3/26/2015. State and National School Nursing Overview Ann Nichols RN, MSN, NCSN State School Health Nurse Consultant

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1 State and National School Nursing Overview Ann Nichols RN, MSN, NCSN State School Health Nurse Consultant School Health in NC: Public Health and Education Clinical Health - DPH Consultation and Technical Assistance Role Role in Provision of Clinical Health Services in Schools Guidance for Best Practice and Addressing Health Related Requirements Example: Assistance with your Medication Policy Educational Health School Health Curriculum Employee and Environmental Health Guidance Special Education and Children Qualified for Health Related Reasons Example: Graduation requirements you put in place related to health classes Things We Will Discuss Today Authority and Resources for School Nursing Practice Current Public School Health Requirements to Consider Immunization Changes for School Year Stand Up Data Collection Project Using the Regional School Health Nurse Consultant 1

2 Authority and Resources for School Nursing Practice What is Nursing? Nursing is a dynamic discipline which includes the assessing, caring, counseling, teaching, referring and implementing of prescribed treatment in the maintenance of health, prevention and management of illness, injury, disability or the achievement of a dignified death. It is ministering to, assisting, and sustained, vigilant, and continuous care of those acutely or chronically ill; supervising patients during convalescence and rehabilitation; the supportive and restorative care given to maintain the optimum health level of individuals, groups, and communities; the supervision, teaching, and evaluation of those who perform or are preparing to perform these functions; and the administration of nursing programs and nursing services NC BON What is Nursing? An independent practice profession that operates according to the laws and rules of the state of North Carolina in providing best practice guided care through collaboration with other professions and application of recognized standards. 2

3 Challenges of School Nursing School nurses work in relative isolation. School nurses must know about health care needs for all types of diagnoses and all ages. School nurses have no consistent, built in structure to support their individual practice. School nurses serve a large number of clients that exceed normal standards of practice. Role of the Nurse Nursing Practice is Governed by: North Carolina Board of Nursing ( 21 NCAC Professional Standards National Association of School Nurses NC School Health Program Manual Other professional organizations Policies and Procedures of Your School Role of the School Nurse National Association of School Nurses (NASN) School Nurse Association of NC American Academy of Pediatrics trics;121/5/1052.pdf North Carolina guidance from DHHS and DPI Individual job description 3

4 NASN School Nurse Roles Direct care to students & staff Leadership for health services program Screening & referral for health conditions Promotion of healthy school environment Promotion of individual health Leadership for health policies & programs Liaison between school, family, community, and health care providers The School Nurse Should be an RN -Independent practice is outside of the NC Scope of Practice for an LPN (NC BON) -LPN works with direction and oversight of the RN -Use of the term nurse is prohibited for unlicensed people Specialty Certification is the Recognized Standard Professional Certification provides an ongoing, quality credentialing process. Certification assures a national standard of preparation, knowledge, and practice. Standard in NC since required by NC DPI within three years of employment for public school nurses and all state funded school nurse positions. 4

5 NC Educational System Structure Local Education Agency (LEA) Central Office Site-based management Relationship to NC DPI Charter Schools 115C F. General requirements. (a) Health and Safety Standards. A charter school shall meet the same health and safety requirements required of a local school administrative unit. Independent Schools Home Schools Training to Help New School Nurse Orientation on line self-paced modules for 3.5 hours of credit; contact your regional consultant School Nurse Roles and Responsibilities new for next school year Annual NC School Nurse Conference October 15/16 at the Koury Convention Center, Greensboro School Nurse Certification Review Course offered fall and winter in different locations NASN Independent School Nurse Conference SNANC Regional Meetings AHEC trainings in your area Current Public School Health Requirements to Consider These are not required for independent schools but set a school standard in NC. 5

6 Selected Public School Requirements Senate Bill 744 / S.L Epinephrine Autoinjectors 115C Possession and self-administration of asthma medication by students with asthma or students subject to anaphylactic reactions, or both. SESSION LAW SENATE BILL 911 Diabetes Care SESSION LAW SENATE BILL 911 Diabetes Care NC School Health Program Manual Appendix Requires for public and charter schools: 115C Possession and selfadministration of asthma medication by students with asthma or students subject to anaphylactic reactions, or both. NC School Health Program Manual E2-9 Needs: - Written medical provider order Student has been instructed Student demonstrated necessary skill level - Written parental request and authorization -School nurse review and verification Student skill level Student maturity Student contract agreement 6

7 Senate Bill 744 / S.L Epinephrine Auto-injectors In public schools specifies the presence of at least two, who does the training, and what types of events are covered. Does not cover the student with individual orders. Is nota standing order. Generalized epinephrine can only be provided in independent schools via a standing order or the Medical Care Commission Credentialing Process (NC SHPM Appendix, Item 2) Use Caution with Standing Orders Standing Orders, Continued 7

8 Immunizations Immunizations School Year Changes Effective July 1, 2015 Some rules are changes to existing vaccine requirements and some are new vaccine requirements Students entering for the remainder of this school year are not subject to these changes Immunization Changes to Existing Requirements Old Polio vaccine four doses; exceptions existed related to 4 th dose and the 4 th birthday Polio vaccine New: 7/1/2015 the booster (4 th ) dose is requiredon or after the 4 th birthday and before entering school for the first time. Varicella vaccine no second dose requirement and parental reporting of disease allowed Varicella vaccine 2 doses administered at least 28 days apart A second dose is required before entering school for the first time. Documentation of disease must be from a physician, nurse practitioner, or physician s assistant verifying history of varicella disease. Documentation must include the name of the individual with history of disease, approximate date or age of infection and a healthcare provider signature. 8

9 Immunization Changes to Existing Requirements Old Tetanus, diphtheria, and pertussis (whooping cough) Tdap A booster dose of Tdapis required for individuals who have not previously received Tdapand who are entering 6 th grade or by 12 years of age, whichever comes first. Compliance checked in 6 th grade. New: 7/1/2015 Tetanus, diphtheria, and pertussis (whooping cough) Tdap A booster dose of Tdapis required for individuals who have not previously received Tdapand who are entering 7 th grade or by 12 years of age, whichever comes first. Compliance checked in 7 th grade. New Immunization Requirements Pneumococcal conjugate vaccine (PCV) 4 doses by 15 months of age The number of vaccine doses required depends on the age of the child when the vaccine series began. No individual 5 years of age or older is required to receive PCV. Meningococcal conjugate vaccine (MCV) 2 doses One dose for individuals is required entering the 7 th grade or by 12 years of age whichever comes first. Booster dose for individuals is required entering the 12 th grade or 17 years of age beginning August 1, If the first dose is administered on or after the 16 th birthday the booster dose is not required. Simultaneous administration of Tdapand MCV vaccines is allowed at the year old recommendation. Compliance checking is grade level dependent Immunization Resources s.htm Materials and outreach documents for all requirements available for download and for ordering. 9

10 Stand Up Data Collection Project Stand Up and Be Counted Collaborative project between the National Association of School Nurses (NASN) and the National Association of State School Nurse Consultants (NASSNC). Develop a national school nursing data set that describes the schools where we work, the school community we care for, the nature of our practice, and outcomes of our care. All school nurses, in every setting and any employer, are included in the set. The data set will not include everything a school nurse does; it is a MINIMUM data set-the same points collected in the same way. Stand Up and be Counted Step 1 Identify and define the variables that will make up the uniform data set a process which NASSNC and NASN have been collaborating on all year. Step 2 Identify how to actually collect standardized data across the nation. The school year is the first effort at collecting a small number of data points that have a standardized definition. As we collect these data, we test a variety of methods to collect, aggregate and report the data at the state and national level. 10

11 Project Data Points Six related to school health staffing: numbers of RNs, etc. Six related to student chronic health conditions: diabetes, etc. Three related to health office visits: where do students go when they see a school nurse? Stand Up Project LEA school nurses are participating via the normal NC School Health Services Report forms (EOY Report) Independent school nurses can participate and should contact Cheryl Blake, cblake@tsdch.org, for assistance Charter school nurses can participate and should contact Ann.Nichols@dhhs.nc.gov for assistance The data will be used at the state and national level to demonstrate the value of school health services led by a professional school nurse. 11

12 FAQs to Regional Consultants Some questions that come in are related to a common, well developed guidance topic. Example delegation of a procedure to an unlicensed person Some questions that come in are new; a new practice, medication, etc. Example reinsertion of g-tubes when displaced at school 12

13 Assistance is available through the school health nurse consultant team. School Health Nurse Consultants North Carolina Division of Public Health State School Nurse Consultant Ann Nichols Mail Address: 1928 Mail Service Center Raleigh, NC Physical address: 5601 Six Forks Road Raleigh, NC : FAX: : Mitchell Graham Cherokee Clay Swain Macon W: West Region Kristin Wike Haywood Jackson Madison rd Ave. SW Taylorsville, NC Buncombe Transylvania Kristin.Wike@dhhs.nc.gov Yancey Henderson McDowell Avery Burke Ashe Watauga Caldwell NW: Northwest Region Amy Quesinberry 127 Westwood Drive Mt. Airy, NC FAX: Amy.Quesinberry@dhhs.nc.gov Alleghany Wilkes Alexander Catawba Iredell SW: Southwest Region Lucy Heffelfinger 1113 Loblolly Lane Newton, NC Surry Yadkin Forsyth Davie Davidson Rowan Rutherford Lincoln Cabarrus Polk Cleveland Gaston Stanly Mecklenburg Union Stokes Anson FAX Lucy.Heffelfinger@dhhs.nc.gov Rockingham Caswell Guilford Randolph Montgomery Moore Richmond Alamance Orange Durham Chatham Scotland Lee Hoke C: Central Region Sonya Dunn 366 Coleridge Road Siler City, NC FAX: Sonya.Dunn@dhhs.nc.gov Person Harnett Cumberland Robeson Vance Granville Warren Wake Bladen Columbus Franklin Johnston Sampson Brunswick Nash Wilson Wayne Duplin Pender Halifax Greene Lenoir New Hanove Northampton Edgecombe Pitt Jones Onslow NE: Northeast Region Casey Spear 1106 Soundside Rd. Edenton, NC FAX: Casey.Spear@dhhs.nc.gov Hertford Bertie Martin Craven Gates Beaufort Pamlico Carteret Tyrrell Washington Hyde Currituck SE: Southeast Region Amy Levy 6225 Falkland Court Fayetteville, NC Amy.Levy@dhhs.nc.gov Dare 4/2014 N.C. Division of Public Health Children & Youth Branch School Health Unit How can you be assured that the assistance you receive is consistent with requirements, statute and best practice? 13

14 FAQ Guidance Process - Consensus New question comes to a consultant Receiving consultant submits question to team for input Receiving consultant researches question Team reviews information, determines other sources needed Summary guidance is developed through use of all resources and team discussion New consensus guidance is then used by all consultants when a related question is received Sample FAQs This Year (other than epinephrine) Intranasal Versed Parental adjustments to diabetes care plans AEDs Pulse oximetry School health services on out of state field trips State and National School Nursing Topics What questions do you have? 14