2008/2009School Nurse Needs

Assessment

Office of Healthy Schools

WVDE

Coordinated School Health Program/Model

Definition of School Nursing: "School nursing is a specialized practice of professional nursing that advances the well being, academic success, and life-long achievement of students.  To that end, school nurses facilitate positive student responses to normal development; promote health and safety; intervene with actual and potential health problems; provide case management services and actively collaborate with others to build student and family capacity for adaptation, self management, self advocacy and learning."

Staffing

• Recommended Ratio by NASN: 1:750 for regular education students 1:225 for students requiring daily school nursing services

and interventions 1:125 for students with complex health care needs

• WV Code §18-5-22: 1:1500 for students in grades K-7

• SB 53 1:1500 for students in grades Pre-K-12 in 18 counties

receiving funding (funding decreases 20% per year from 2008 until zero since approval of new School Funding Formula)

5

2

1

7

8

4

MonroeWyoming

Summers

McDowellMercer

Raleigh

113

7

8

3

3

Boone

ClayPutnam

Kanawha1

6

833

Lincoln

Mason

Mingo

Wayne

Logan

Cabell

2

36

5

8

5

Hancock

Brooke

Ohio

Marshall

Wetzel

4

4.67

6

3

Berkeley

Grant

HampshireMineral

Morgan

Pendleton

Hardy

Jefferson

2

1

1

3

145.22

6

`

Fayette

Greenbrier

Nicholas Pocahontas

Webster

Braxton

1

5

3

3

2

4

Wirt1

Jackson

Roane

Wood

Pleasants

Calhoun

Ritchie

Tyler

1

1

12

6.50

19.50

Gilmer1

Harrison

Barbour

Marion

Monongalia

Preston

Randolph

Taylor

Tucker

Upshur

Doddridge

Lewis 1

2

2

3

3

5

1

2

9

7.25

8

6

#

#

Number of Certified School Nurses provided through Education

School-Based Health Centers serving one or more schools

The Regional Education Service Agency (RESA)

1

2

3

2008/2009WEST VIRGINIA

Distribution of School Nurses and

School Based Health Centers

2

Number of School Nurses according to the 2008/09 School

Nurse Needs Assessment

WV State Board of Education

School Health Policies • Policy 2422.7, Standards for Basic and Specialized Health

Care Procedures plus accompanying BSHCP Manual(Care Plans and management of all specialized health procedures by certified school nurse)

• Policy 2422.8, Medication Administration (Prescribed and OTC)

• Policy 2423, Communicable Disease (Immunizations, education and protocol regarding communicable

diseases)

Screening Services

• Immunizations

• Hearing

• Vision

• Growth & Development

• Height/Weight

• Blood Pressure

• Other Conditions

2008/09Student Screenings

20815 22582

34417

24281

25091

6763

68420

5735

58343

96027

2008/09 Student Screenings

Blood Pressure

Dental

Ht/Wt

Body Mass Index

Hearing

Scoliosis

Vision

Cholesterol

Lice

Immunizations

Number of Students Screened in 2008/09

Incorporating collaborative efforts with Community and Local Health Care Providers

through parent approved sharing of health information

HealthCheck includes: Comprehensive health and developmental history Comprehensive physical examination Age appropriate immunizations Labs as recommended from well child visit Developmental screening including speech and language Vision and hearing screening Dental screening

Case Management

The certified school nurse’s role includes major responsibility for students with medical or other health problems. School nurses delegate, train, monitor and supervise school personnel performing health care procedures. The school nurse reviews provider orders, ensures medication dosage levels are accurate, monitors side-effects, assesses daily health and chronic disease status of students, documents, communicates with community medical providers and educates students, parents, staff and the community in health promotion. These actions do not describe the complete role of the school nurse but enable us to see the complexity especially when dealing with extremely high student ratios along with 15-20% needing specialized health care.

Nursing/Health Care Procedures

Children needing management of chronic health care conditions attend WV schools daily. Several students require school nursing services in combination with home visits to support and sustain their school attendance.

Specialized Health Care Procedures

Specialized health care procedures range from administration of an oral medication to inhalation therapy, blood glucose monitoring and suctioning for students who need tracheotomy care. In some cases, more than one procedure is provided for an individual student.

Medication

School nurses are facing a crisis regarding how medications administered to students at school are going to be done legally and safely. Emergency medications require higher skill levels and less delegation, at times. The ability to monitor for side effects and low/high dosage levels are skilled assessments needing a certified school nurse.

Epilepsy/Seizures

Epilepsy affects about 2.7 million Americans, results in an estimated annual cost of $15.5 billion in medical costs and lost or reduced earnings and production. People of all ages are affected, but particularly the very young and elderly. About 10% of Americans will experience a seizure sometime during their lifetime and about 3% will have had a diagnosis of epilepsy by age 80.

(CDC, 2006)

2006/07 and 2008/09Epilepsy/Seizures Comparison

Attention Deficit Hyperactivity Disorder

(ADHD)

• Most commonly diagnosed childhood behavior disorder

• Affects 3 to 5 percent of school-aged children

• Core symptoms = lack of attention & concentration and

a high level of activity/distractibility/impulsivity

2006/07 and 2008/09ADD/ADHD Comparison

DiabetesDiabetes is a disease in which the body does not

produce or properly use insulin. Insulin is a hormone that is needed to convert sugar, starches and other food into energy needed for daily life. The cause of diabetes is a mystery, although both genetics and environmental factors such as obesity and lack of exercise appear to play roles. There are two major types of diabetes:

                                                

Diabetes Type 1 - A disease in which the body does not produce

any insulin, most often occurring in children and young adults. People with Type 1 diabetes must take insulin injections daily to stay alive. Type 1 diabetes accounts for 5 to 10 percent of diabetes. The administration of insulin CANNOT be delegate to WV school personnel due to its complexity. A potential error in the administration of insulin can lead to severe complications or

even the DEATH of a student.

2006/07 and 2008/09 Diabetes Type I Comparison

Diabetes Type 2 - A metabolic disorder resulting from the

body's inability to make enough, or properly use, insulin. It is the most common form of the disease. Type 2 diabetes accounts for 90 to 95 percent of diabetes. Type 2 diabetes is nearing epidemic proportions, due to an increased number of older Americans, and a greater prevalence of obesity and sedentary lifestyles.

2006/07 and 2008/09 Diabetes Type II Comparison

Asthma• The most common serious childhood disease

• Is the most common cause of missed school days

• Cause of more than 3 million physicians visits in U.S. yearly

• Over 13,000 reported cases in WV schools last year

2006/07 and 2008/09Asthma Comparison

ConclusionThe number of students with chronic health conditions require schools to provide even more complex health care, necessitates a careful look at the numbers of nurses who provide daily care to our WV public school students. The health services provided by certified school nurses in WV are essential, not only to the health, safety and educational progress of students, but also to the academic mission and school climate of schools.

Rebecca King

Coordinator

rjking@access.k12.wv.us

304-558-8830

Office of Healthy Schools Website

http://wvde.state.wv.us/osshp/main/