Teresa DuChateau, DNP, RN, CPNP
May 11, 2016
Happy School Nurse Day!
No more Band-Aids and Boo Boos!
Although I understand why people use graphics, such as Band-Aids and “boo boos” to illustrate the role of a school nurse, I feel it doesn’t provide a true representation of the complex role of the school nurse and actually does a disservice to school nurses.
This type of graphic is frequently used to illustrate the role of a school nurse. Although loving, this photo portrays the school nurse as a pediatric healthcare provider responding to minor injuries that occur in school; putting a Band-Aid on a boo boo. A school nurse is so much more!
Unfortunately, it is difficult to find a graphic that accurately illustrates the role of a school nurse. For example, it is difficult to visually represent one nurse with a patient load of 5,000 children. Although this sounds unrealistic, it is a reality for many school nurses. The school nurse doesn’t have the same role as an acute care nurse working in a hospital or clinic, they are not assessing 5,000 patients during their shift, but they are prepared to respond to the health needs of any one of those 5,000 children.
The school nurse has developed care plans for students who have a chronic health condition, such as epilepsy, diabetes, asthma, and sickle cell and trained hundreds of school staff to care for these students and respond to a medical emergency.
The school nurse triages telephone calls from unlicensed school staff in multiple schools throughout the district and uses critical thinking skills to assess the patient using someone else’s eyes. This school nurse develops a plan of care for the student and communicates the plan effectively so others have the needed knowledge to carry out the plan.
The school nurse advocates for the needs of students and ensures that students with health concerns are receiving the educational accommodations that are needed. The school nurse speaks up when student safety is in jeopardy and doesn’t back down until a safe plan of care is implemented.
The school nurse facilitates the development of a district and school level emergency management response plan that includes the health needs of students with life threatening and chronic conditions. The school nurse monitors federal and state policy to ensure that the district is providing the appropriate health services. School nurses research trends in student and staff illness complaints and watch for signs of communicable diseases.
We need to stop using Band-Aids to promote the role of the school nurse.
And start using a SUPER HERO cape! 
Teresa DuChateau, DNP, RN, CPNP
March 19, 2016
Reconnect to Public Health Roots For Support and
to Impact Student and Public Health Policy
The first full week of April is known as National Public Health Week, a week where communities recognize the contributions of public health workers. School nurses are essential members of the public health infrastructure but being isolated within the walls of a school, school nurses often lose sight of their public health roots. Re-engaging with public health professionals would not only provide school nurses with increased professional support but could also have a significant impact on public and school health policy initiatives.
Research indicates that education is the strongest predictor of long-term health (Alliance for Excellent Education, 2006, Freudenberg and Ruglis, 2007) which has led public health leaders to position school dropout as a priority health issue (U.S. Department of Health and Human Services, 2016). Many of the conditions that influence attendance, behavior and academic performance are associated with whether or not students are healthy. “Unmet physical, mental, and emotional health issues — including asthma, vision deficiencies, hunger, pregnancy, repeated exposure to traumatic stress such as violence and other poverty-generated factors — will affect a student’s ability to succeed academically” (Wright, 2013). School nurses have the education and knowledge needed to identify children at risk of dropping out of school due to physical or mental health concerns. School nurses can work with other school staff to assess the needs of the child and their family and develop a plan to support the student in reaching their academic goals. Charles Basch (2011) states, “by systematically addressing educationally relevant health disparities, schools can reduce both educational and health disparities” (p. 594).
But schools can’t do it alone. School nurses should remember to reach outside the school walls and partner with other public health workers to provide “school based interventions such as coordinated school health programs; health clinics; mental health programs; substance abuse prevention and treatment programs; comprehensive sex education, human immunodeficiency virus infection prevention, and pregnancy prevention programs; special services for pregnant and parenting teens; violence prevention programs; and interventions to change the schools’ social climate” (Freudenberg and Ruglis, 2007, p.3). Schools can join forces with local public health officials to create sustainable partnerships with shared resources. These collaborative relationships can evolve to partnerships where information and data are shared to develop student health interventions (Chiang, Meagher, and Slade, 2015). With the integration of public health and educational resources, more rigorous evaluations can be conducted to determine the impact of these interventions on student health and academic success.
School nurses who have yet to develop a relationship with public health entities within their community can initiate a partnership by gathering with public health officials to identify and discuss mutual student health priorities (Blank, 2015). “The alignment, integration, and collaboration across health and education sectors hold the potential for greater efficiency, reduced resource consumption, and improved outcomes for both sectors” (Chiang, Meagher, Slade, 2015, p. 775). A valuable resource in Wisconsin is the Assessing and Improving Community Health in Wisconsin website. This website is supported by Wisconsin Partnership Program, University of Wisconsin School of Medicine and Public Health. Local health departments and non-profit hospitals in Wisconsin have identified eight key health improvement areas and picked priority areas for action. They include:
- Access to Care
- Excessive Alcohol Consumption (Alcohol)
- Prescription and Illicit Drug Abuse (Drug Abuse)
- Mental Health Needs/Issues (Mental Health)
- Nutrition
- Obesity
- Physical Activity
- Tobacco Use
School nurses can utilize the website to identify which health issues have been identified as a priority in their county.
For example, Drug Abuse (Prescription and Illicit Drug Abuse) was identified as a priority by 43 health departments and 53 Wisconsin hospitals. Columbia County Division of Health has developed objectives that they are looking to implement in local schools. This provides a prime opportunity to collaborate on addressing youth drug abuse while also evaluating other areas for collaboration.
With the creation of these collaborative relationships, educators and public health professionals, including school nurses, can work together to ensure the adoption and implementation of policies that have a positive impact on student health and academic achievement.
References
Alliance for Excellent Education. (2006). Healthier and Wealthier: Decreasing Health Care Costs by Increasing Educational Attainment. Available at: http://www.all4ed.org/publication_material/healthier_wealthier2006 Accessed March 17, 2016
Blank, M.J. (2015). Building Sustainable Health and Education Partnerships: Stories from Local Communities. Journal of School Health, 85(11), 810-816.
Chiang, R.J., Meagher, W., Slade, S. (2015). How the Whole School, Whole Community, Whole Child Model Works: Creating Greater Alignment, Integration, and Collaboration Between Health and Education. Journal of School Health, 85, 775-784.
Columbia County Division of Health. (n.d.). Drug Abuse. Available at: http://www.improvingwihealth.org/implementation.php?organization=L12&priority=6
Freudenberg N, Ruglis J. (2007). Reframing School Dropout as a Public Health Issue. Preventing Chronic Disease, 4(4), 1-11. Available at: http://www.cdc.gov/pcd/issues/2007/oct/07_0063.htm Accessed March 17, 2016
U.S. Department of Health and Human Services. (2016). Healthy People.gov. Social Determinants of Health. Available at: https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-of-health/objectives Accessed March 19, 2016
UW Population Health Institute. (n.d.) Assessing and Improving Community Health in Wisconsin. Available at: http://www.improvingwihealth.org/about-the-project.php
Wright, T.D. (2013). Center for School, Health, and Education at the American Public Health Association. Available at: https://www.apha.org/~/media/files/pdf/topics/school/graduation_is_public_health_roi.ashx
February 25, 2016
Teresa DuChateau, DNP, RN, CPNP
Transition Planning for Children with Chronic Health Conditions
Scroll through a school district website and you are likely to find a mission statement that includes a pledge to assist children in developing their full potential and become responsible, respectful, productive citizens. I have read school mission statements that state, “All students will graduate College and Career Ready” and the school will provide learning opportunities to “to prepare our students to work and live in an increasingly diverse and global society.” The National School Boards Association (2016) states, “all children should have equal access to an education that maximizes his or her individual potential.”
I will be the first to admit that I am no expert in Common Core and its standards but I do know enough to understand that Common Core is a polarized topic. In the United States we have become very focused on testing what children know and ensuring that they have mastered the skill by a specific grade level. The Common Core website states that Common Core is “a set of clear college- and career-ready standards for kindergarten through 12th grade in English language arts/literacy and mathematics” (Common Core Initiative, 2016). The Common Core Initiative (2016) goes on to state that, “Promoting a culture of high expectations for all students is a fundamental goal of the Common Core State Standards.” With this intense focus on English language arts/literacy and mathematics, how has our focus on assisting children in mastering basic life skills shifted? More specifically, how are we supporting children with chronic conditions in our schools?
Studies suggest that as many as 1 out of 4 children in the U.S., or 15 to 18 million children age 17 years and younger, suffer from a chronic health condition (Van Cleave et al., 2010; van der Lee et al., 2007). How do schools address the challenges these children will face as adults? How are we preparing children with chronic health conditions to manage their health so they can succeed in college and the job force?
This is not an essay to bash the Common Core or public schools. Schools are trying to achieve the almost impossible, preparing EVERY child to succeed beyond high school. Schools lack the necessary resources to provide children with the support they need. In the United States we have pledged, with the reauthorized Individuals with Disabilities Education Act (IDEA), to provide transition services for children who have an Individual Education Plan. These transition plans should include “instruction, related services, community experiences, the development of employment and other post-school adult living objectives, and, if appropriate, acquisition of daily living skills and functional vocational evaluation” (U.S. Department of Education, Office of Special Education Programs, 2007). Additionally, Common Core Initiative (2006) states that students with disabilities (which include some children with a chronic health condition) should have, “teachers and specialized instructional support personnel who are prepared and qualified to deliver high-quality, evidence-based, individualized instruction and support services.” Who is more prepared than a school nurse to assist children in understanding their chronic condition and providing the support and education to gain the skills and knowledge to manage their chronic condition now and when they enter adulthood? But where are the school nurses? According to the National Association of School Nurses (2012), only 45 percent of public schools have a full-time nurse available to students and another 30 percent of schools only have a part-time nurse.
The NURSE Act (Nurses for Under-Resourced Schools Everywhere), introduced by Montana Senator Jon Tester, “will allow schools or state agencies to apply for federal grants to reduce the cost of hiring a nurse” (Tester, 2016). The NURSE Act will assist school nurses in fulfilling their mission to ensure that every student is healthy, safe, and ready to learn. The NURSE Act helps already strapped schools, achieve their mission of supporting ALL children achieve their fullest potential. The increased funding for school nurses has the potential to provide “specialized instructional support” to students with chronic conditions. As Eric Feaver, President of MEA-MFT states, “School nurses are educators, too,” (Tester, 2016). I applaud Senator Tester’s advocacy for student health and I encourage other national leaders to join in supporting the NURSE Act.
References:
Common Core State Standards Initiative. (2016). Application to Students with Disabilities.Available at: http://www.corestandards.org/wp-content/uploads/Application-to-Students-with-Disabilities-again-for-merge1.pdf
National Association of School Nurses. (2012). The Case for School Nursing. Available at: https://www.nasn.org/portals/0/about/The_Case_for_School_Nursing.pdf
National School Boards Association. (2016). About Us. Available at: https://www.nsba.org/about-us Accessed: February 25, 2016.
Tester, J. (2016). Tester Introduces Bill to Improve Student Health. Available at: http://www.tester.senate.gov/?p=press_release&id=4368 Accessed: February, 25, 2016).
Van Cleave. J., Gortmaker, S.L., Perrin, J.M. (2010). Dynamics of Obesity and Chronic Health Conditions Among Children and Youth. JAMA, 303, p. 623–630.
van der Lee, J.H., Mokkink, L.B., Grootenhuis, M.A., Heymans, H.S.A., Offringa, M. (2007). Definitions and Measurement of Chronic Health Conditions in Childhood. JAMA,297, p. 2741–2751.
U.S. Department of Education, Office of Special Education Programs, 2007. Topic: Secondary Transition. Available at: http://idea.ed.gov/explore/view/p/,root,dynamic,TopicalBrief,17, Accessed: February 25, 2016.