Iowa School Nursing. August 15, 2007

Transcription

1 Iowa School Nursing August 15, 2007

2 Jeff Berger Department of Education Legislative and Policy Liaison May 2007 School Leader Update- Legislative Edition Legislative Update

3 SF 277-Student Achievement and Teacher Quality HF877-Voluntary access to statewide quality 4-year4 year-old preschool HF 909 Mandate for school districts to release free/reduced lunch lists to the Hawk-I I program- HF 611-Update of local Human Growth and Development Curricula Others

4 Rita Gergely Chief, Bureau of Lead Poisoning Prevention Division of Environmental Health, IDPH , 2026, HF 158-Lead screening prior to age of 6 - Parents provide school district lead screening evidence prior to age 6. School district forwards evidence to DPH within 60 days of start of school. A variety of exceptions/waivers. School districts provisionally enroll a student. IDPH to develop rules. ICE/default.asp?Category=billinfo&Service=Billbook &menu=false&ga=82&hbill=hf158

5 Kim Tichy Immunization Registry Coordinator Iowa Registry Immunization System (IRIS), IDPH , IRIS Help Desk:

6 Bob Russell, DDS, MPH Public Health Dental Director, IDPH , HF 906-Dental screening Parents provide dental screen evidence to school district prior to age 6 and high school. School district forwards evidence to DPH within 60 days of start of school. A variety of exceptions/waivers available. School districts provisionally enroll a student in certain circumstances. Bill applies school year. ICE/default.asp?Category=billinfo&Service=Billbook&m enu=false&ga=82&hbill=hf906

7 Barb Smith Medication Administration Course

8 Assuring Safe, High Quality Health Care Pre-K 12 Educational Settings American Nurses Association (ANA) Position Paper March 16, 2007 Congress on Nursing Practice & Economics Adopted by: ANA Board of Directors sition/practice/assuringsafehealthcarepr ek.pdf

9 Purpose Children should be healthy to learn and learn to be healthy. Education has a central role in teaching students to improve their health & reduce health-risk behaviors, to optimize learning & achievement.

10 The school nurse secures health, safety and lives of children (and adults) in educational settings Educational settings include classrooms, field trips, sporting events & other school-related activities

11 Summary 20% of combined US population of children and adults are in schools on a weekday (AHA, 2004). To best serve health needs of students & staff in educational settings, ANA supports a collaborative school health model requiring cooperation & participation of school nurse, students, families, teachers, school administrators & staff, other health care professionals, & community. In the model, school nurse serves as manager & coordinator of care, information, education, personnel & resources to take best advantage of schools unique position in addressing students safety & health care needs.

12 School nurses are essential in promoting health, injury prevention & providing direct health services to school students & staff. To assure children s s safety, it is essential that other responsible individuals (both health care & non- health care personnel) in school setting receive education & practice in various health care activities, under direction of school nurse.

13 Public policy must guarantee a central health care professional-- --educated, knowledgeable with up-to to-date skills-- --to be available daily to students in educational setting, to best protect fundamental public health & educational priority our nation s s children represent. The central health care figure best prepared to serve in this role is the registered school nurse.

14 Recommendations 1. ANA supports assignment & daily availability of a registered school nurse for management & implementation of school health services at recommended ratio of one nurse for every 750 students, with an ultimate goal of at least one nurse in every school. Daily availability requires onsite registered nurse for at least a portion of every day & otherwise available for immediate collaboration or consultation by alternate means of communication. If school nurse is assigned to more than one facility, total number of students the nurse serves should not exceed 750.

15 2. ANA supports a modified ratio of fewer students per nurse, dependent on number & severity of disabilities within student population. 3. ANA supports safety assurances for all children, requiring individuals other than school nurses, when performing health care related tasks in educational setting, to follow guidelines and protocols taught to them led by school nurse. 4. ANA supports development & dissemination of instructional curricula to assist school nurses in educating non-healthcare providers to competently perform delegated tasks in an educational setting. Examples provided.

16 5. ANA supports dissemination of consistent information on delegation to school nurses reflecting both legal requirements of their state & professional standards required of them as professional RNs. 6. ANA continues its advocacy for public policy & funding to provide at least one registered nurse for every 750 students in educational settings.

17 References Nursing s s Social Policy Statement 2nd ed. (2003) Code of Ethics for Nurses with Interpretive Statements (2001) School Nursing: Scope and Standards of Practice (2005) Principles for Delegation (2005) Delivery of Care in Schools for Children with Diabetes (2005)

18 California K.C. et al. v. Jack O Connell, O et al. Diabetes Management in Schools K.C. Settlement Agreement & Legal Advisory Q & A - K.C. Settlement Agreement & Legal Authority Helping Student with Diabetes Succeed: A Guide for School Personnel (Outside Source)

19 Children With Diabetes Win Assurance of Legally Required Services at School California Department of Education (CDE) and American Diabetes Association (ADA) Agreement - In-School Care for Students OAKLAND 8/8/07 announced agreement ensuring California students classified as disabled because of diabetes will be safe at school & enjoy same legally required educational opportunities as their peers. The agreement clarifies rights of eligible students with diabetes in every school district throughout the state.

20 Lawsuit, filed as a class action October 2005, against CDE & two Bay Area school districts (San Ramon Valley Unified & Fremont Unified) under federal disability civil rights & special education laws. Each district entered into a separate agreement with plaintiffs detailing care it will provide its students with diabetes. Litigation filed by four families & ADA in federal district court, San Francisco alleged some California school districts were not providing insulin administration & other services to students with diabetes-related disabilities who were legally entitled to at school. "A lack of resources, uncertainty about how services are best delivered & lack of clarity about state & federal requirements have in some instances caused hardship to parents of children with diabetes. No parent should have to put a job at risk to administer legally required diabetes treatment to their child during the school day."

21 Under agreement, each local educational agency (LEA) will manage delivery of care in best possible way for students whose Individualized Education Programs (IEP) or 504 Plans require administration of insulin & related services during the school day. CDE issued a Legal Advisory to all California school districts providing guidance on health care services for students with diabetes & outlining rights of these students under federal anti-discrimination & special education statutes Section 504 of Rehabilitation Act of 1973, Americans with Disabilities Act, & Individuals with Disabilities Education Act (IDEA). The Advisory explicitly states school districts have an obligation to provide insulin administration & related services to eligible students who need assistance.

22 Who May Administer Insulin in California to Students with Diabetes as a Related Service Under Section 504 and IDEA California Law: Business & Professions Code section 2725(b)(2) & California Code of Regulations,, Title 5, section 604 authorize following types of persons to administer insulin in California s s public schools pursuant to Section 504 Plan or IEP:

23 1.self administration, with authorization of student s s licensed health care provider & parent/guardian; 2.school nurse or school physician employed by LEA; 3.appropriately licensed school employee (i.e., RN or licensed vocational nurse) who is supervised by a school physician, school nurse, or other appropriate individual; 4.contracted RN or licensed vocational nurse from private agency or registry, or by contract with a public health nurse employed by local county health department;

24 5. parent/guardian who so elects; 6. parent/guardian designee, if parent/guardian elects, who shall be a volunteer who is not an employee of LEA; 7.unlicensed voluntary school employee with appropriate training, but only in emergencies as defined by law (Section 2727(d) of Business & Professions Code epidemics or public disasters). When no expressly authorized person is available under categories s 2-4, 2 supra, federal law - the Section 504 Plan or the IEP - must still be honored and implemented. Thus, a category #8 is available under federal law: 8.voluntary school employee who is unlicensed but who has been adequately trained to administer insulin pursuant to student s s treating physician s s orders as required by Section 504 Plan or IEP.

25 Federal Law Federal law under Section 504 & IDEA provides administration of insulin can be determined to be a related service that must be provided to a student pursuant to Section 504 Plan or IEP to ensure FAPE. CDE s Program Advisory recognized students rights under Section 504 & IDEA are distinct from state legal requirements. (See.)

26 Reconciliation of State & Federal Law When federal & state laws are reconciled, it is clear that it is unlawful for an LEA to have a general practice or policy that asserts it need not comply with IDEA or Section 504 rights of a student to have insulin administered at school simply because a licensed professional is unavailable. In such situations, federal rights take precedence over strict adherence to state law so educational & health needs of student protected by Section 504 Plan or IEP are met.

27 Q&A on Diabetes Case Settlement What does this settlement agreement do? Spells out legal LEA responsibilities when student is identified,, by IEP or 504 team, for special education and/or related services as a result of diabetes & requires insulin during school day. Makes clear school districts are obligated to provide insulin administration & related services to eligible students not able to self-administer. Spells out who may administer insulin at a school & requires LEA to provide training in diabetes management to a volunteer, non- licensed staff member when school nurse or other licensed professional is not available. Makes clear a district must meet individual education needs of each child who has a disability involving diabetes & may not operate on basis of blanket policy regarding administration of health services, such as across-the the-board limitations on types of services district will provide. Makes clear districts ensure eligible students are administered insulin during school day as required by IEP or 504 plan.

28 Which students are affected by the settlement? A student with diabetes who is disabled under Section 504 of Rehabilitation Act of 1973 and/or IDEA and whose IEP or Section 504 Plan requires health services related to the disability of diabetes. Under settlement, LEAs must affirmatively seek to find & evaluate all students eligible for services under federal law.

29 What if a student requires insulin administration and no school nurse is available? Financial burden or other difficulty to a LEA is not a valid defense for not providing school health services required under a child s s IEP or Section 504 Plan. The district must either contract for nursing services or train voluntary school personnel to provide such services. May LEA require a parent or other relative to come to school to administer insulin? No. A district must provide services needed by child during course of regular school day & during school- sponsored activities, pursuant to one of eight legally recognized approaches set forth in Legal Advisory.

30 How will CDE ensure students with diabetes get special educational services they need? CDE will notify school districts of these legal responsibilities & monitor districts for compliance, according to terms of settlement agreement.

31 he/hn/diabetesmgmt.asp

32 Iowa School Nurse Mailing List Iowa School Nurse (iowasn) Mailing List is a communication linking tool for Iowa School Nurses & Department of Education. Iowa School Nurses may request information, advice, share news, initiatives and receive news. School nurses joining the list will add their address to online school nurse mailing list and may send messages to all members at any time. When messages are posted, message automatically goes to everyone on the list. To join the mailing list, send a blank to: Join-iowasn@lists.ed.iowa.gov iowasn@lists.ed.iowa.gov To cancel the mailing list send a blank to: leave-iowasn@lists.ed.iowa.gov To send a message to other school nurses on the list, type title in subject, message in the body, and send to: iowasn@lists.ed.iowa.gov No other commands are necessary and joining is free. School Nurses on the list request nurses asking questions to summarize marize responses received & post the summary on the list.

33 School Leader Update 854/1006/ August issue: Lead and Dental Screening Common registration issues Attendance issues Medicaid

34 Dates to Note August 21- Bully/Harassment ICN, 1pm-3pm August 25- Iowa Citizens Summit Summit-Childhood Obesity October 10- School Nurse Workshop, IWCC November University of Iowa, School Nurse Conference, West Des Moines

35 Charlotte Burt Consultant Iowa Department of Education 400 E 14 th Street Des Moines IA charlotte.burt@iowa.gov

36 PowerPoint Presentations Medicaid and School Nursing ICN session PowerPoints posted at /iowa_database/even t-detail.cfm?id=8110

37 School Nurse SPR 282 Iowa Administrative Code (11), paragraph b b. Requirements for a statement of professional recognition (SPR) for school nurses. If a person has passed the registered nurses examination and is licensed by the Iowa board of nursing, the person may obtain a statement of professional recognition (SPR) from the board of educational examiners. (1) An applicant will be issued an SPR if the applicant: 1. Has passed the registered nurses examination, is licensed by the Iowa board of nursing and has a baccalaureate degree. 2. While employed by an accredited K-12 school district, maintains licensure with the Iowa board of nursing. (2) Renewal requirements for the SPR are as follows: 1. The applicant must apply for renewal every five years. 2. The applicant must maintain continual licensure with the Iowa board of nursing. 3. The applicant must complete continuing education as required by the Iowa board of nursing. (3) The school nurse SPR shall be valid for five years. (4) All fees are nonrefundable. The fee for issuance of the SPR certificate shall be the same as for a standard license. (5) The holder of an SPR is authorized to promote the health and safety of the students in an accredited school district, including providing medical treatment as allowed under the authority granted by virtue of holding a license from the Iowa board of nursing. (6) A school district may require an SPR, but the board of educational examiners does not require an SPR for nurses working in a school district.

38 Iowa Board of Educational Examiners (BOEE) or Select Statement of Professional Recognition School Nurse

39 9/13 the State Board of Education will be asked to amend subrule 281 IAC 12.4(12) : 12.4(12) Nurses. Each The board that employs of each school district shall employ a school nurse,, and shall require a current license to be filed with the superintendent or other designated administrator as specified in subrule 12.4(10). This will conform to section 4 of SF 277, which adds nurses back into the Code, for districts. The only accreditation issue is that the district must "have" a school nurse, so that's all the rule can say. means omit