start of school year regarding district policy.
• Disseminate information to staff members who are hurt on the job.
• Act as liaison for any injured employee until care is received for injury.

Immunizations:

• Updates immunization records as needed.
• Compiles data and prepares yearly report as required.
• Hepatitis B Series mandate: Reviews all charts for compliance with law and notify parents of any non-compliant situations. Chart all incoming related immunizations of either the three-dose or Recombivax (two-dose) type on permanent health card.
• Contact parents for non-compliance then record vaccines on permanent health cards.
• Completes County and State Immunization Report every November.
• Ensure that all religious exemptions follow state guidelines properly.

Health Awareness List:

• Compiles and lists all medical problems of students and staff.
• Update Health Awareness List regarding transfer students as needed.
• Reviews with all faculty members including paraprofessionals working directly with students in a teaching or non-teaching capacity as well as with the administration and guidance counselor.
• Faculty updated with medical information as needed.
• Create care plans and emergency plans based on health awareness list.

Physical Education Excuses:

• Compiles a computerized list of students that are excluded from PE due to injury, illness or surgery.
• Removes students from computer list when cleared for gym.
• E-mails gym excuse list to PE staff daily.
• Charts all PE excuses on health cards.
• Issue elevator pass, 5 minute corridor pass and safe room pass to all students who are casted or on crutches.

Transfer Students:

• Review all incoming physicals as well as immunizations for compliance prior to the first day of school and charts all immunizations and physicals on health card. Review, evaluates and discuss any compliance issues with parents on a need-be basis.

County Schools:

• Maintain health records on Manasquan School District students attending the following county schools who participate in the sports program MHS. Monmouth Vocational School, Academy of Allied Health and Sciences, Communications High School, High Technology High School, Bio-Tech High School, Marine Academy of Science and Technology.
• Maintain open communication with the school nurses in all the county schools on a daily basis, regarding injuries and illnesses.

Sending District Elementary Schools:

• Arrange to meet with each of the elementary school nurses from each of the seven sending districts to receive 9th grade charts, health files and to discuss care plans and individual health concerns.
• Send letters to freshman families regarding sports physicals and medication policy.

Heights and Weights:

• Reviews and records on heath card.
• Follow-up with parents on obvious deviations according to normal growth and development patterns and/or BMI (Body Mass Index).

Individual Health Care Plans (IHCP):

• Write, distribute and explain Emergency and IHCP's for students requiring such to faculty and paraprofessionals on a case to case basis.

Tuberculosis Screening:

• Administers test, reads and records Mantoux tests on new faculty members as well as on transfer students per state requirements.
• Refers positive reactors to Monmouth County Health Department for chest x-ray and treatment if indicated.
• Follows up on all positive results.
• Completes Annual TB Report and submit to the Department of Health and Senior Services.
• Order and arrange for pickup of all needed supplies from Monmouth County Health Department.

Audiological Screening:

• Students screened in accordance with NJ State Guidelines.
• Recording of such on NJ Health Card (A45), referrals to parents as needed with subsequent follow-up.

Vision Screening:

• Students screened in accordance with NJ State Guidelines.
• Recording of such on NJ Health Card (A45), referrals to parents as needed wit subsequent follow-up.

Scoliosis Screening:

• Performs screening every other year according to state statutes on all students age 10-18.
• Referrals forwarded to parents and follow-ups on physician visit outcomes.

Health Room Supplies:

• Submits yearly order according to projected needs and budget.
• Organize all deliveries and confirm all items against packing slips and original orders.
• Storage of new and existing supplies.

Accident Reports:

• Prepares reports for staff/students as necessary and distributes to principal and Board Office.
• Follow-up on any injuries.

Health Room Visits:

• Daily assessment, evaluation and treatment of both student and staff emotional/physical health concerns on both an emergency and non-emergency basis and the recording of such on the Genesis software program.
• Frequent parental contact by telephone and/or conferencing accomplished on a case-to-case basis. Increased contact due to age of population.
• Utilization of local first aid squad/paramedics, as required.
• Referrals to Division of Family and Youth Services as indicated after conferring with team members.

Medication:

• All daily and as needed medication orders are data entered into the GENESIS Medical program and logged in per student visit.
• Obtains proper physician/parent authorization on a yearly and as needed basis for all meds kept in health office and administrators according to physician's specific orders.
• Asthma Action Plan for asthmatics obtained from physician/parent on all students requiring possible use of inhalant/nebulizer medications as per NJ State Mandate.
• Secures Emergency Allergy Action Plan of all students requiring an Epi-Pen.
• Charts all meds on individual permanent health cards (A-45).
• End of the year mailing to all parents whose child/children had medication in the nurse's office, including proper forms for the following school year as well as pick-up and drop-off procedures for medications.

Epi-Pen Delegates:

• Provide in-service for staff designees.
• Updates delegates as needed.

AED Response Team:

• Maintain Basic Life Support and Advanced Cardiac Life Support Certification
• Serve as member of AED response team.

First Aid Orders:

• Reviews and updates standing orders as needed with school physician.

Substitute Nurses:

• Reviews resumes, conducts personal interviews and recommends candidates for addition to our sub-nurse list for board approval.
• Orients sub nurses to office policy and procedures.
• Secures substitute nurse for all required field trips.
• Secures substitute nurse when scoliosis screening is being conducted.

Field Trips:

• Prepares first aid boxes, medications including inhalers/nebulizer treatments with accompanying equipment and corresponding physician's orders.
• Copy of Health Awareness List for the specified group included.
• Accompany students on overnight field trip as specified by the school principal.

Policy Development:

• Develops policy or changes existing policy as need arises according to Manasquan District Policy and/or State Mandates issued.
• Keeps administration and staff fully updated on any upcoming changes as necessary.

Continuing Education:

• Attends district in-services as well as outside workshops and in-services that relate directly to school nursing in order to grow professionally as well as to meet the 100 hour/5 year mandate required of all teachers.

NJ Family Care Coordinator:

• Packets are distributed to all incoming transfer students.
• Assists families with problems encountered during enrollment process.

Flu/Pneumonia Vaccine Clinic:

• Coordinate annual Flu and Pneumonia Vaccinations for District staff with the VNA of Central Jersey. Newsletter distributed to district staff with pre-registration in nurse's offices.

Annual Blood Drive:

• Conduct Annual Blood Drive to benefit the Central Jersey Blood Center

Intervention & Referral Services Team:

• Active member of team.
• Medical screening process performed and recorded on all new referrals.
• Individual findings discussed at meetings and appropriate referrals made at that time.

Membership:

• Maintains current membership in the County, State, and National School Nurse's Associations.

Staff In-service:

• In-services staff as required by mandates and/or needs, by principal's request.

Float Nurse Training:

• Continually updates and trains part-time nurse (Susan McCoy) on continually changing office procedures, State and county mandates and oversees individual daily projects.
• Provides feedback as needed.

Manasquan High School Special Concerns

The Sport Program at Manasquan High School generated over 800 athletes for 2007-2008. The School Nurse arranges Sport Physicals to be done with Jersey Shore Medical Center team of Sports Physicians on all students and those from the sending districts as well. All physicals done through the school or private physician must be processed through the School Nurse prior to being sent to the Athletic Director (AD) for final eligibility. Additionally district students attending High Tech High School, Academy of Allied Health and Science, Communications High School, MAST and Biotech High School participating in MHS activities must be processed through the High School nurse prior to participation. The enormous task of handwriting up to 800 letters clearance/denial letters to parents was delegated to secretarial personnel through the Superintendents Office this past summer so the task can be carried out more effectively and in a timely manner. Over 2000 sport packets are printed and assembled through the High School nurses office. This is a task that could be delegated out.

As a result of a discussion with nurses during a recent meeting, the Athletic Department offers clerical and technical assistance processing the applications for eligibility throughout the school year and posting downloadable Athletic forms on the Athletic Department's website for the community. A visit to the Athletic Department website's of other schools will provide insight to how this is displayed. Processing sports applications is a time consuming task, especially during the month of September when this office is inundated with Interscholastic Sports Applications, Sports Physical Reviews, review of health records, updating health records, obtaining prescriptions and medications for students, creating the health awareness list and transferring an enormous amount of student files in and out of the district due to transfers to and from other schools. Secretarial services that were provided through the Superintendents office for 6 weeks during the summer from June 20th till August 8th, proved to be an immeasurable help. Data from the sport physicals was entered into a sports physicals database that will allow for easy access as students move from one sport season to the next. After the school nurse determined physical eligibility by reviewing the sport physical, sports participation rosters were created and provided to the Athletic Director by the secretary to attach academic eligibility. If a secretary was assigned to the office, the data could be entered into the Genesis database as well. It is the recommendation of this office that all sports participation information and forms be scanned and posted online for the community we serve, and be accessible via the Athletic Departments website as it is in other districts.

It is especially essential now that we have moved to Random Drug Testing (RDT) and maintaining the privacy and rights of students is critical so that this program can be carried out as planned. Utilizing the Health Office to perform and carry out RDT and testing for Under the Influence is another area of concern that involves intentionally abandoning the health care needs of other medically fragile students during the length of time that is needed to process each Drug Test. The time involved for this process is usually one hour as it involves properly informing the individual, obtaining consent, obtaining and securing the specimen. This is often an emotional time for the student and must be handled properly. Some school districts deal directly with law enforcement agents who handle the entire process of Drug Testing, and neither the School Nurse nor the Health Office is involved at all.

The High School property also houses the joint Manasquan/Wall Alternative School, which has students with many medical/ emotional problems. The High School Nurse has responded to emergency calls at that facility, and has had to "leave the building" to administer first aid and treatment.

The High School (school nurses) manages the added health care needs of our physically challenged and wheel chair restricted students as well. Because there is no facility for Physical Therapy in the district, therapy is conducted in the nurse's office two hours a day, three days a week. In addition, our medically fragile student eats lunch in the nurse's office for observation in the event the student may require airway suctioning during mealtime.

District Recommendations

In preparing the nursing services plan each year, it is critical to again review and reevaluate not only population size, but also the severity and complexity of health concerns and associated time requirements. The attached summary of data from each school supports the need for a full time certified school nurse in each building as well as the continued addition of the float nurse who is shared equally between the high school and the elementary school. Amplified conditions and the ever expanding responsibilities of the Manasquan High School and Manasquan Elementary School health offices relate to increased student and staff population, increased number of medically and emotionally fragile students requiring extensive health care, increasing numbers of classified students with medical involvement, more students with individual health care plans and emergency health plans requiring increased parent and teacher communication as well as highly concentrated needs of sports programs and new immunization mandates from the state.

Reviewing of sports packets, emergency cards, individual health records, reviewing and updating doctor's orders with corresponding medications, updating and sharing of the health awareness list with faculty members, reviewing transfer student files due to a constant influx of students form other school districts and outflow of students to new school districts and other responsibilities too numerous to name, places a tremendous burden on the school nurse. Much of this paperwork could be accomplished by a clerical staff member and takes quality time away from the students that present with a host of physical and/or emotional problems. Assessing, planning and providing nursing care and emotional support to these students is paramount to their academic success in school as well as their overall success in life.

The district sports program is a tremendous undertaking for the district school nurses. The sport packet now consists of 10 documents, only two of which contain health related information. Quite often, students return the 10 page packet incomplete. This requires numerous follow up phone calls to the student's home or private MD until the packet is completed or corrected, prior to participation. All student/athletes must be cleared by the School Sports Physician and School Nurse who review each applicant thoroughly and completely before placing the student on a sport roster for the AD to consider for participation. This process is mandated by the NJSIAA guidelines which the school nurse follows. The guidelines also require each student to receive a written letter of clearance or denial with follow up instruction toward eventual clearance. This enormous task of handwriting up to 800 letters was delegated to secretarial personnel through the Superintendents office this past summer so the task can be carried out more effectively and in a timely manner.

The ever increasing Hispanic population to this area raises another concern for the School Nurse. The need for a designated interpreter who can be called upon when students present to the health office (for the health interview, physical exam, random drug testing and testing while under the influence (HS only), and when health issues need to be discussed and referrals are made to other health care agencies, such as clinic appointments, NJ Family Care referrals and follow up with immunization requirements), cannot be overemphasized. This population group presents with multifaceted issues which often require a great amount of time to determine, decipher and refer to the proper resources.

Based on the nature of the information kept in the nurses office and taking into consideration the HIPAA (Health Insurance Portability and Privacy Act) law of 1996 that is required by the Department of Health, confidentiality must be maintained at all times in the school health office setting. HIPAA addresses the security and privacy of health data and information in a health care setting. Having only one consistent person (aside from the nurses directly caring for the students) handling the students records cuts down on the possibility of confidentiality issues. The inclusion of clerical assistance is now imperative due to the ever increasing amount of paper and computer work associated with increased required documentation placed on the district by the NJ Department of Education as outlined in the School Health Services Guidelines.

Clerical help in the office would enable the nurses to concentrate on caring for an increasingly needy population. It is especially needed on the days that the float nurse is scheduled at the opposite school, and the full time nurse is covering her building alone, and called to respond to emergencies, leaving the health office unattended. Closing and locking the door to the health office is not an option as this is locking out the asthmatics, diabetics or anyone else who may need urgent care or medication. It is also intentional abandonment of the student or staff member that is seeking help. The addition of extra help would also ensure that both the high school nurse and the elementary school nurse could consistently partake of their lunch and break times. As it is, neither nurse is afforded prep time except on the days when there are two nurses in either health office.

Consistent, full-time clerical help for both the elementary school health office and the high school health office would allow for both school nurses to continue providing quality, efficient, safe student and staff health care in order to better meet the health care needs of the student body and district faculty. The majority of the nurse's time should be in direct contact in assisting the students with their emotional, social and physical health care needs and not behind a desk.

One full-time certified school nurse, one part-time certified school nurse to be shared between both buildings, and the addition of full time clerical help with computer knowledge and skills for each building is required to meet the needs of the Manasquan School District to continue to ensure safe practice.

Respectfully submitted,

___________________________  Date: ___________

Laurie Cosgrove, RN, BSN, CSN,

School Nurse MES

___________________________  Date: ___________ 

Cheryl Bontales, RN, MSN, CSN

School Nurse MHS

__________________________  Date: ____________

Susan Tellone, RN, MSN, CSN

School District Float Nurse 

_________________________   Date: ____________

Dr. Jane Go
School Physician