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From Magic City Morning Star Letters
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:
Sports Program:
Working Papers:
State Mandates:
Emergency Cards:
Workman's Compensation:
Immunizations:
Thanksgiving/Christmas Baskets: (Laurie Cosgrove)
Health Awareness List: (Laurie Cosgrove)
Physical Education Excuses:
Pre-School Special Education: (Laurie Cosgrove)
Kindergarten: (Laurie Cosgrove)
Transfer Students: (Laurie Cosgrove)
Heights and Weights:
Individual Health Care Plans (IHCP): (Laurie Cosgrove)
Tuberculosis Screening:
Audiological Screening:
Vision Screening:
Scoliosis Screening:
Health Room Supplies:
Accident Reports:
Health Room Visits:
Medication:
EpiPen Delegates:
AED Response Team: (Laurie Cosgrove)
First Aid Orders:
Substitute Nurses: (Laurie Cosgrove)
Field Trips: (Laurie Cosgrove)
Policy Development: (Laurie Cosgrove)
Continuing Education:
NJ Family Care Coordinator: (Laurie Cosgrove)
Flu/Pneumonia Vaccine Clinic:
Intervention & Referral Services Team: (Laurie Cosgrove)
Special programs: Laurie Cosgrove)
Membership:
Staff In-service:
Wellness Committee:
Float Nurse Training: (Laurie Cosgrove)
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:
Sports Program:
Working Papers:
State Mandates:
Emergency Cards:
Workman's Compensation:
Immunizations:
Health Awareness List:
Physical Education Excuses:
Transfer Students:
County Schools:
Sending District Elementary Schools:
Heights and Weights:
Individual Health Care Plans (IHCP):
Tuberculosis Screening:
Audiological Screening:
Vision Screening:
Scoliosis Screening:
Health Room Supplies:
Accident Reports:
Health Room Visits:
Medication:
Epi-Pen Delegates:
AED Response Team:
First Aid Orders:
Substitute Nurses:
Field Trips:
Policy Development:
Continuing Education:
NJ Family Care Coordinator:
Flu/Pneumonia Vaccine Clinic:
Annual Blood Drive:
Intervention & Referral Services Team:
Membership:
Staff In-service:
Float Nurse Training:
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,
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 © Copyright 2002-2008 by Magic City Morning Star |