Oregon Department of Education Rob Saxton, Deputy Superintendent 2013 Annual School Nurse Report

Transcription

1 Oregon Department of Education Rob Saxton, Deputy Superintendent 2013 Annual Nurse Report This report was amended on April 21, 2014 to correct the number of certified nurses on page 3 to and to remove the language that defined a school nurse as a subset of registered nurse to align with district reporting. Sarah Drinkwater, Assistant Superintendent Leslie Currin, State Nurse

2 Executive Summary Many Oregon students arrive at school with health conditions that influence the student s ability to access and benefit from the education provided. nurses help to meet the needs of such students. Oregon law sets forth 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) Oregon law also directs the Oregon Department of Education to report to interim legislative committees information regarding the availability of licensed practical nurses, registered nurses and school nurses in each school district and the number of medically complex, medically fragile, and nursing dependent students in each school district. The report is due October 1 of each year and covers the prior school year. Year Nurse Availability # of s Reported Year Reported (total combined ) Ratio , :2, , :1,823 Data submitted by school districts during the annual collection 414, Data solicited from districts by phone 149, Total 563, :2,128 The ratio of nurses to students, in districts reporting data for the school year is 1:2,128 1

3 s in Need of Nursing Care Year # of Year # of # of Nursing Complex s Fragile s Dependent s ,073 1, ,705 3, Data submitted by school districts during the annual collection 14,717 2, Data solicited from districts by phone 2, Total 17,489 2, The complete 2013 Fragile Data Collection Report is available at: 2

4 in Oregon and s with Certain Medical Impairments (House Bill 2693, 2009) Background Many Oregon students arrive at school with existing health conditions that influence the student s ability to access and benefit from the education provided. In order to best assist these students to complete and excel in their educational efforts, it is vital that health care needs within the school program be addressed and met. The data presented in this report 1 is an effort to reflect more accurately the actual health needs of Oregon students and the overall numbers of students who have health care needs in Oregon schools. It also presents data on the number of school nurses who provide this care in the Oregon public school setting. Who is Providing Health Care in s? Health care in schools is provided by nurses licensed to practice in the state by the Oregon State Board of Nursing. Under Oregon law, must be supervised by. The number LPNs who work in schools is considerably fewer than the number of registered nurses. According to the Oregon State Board of Nursing, Oregon has 50,466 and only 4,679, statewide. 2 As defined by ORS , a school nurse means a registered nurse who is certified by the Teacher Standards and Practices Commission as qualified to conduct and coordinate the health services programs of a school. The TSPC issues a certificate to those who meet the requirements promulgated by the commission for school nurses, though there is no state requirement that schools/school districts employ TSPC certified school nurses (ORS ). To be eligible for a school nurse certification, the individual must hold a current registered nurse license issued by the Oregon State Board of Nursing and must successfully complete 30 clock hours, three quarter hours, or two semester hours of specified coursework that includes school health policies, issues, and funding; school law and legal responsibilities of school nurses; the nursing process in the school setting; schools and society; mental health and counseling concepts; the exceptional child characteristics (disabled, gifted, learning disabled); physical and developmental assessment of the school-age child; the role and responsibilities of the school nurse; human growth, development, and learning; diversity; and school emergencies. 3 There are certified school nurses in Oregon. 4 1 Some, but not all, of these conditions may also be reflected in state data on Special Education. 2 Retrieved 9/30/ OAR NOTE: Oregon universities do not offer this coursework; nurses must attend schools in other states, generally Washington or California. 3

5 Oregon law 5 allows school districts to train non-health professionals to meet the needs of medically complex students and students without identified medical needs. The vast majority of this training is provided by licensed nurses; thus, one nurse, working for a district, may delegate and training nonlicensed school staff in tasks of nursing. have the authority to perform this delegation and training under Division 47 of the Oregon Nurse Practice Act. These personnel are not reported to the Oregon Department of Education and therefore, ODE staff does not know how many non-medically licensed school district staff are used to meet this standard. As a result, the reported ratios may be misleading. Oregon Law In addition to laws setting forth the requirements for nurses, Oregon law sets forth a nurse to student staffing ratio (ORS ). 6 (2) Each school district shall ensure that the district has access to a sufficient level of nursing services to provide: (a) One registered nurse or school nurse for every 225 medically complex students. (b) One registered nurse or school nurse for every 125 medically fragile students. (c) One registered nurse or school nurse, or one licensed practical nurse under the supervision of a registered nurse or school nurse, for each nursing-dependent student. (3) In addition to the requirements of subsection (2) of this section, each school district is encouraged to have one registered nurse or school nurse for every 750 students in the school district. (4) (a) A school district may satisfy the requirements of subsection (2) of this section by using the most cost-effective means available. (b) A school district may satisfy the requirements described in subsection (2)(a) of this section and the recommendations described in subsection (3) of this section by: (A) Providing personnel trained and supervised by a registered nurse or school nurse; and (B) Complying with the requirements of ORS to (5) (a) A registered nurse or school nurse is responsible for coordinating the school nursing services provided to an individual student. The registered nurse or school nurse shall work in partnership with the student s parent or guardian, health care provider and appropriate school staff to the extent allowed by law. (b) Decisions related to when or where a student receives school nursing services must jointly be made by the registered nurse or school nurse, the parent or guardian of the student and any appropriate school staff. This paragraph does not apply to students who have an individualized education program and for whom special education and related services are determined by an individualized education program team. 5 ORS (4)(b)(A) 6 HB 2693 (2009) 4

6 (6) The Department of Education shall submit to the State Board of Education and the interim legislative committees related to education an annual report no later than October 1 of each year that is based on the previous school year and that provides information on: (a) The availability of licensed practical nurses, registered nurses and school nurses in each school district; and (b) The number of medically complex students, medically fragile students and nursing-dependent students in each school district. Sec. 5. For the purpose of fulfilling the recommendations for registered nurses and school nurses in a school district, as described in section 2 (3) and (4)(b) of this 2009 Act [ (3) and (4)(b)], as amended by section 4 of this 2009 Act, school districts are encouraged to provide: (1) One registered nurse or school nurse for every 3,500 students by July 1, (2) One registered nurse or school nurse for every 2,500 students by July 1, (3) One registered nurse or school nurse for every 1,500 students by July 1, (4) One registered nurse or school nurse for every 750 students by July 1, [2009 c.843 5] The annual Nurse Report consists of two sections: Section One: Nurse availability in Oregon Section Two: The number of students with medical impairments (medically complex, medically fragile and nursing dependent) Data Collection districts were asked to submit data May-July 2013 for the previous school year. ODE staff communicated the data request to all districts in a variety of formats. Additionally, training via video conferencing was offered to all districts and posted on the ODE website for later access. By the deadline, ODE had received data from 121 out of 197 school districts in the state. ODE staff followed up with personal phone calls to districts that hadn t submitted by the deadline. Following phone calls, ODE had data on 195 of 197 school districts. Section 1: in Oregon In the 195 districts that reported, there are full-time equivalent () nurses employed who serve students. See district-by-district data in Appendix A. Total enrollment in Oregon schools, according to the Fall Enrollment report for was 563,714 students xls 5

7 The ratio of nurses to students, in districts reporting data for the school year, is 1:2,128. Year # of Enrolled s in Reporting Districts Reported (total combined ) Nurse: Ratio , :2, , :1,823 Data submitted by school districts during the annual collection 414, Data solicited from districts by phone 149, Total 563, :2,128 Understanding that districts may need time to increase the number of school nurses in district schools, House Bill 2693 (2009) provided phased-in targets. s were encouraged to provide the following nurse-to-student ratios: One registered nurse or school nurse for every 3,500 students by July 1, 2014 One registered nurse or school nurse for every 2,500 students by July 1, 2016 One registered nurse or school nurse for every 1,500 students by July 1, 2018 One registered nurse or school nurse for every 750 students by July 1, 2020 Number of Reported in Oregon s Combined Total Category Data Data submitted by solicited Total school from school districts districts by during the phone annual collection ( who meet the further requirements set in place by the Teacher Standards and Practices Commission and may be designated by that Commission as school nurses )

8 Section Two: s with Medical Impairments For purposes of this report, students with medical impairments fall into three categories: medically complex medically fragile nursing dependent NOTE: Some of the data for this report is reflected in the Special Education Child and the Special Education Child Find education health impairments data collection including: Intellectual Disability, Hearing Impairment, Visual Impairment, Deaf-Blindness, Speech or Language Impairment, Emotional Disturbance, Orthopedic Impairment, Traumatic Brain Injury, Autism Spectrum Disorder, Specific Learning Disability, Developmental Delay, and Other Health Impairments. However, IDEA and 504 Health-Eligible students are not the totality of students in Oregon schools who have health impairments which impact their educational access. (e.g. children with asthma) Complex s Oregon law defines medically complex students as those students who may have an unstable health condition and who may require daily professional nursing services. 7 s in this category have health conditions which require a licensed nurse to do an assessment, write a health care plan, and teach tasks of care to non-nurse school staff who are working directly with the student. The nurse has intermittent direct contact with the student, for instance to write a health care plan, address emergent problems, monitor school staff performance of tasks, access new medical orders, and similar tasks. An example of a student in this category would be one who has medically stable epilepsy. The school nurse will access medical orders, assess the student, write a care plan for the student, and teach nonnurse school staff how to recognize and assist the student during student seizure activity. The nurse will also periodically monitor the student during the school year, and intervene if a change is needed in health services provided by the school. In , districts reported 17,489 medically complex students. This is an increase of 4784 students reported as medically complex in Fragile s fragile students are those students who may have a life-threatening health condition and who may require immediate professional nursing services. 8 7 ORS (1) 8 Ibid. 7

9 s in this category have a health condition which requires frequent (often daily) one-on-one intervention by a licensed school nurse. An example of this would be a six-year-old student who is newly diagnosed with diabetes. Nurse intervention is required on a daily basis to check blood status, configure correct insulin doses, and administer insulin. As this student s medical condition becomes more stable, and the student matures, the student s category may change to one which requires less intense school health services. In , districts reported 2497 medically fragile students. This is a decrease of 681 students reported as medically fragile in Nursing-Dependent s Nursing-dependent students are those students who may have an unstable or life-threatening health condition and who may require daily, direct, and continuous professional nursing services. 9 s in this category have health conditions which require the constant, one-on-one attention of a licensed nurse, in order to access their educational program. An example of such a student would be one with an impaired respiratory system, who has a tracheostomy tube and must be frequently suctioned by the attendant nurse. s with this medical condition commonly need suctioning several times during the school day. A licensed nurse usually works one-to-one with these students during the school day, because medical assessment by a licensed nurse is needed each time a student is suctioned. In , districts reported 124 nursing-dependent students. This is an increase of 35 students reported as nursing dependent in # of Nursing # of # of Fragile Year Dependent Complex s s s ,073 1, ,705 3, Data submitted by school districts during the annual collection 14,717 2, Data collected from district by phone 2, Total 17,489 2, Conclusion This data collection remains a relatively new one for schools. The terms, medically complex, medically fragile, and nursing dependent are not used in other laws. During the first year of the collection, there was confusion over which students were encompassed by the terms, and there was 9 Ibid. 8

10 some miscommunication between local district IT data staff and local district school nurses. ODE increased its efforts to clarify the law with districts, and data from the second and third years are more reliable. Anecdotally, ODE believes that many more students are arriving at school with insulin-dependent diabetes and severe allergy reactions than in prior years. Federal IDEA does not include these two health impairments under special education law. However, the US Office of Civil Rights has created guidance for schools on which students qualify for 504 plans 10. s with diabetes and severe allergy reactions are eligible for 504 plans. According to a study last year funded by the Centers for Disease Control and Prevention and the National Institute of Health, the number of children with Type 1 diabetes increased 23 percent nationwide in the past decade. The increase in children with Type 2 diabetes was 21 percent. The Eugene-Register Guard reported that the Bethel District and Springfield District have seen the number of students with Type 1 diabetes double in the past five years. 11 In conclusion, the data reflected in this report is the most comprehensive of the three collection years. As with all such data collections, results depend on response from local district partners. Response for this year comprises over 95% of Oregon s school districts, and reflects a growing understanding of the collection parameters by district staff. 10 The Section 504 regulations require a school district to provide a "free appropriate public education" (FAPE) to each qualified student with a disability who is in the school district's jurisdiction, regardless of the nature or severity of the disability. Under Section 504, FAPE consists of the provision of regular or special education and related aids and services designed to meet the student's individual educational needs as adequately as the needs of nondisabled students are met. 11 More Eugene students diagnosed with Type 1 diabetes. Eugene Register Guard, Sept. 27, Retrieved September 29, Revised HB 2220 page: 9

11 APPENDIX A Fragile Data Collection Districts Reporting Fragile Nursing Dependent Complex Adel SD Adrian SD Alsea SD 7J 0 0 * Amity SD 4J Annex SD Arlington SD Arock SD Ashland SD 5 * Ashwood SD Astoria SD 1 * Athena-Weston SD 29RJ 0 0 * Baker SD 5J * Bandon SD 54 * * * Banks SD Beaverton SD 48J 102 * Bend Lapine Admin SD 1 30 * Bethel SD * * Blachly SD Black Butte - Did not report Brookings-Harbor SD 17C Burnt River SD 30J Butte Falls SD Camas Valley SD 21J * Canby SD 86 0 * Cascade SD 5 * * Centennial SD 28J Central Curry SD

12 APPENDIX A Fragile Data Collection Districts Reporting Fragile Nursing Dependent Complex Central Linn SD * * Central Point SD Central SD 13J 53 * Clatskanie SD 6J 7 * * Colton SD Condon SD 25J Coos Bay SD Coquille SD 8 8 * Corbett SD Corvallis SD 509J 127 * Cove SD 15 * Creswell SD 40 0 * Crook y SD * Crow-Applegate-Lorane SD Culver SD 4 * Dallas SD David Douglas SD * Dayton SD 8 * Dayville SD 16J Diamond SD Double O SD Douglas y SD Drewsey SD Dufur SD Eagle Point SD 9 * Echo SD

13 APPENDIX A Fragile Data Collection Districts Reporting Fragile Nursing Dependent Complex Elgin SD Elkton SD Enterprise SD Estacada SD Eugene SD 4J 15 * Falls City SD * Fern Ridge SD 28J Forest Grove SD * Fossil SD 21J Frenchglen SD Gaston SD 511J * 0 * Gervais SD Gladstone SD 115 * * Glendale SD 77 * 0 * Glide SD 12 * 0 * Grants Pass SD Greater Albany Public SD 8J Gresham-Barlow SD 10J 18 * Harney y SD Harney y SD Harney y Union High SD 1J Harper SD Harrisburg SD 7J * Helix SD * Hermiston SD 8 * * Hillsboro SD 1J 320 *

14 APPENDIX A Fragile Data Collection Districts Reporting Fragile Nursing Dependent Complex Hood River y SD 69 * Huntington SD 16J 0 0 * Imbler SD 11 * 0 * Ione SD R Jefferson SD 14J Jefferson y SD 509J Jewell SD 8 * John Day SD Jordan Valley SD Joseph SD Junction City SD 69 * Juntura SD Klamath y SD Klamath Falls City s Knappa SD La Grande SD 1 * 0 * Lake y SD Lake Oswego SD 7J * * Lebanon Community SD Lincoln y SD Lowell SD Malheur y SD Marcola SD 79J Mapleton SD McKenzie SD McMinnville SD Medford SD 549C

15 APPENDIX A Fragile Data Collection Districts Reporting Fragile Nursing Dependent Complex Milton-Freewater Unified SD 7 * Mitchell SD Molalla River SD 35 * Monroe SD 1J Monument SD Morrow SD 1 * Mt Angel SD 91 * Myrtle Point SD Neah-kah-nie SD * Nestucca Valley SD 101J Newberg SD 29J North Bend SD * North Clackamas SD * North Douglas SD * North Lake SD North Marion SD North Powder SD 8J North Santiam SD 29J * North Wasco y SD Nyssa SD Oakland SD * Oakridge SD Ontario SD 8C 13 * Oregon City SD * Oregon Department of Education Oregon Trail SD

16 APPENDIX A Fragile Data Collection Districts Reporting Fragile Nursing Dependent Complex Paisley SD Parkrose SD 3 * * Pendleton SD 16 * Perrydale SD Philomath SD 17J Phoenix-Talent SD 4 * Pilot Rock SD * Pine Creek SD Pine Eagle SD 61 * 0 * Pinehurst SD Pleasant Hill SD Plush SD Portland SD 1J Port Orford-Langlois SD 2CJ Powers SD Prairie City SD Prospect SD Rainier SD Reedsport SD 105 * * * Redmond SD 2J 64 * Reynolds SD Riddle SD 70 * 0 * Riverdale SD 51J Rogue River SD 35 * Salem-Keizer SD 24J 45 * Santiam Canyon SD 129J Scappoose SD 1J

17 APPENDIX A Fragile Data Collection Districts Reporting Fragile Nursing Dependent Complex Scio SD Seaside SD Sheridan SD 48J 0 * Sherman y SD Sherwood SD 88J 111 * Silver Falls SD 4J Sisters SD 6 * Siuslaw SD 97J South Harney SD South Lane SD 45J South Umpqua SD South Wasco y SD Spray SD Springfield SD 19 * St Helens SD 502 * St Paul SD Stanfield SD Suntex SD Sutherlin SD 130 * Sweet Home SD 31 * Three Rivers/Josephine y SD Tigard-Tualatin SD 23J 445 * Tillamook SD 9 * Troy SD Ukiah SD 80R Umatilla SD 6R *

18 APPENDIX A Fragile Data Collection Districts Reporting Fragile Nursing Dependent Complex Union SD 5 * 0 * Vale SD 84 0 * Vernonia SD 47J * * Wallowa SD Warrenton-Hammond SD West Linn-Wilsonville SD 3J 0 * * Willamina SD 30J Winston-Dillard SD * Woodburn SD Yamhill Carlton SD 1 * * Yoncalla AD * TOTAL 2, , Appendix A includes Fragile Data submitted by districts and data solicited by phone by ODE to complete the Collection. 8