The Role of the School Nurse in
Special Education Jessica Gerdes, MS, BSN, BA, RN, NCSN
Principal Consultant, ISBE Juanita Gryfinski, MS, MA, BSN, RN, NCSN
Department Chair, Health Services, District 303, St. Charles
Special Education Directors’ Conference Aug. 8, 2013
Learning Objectives
• The learner will be able to: – Discuss the impact of health – related disparities on
academic achievement
– Discuss recent state and federal laws related to health care in schools
– Describe the role of school health nurse in regular education (504, RtI) and in special education (IEP) services for students with health conditions
– Describe the best practice guidelines of ISBE related to conducting medical review component of special education , pre and post placement
Health Conditions among school-age
• School nurse role in regular education
• Health conditions among students
Visual problems: ~20% of youth
Asthma: ~14% of youth <18
Teen pregnancy: 1 in 3 teens (in some areas)**
Violence: 28% of adolescents bullied at school
Physical activity: ~2 in 3 don’t get enough
Breakfast: ~20% of youth skip it
Hyperactivity: ~8% of youth 6-17 diagnosed
7 Priority, Educationally Relevant Health Factors
1) Vision
2) Asthma
3) Teen pregnancy
4) Aggression and violence
5) Physical activity
6) Breakfast
7) ADHD
Life Threatening Allergies
• Over 350 EpiPen prescriptions
• 20% unknown LTA reactions 1st time while at school
• Food Free Celebrations
• Principal and School Nurse approval for food in curriculum
Asthma 9.8% of student body
Every Health Risk Makes a Difference
Federal Law, State law and Court Cases
Federal Law
• Section 504 of Rehabilitation Act
• IDEA 2004
• ESEA / NCLB
Court Cases
• Tatro – 1984 • Garrett – 1999
State laws regulating medical professionals
• Laws intended to protect the public safety
• Nurse Practice Act: 225 ILCS 65/50-5’ Section 50.1
– Defines Professional and Practical nursing
– Defines Scope of Work related to each level
– Defines “nursing task” as: – work not requiring nursing knowledge, judgment or decision-making
– Defines “nursing activity” as: – one that is learned due to knowledge acquired through an approved nursing program for licensure
Supervision of Health/Medical Staff
• RN (or MD) supervises and directs activities of LPN (per Nurse Practice Act and Medical Practice Act)
• RN/School Nurse activities do not require additional medical supervision (Nurse Practice Act)
• RN may also supervise other RNs, RNs or LPNs serving as 1:1 nurse, Certified Nursing Assistant (CNA) or school staff (either licensed as teachers, licensed as paraprofessionals, but not health-care licensed personnel, UAP)
• Implications in use of private duty nurse (LEA hired, agency hired)
Illinois statute defining School Nurse
P.A. 90-548, Section 10-22.23 - Dec. 1997 Any school nurse first employed on or after
July 1, 1976, whose duties require teaching or the exercise of instructional judgment or educational evaluation of pupils, must be certificated under Section 21-25 of this Act
School districts may employ non-certificated registered professional nurses to perform professional nursing services.
Illinois statute defining School Nurse (continued)
JCAR Administrative rules, Title 23, chapter 1, Section 1.760 Cont’d
The duty to provide professional nursing services as defined in "The Illinois Nursing Act" shall not be included among the functions assigned to any school district personnel not covered by the job description required for school nurses.
ISBE Role in 504
• Regular education, not special education
• ISBE provides technical assistance to schools, suggesting ways to incorporate needs into plan
• ISBE provides technical assistance to parents, suggests access to 504
• OCR serves as the agency with jurisdiction over disagreements
Role of School Nurse 504 Team
• As an expert on health-related issues and a member of the 504 team, the school nurse – Assesses student’s health related needs
– Provides consultation to other IEP team members
– Serves as the liaison between student’s specialized health care and IEP staff
– Serves as an informational resource to IEP members
– Advocates on behalf of the youth and family
– Writes or assists to write 504 plan
– Carries out agreed upon health and/or nursing services
Zimmerman, 2006; Betz & Nehring, 2007
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RtI – a newer approach to meeting student needs
Step I: Universal Supports for all students
Step II: Data review by Problem Solving Team
Step III: Targeted interventions and progress monitoring for struggling learners
Step IV: Intense interventions and progress monitoring for struggling learners
Step V: Referral to special education when student demonstrates little or no response to both targeted and intense interventions
Step VI: General education and special education personnel collaboratively teach and monitor student progress; adjust EP and service as needed for eligible students
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A Three Tiered RtI Model
Kurns, Sharon M.A., Tilly, W. David Ph. D. Response to Intervention Blueprints: School Building Level. National Association of State Directors of Special Education Council of Administrators of Special Education
The Role of the School Nurse as a Member of the RtI Team
Struggling students may have health or physical concerns that must be addressed BEFORE learning can occur.
Basic health and safety needs
must be fulfilled before achievement and mastery can take place. (Maslow’s Hierarchy of Needs)
The Role of the School Nurse as a Member of the RtI Team
School Nurses play a key role in the problem solving process and identification of health related barriers to learning at all levels of instruction and intervention.
The Role of the School Nurse as a Member of the RtI Team
Assess the impact of student health on academic achievement and/or behavior through…
• Reviewing student medical records
• Conducting a Health History
• Conducting Classroom Observations
• Communicating professional findings with parents, teachers and medical providers
• Developing, implementing and monitoring a plan of care and/or interventions to support academic achievement
Problem Solving Process
Evaluate Did our plan improve learning?
Problem Analysis How does this problem impact learning?
Define the Problem Is there health related problem?
Develop/Implement Nursing Action Plan/Individualized Health Care Plan
Count Down to RtI; The School Nurse Response
All Students – Tier I
1. Prevention and control of communicable diseases to maximize attendance
2. Implementation of school-wide health promotion activities
3. Monitor attendance records and notify administration of concerns
4. Provide health screening (vision & hearing) to identify possible barriers to learning
5. Implement therapeutic nursing interventions to keep students in the classroom ready to learn
6. Provide expert resource for curriculum content related health and wellness
7. Provide and promote health counseling and education
Tier I
Count Down to RtI - The School Nurse Response
Borderline Students – Tier II 1. Consult with parents regarding health and
attendance issues providing health referrals and resources
2. Communicate with administrators regarding excessive absences
3. Minimize interruptions to learning through health counseling and referral
4. Provide health assessments and referrals where needed
5. Participate on the Section 504 team 6. Conduct small group instruction in health
related concerns 7. Assist with identifying general education
accommodations
Tier II
Count Down to RtI - The School Nurse Response
At Risk Students – Tier III 1. Administer intensive nursing procedures
and treatments as indicated 2. Identify and implement
accommodations for students with chronic or acute illnesses in the classroom
3. Communicate with parents regarding classroom accommodations and possible community resources
4. Provide individualized health counseling and health instruction
5. Provide individualized parent education 6. Develop and implement individualized
health education plan
Tier III
Medical Staff Responsibilities in regular education
Identify nursing and related services needed to manage student’s special health care needs RN develops individual health care plan (as needed), which may or may not later become part of the IEP Monitor student’s response to nursing and medical interventions Troubleshoot communication among teaching staff, parents, health care providers and students
Medical Staff Responsibilities in Special Education
• IDEA: When considering a student's eligibility for special education services, federal regulations implementing the Individuals with Disabilities Education Act (IDEA) require that the student be assessed in all areas related to the suspected disability, including, if appropriate, health, vision, hearing, social and emotional status, communicative status and motor abilities.
• ISBE rules and school code: Definition of this “medical review”
Medical Staff Responsibilities in Special Education
Known special health care needs should be referred to the medical staff (RN, MD) Unknown special health care needs are elicited by the medical staff (RN, MD) while obtaining health information that may impact the child’s educational performance Medical staff review all necessary medical/health data (medical review) Interprets pertinent medical and health data to team
Medical Review
Guidelines issued by ISBE are posted at www.isbe.net
• Defines components:
• Subjective information
• Objective information
• Assessment (educationally relevant medical findings)
• Plan
ISBE Licensed School Nurse Responsibilities
Only the ISBE endorsed school nurse:
Makes recommendations regarding functional goals relevant to educational interventions, accommodations or modifications to instruction or the learning environment based on results of medical review
ISBE Licensed School Nurse
Assists with the development of the IEP, including:
incorporating findings into PLAAFP
Integrates IHP into the IEP, if needed
Identifies health and academic accommodations needed to perform adequately:
• Classroom
• Occupational training
• Community
ISBE Licensed School Nurse
Makes recommendations regarding student health goals (related to academics)
Incorporates self health care into transition goals
Serve as liaison between interagency teams
ISBE Licensed School Nurse
ISBE licensed school nurse: Regularly evaluates the health goals in the IEP for effectiveness in terms of:
• student health
• student academics
Participates in re-evaluations and writes progress reports as needed to team and parents
ISBE Rules Concerning Qualifications of Personnel to Conduct
Medical Review • Implementation of rule in section 226.800, beginning July
1, 2013, is now in place: • Beginning July 1, 2013, a School Service Personnel
Certificate endorsed for school nursing (23 Ill. Adm. Code 25.245); or a license to practice medicine in all of its branches; or a bachelor’s degree or higher and a license issued under Article 60 or Article 65 of the Nurse Practice Act [225 ILCS 65/Art. 60 or Art. 65],
• provided that only a person holding a School Service Personnel Certificate endorsed for school nursing shall make recommendations regarding educational interventions, accommodations or modifications based on the findings.
Pending Board Action
• ISBE board action on Rule 226, qualifications of personnel to conduct medical review, is anticipated for board meeting later this summer
• In response to regional shortages of qualified personnel, delay implementation for two years
• During this period, develop a “stop gap” measure to assist practicing RN’s to gain knowledge of Special Education rules and the IEP process via a web based professional development program
• Implement new rules July 1, 2015
Pending Board Action
After July 2015, if no ISBE licensed/endorsed school nurse available: Document lack of availability Hire non-qualified staff Staff must pass ISBE approved training within one year What has not and will not change: Only medical personnel are authorized to conduct medical review; this excludes other support personnel, parents, administrators, teachers
“You can’t educate a child who isn’t healthy and you
can’t keep a child healthy who isn’t educated”
Dr. Joycelyn Elders
Former US Surgeon General
School Nurses Help Students with Health Needs Access Their Education
