Iowa School Nursing. August 15, 2007

(1)

Iowa

School Nursing

August 15, 2007

(2)

Jeff Berger

Department of Education

Legislative and Policy Liaison

May 2007 School Leader Update

-

-Legislative Edition

Legislative Edition

http://www.iowa.gov/educate/content/view/854/1006/ http://www.iowa.gov/educate/content/view/854/1006/

Legislative Update

http://www.iowa.gov/educate/content/view/171/1014/ http://www.iowa.gov/educate/content/view/171/1014/

(3)

SF 277

-

Student Achievement and

Teacher Quality

HF877

-

Voluntary access to statewide

quality 4

-

year

-

old preschool

HF 909

–

Mandate for school districts to

release free/reduced lunch lists to the

Hawk

-

I program

-

-HF 611

HF 611

-

Update of local Human Growth

and Development Curricula

–

Others

(4)

Rita Gergely

Chief, Bureau

of of

Lead Poisoning

_{Lead Poisoning}

PreventionPrevention

Division of Environmental Health, IDPH

800

800 -

-

972

972 -

-

HF 158

-

Lead screening prior to age of 6

-

-Parents provide school district lead screening Parents provide school district lead screening

evidence prior to age 6. School district forwards evidence prior to age 6. School district forwards

evidence to DPH within 60 days of start of school. A evidence to DPH within 60 days of start of school. A

variety of exceptions/waivers. School districts variety of exceptions/waivers. School districts

provisionally enroll a student. IDPH to develop rules. provisionally enroll a student. IDPH to develop rules.

http://coolice.legis.state.ia.us/Cool http://coolice.legis.state.ia.us/Cool- -ICE/default.asp?Category=billinfo&Service=Billbook ICE/default.asp?Category=billinfo&Service=Billbook &menu=false&ga=82&hbill=HF158 &menu=false&ga=82&hbill=HF158

(5)

Kim Tichy

Immunization Registry Coordinator

Iowa Registry Immunization System

(IRIS), IDPH

515

515 -

-

281

281 -

-

4288,

[email protected]

IRIS Help Desk: 800

(6)

Bob Russell, DDS, MPH

Public Health Dental Director, IDPH

515

515 -

-

281

281 -

-

4916,

[email protected]

HF 906

-

Dental screening

–– Parents provide Parents provide dental screen evidence to school district prior to age 6 dental screen evidence to school district prior to age 6

and high school. School district forwards evidence to and high school. School district forwards evidence to

DPH within 60 days of start of school. A variety of DPH within 60 days of start of school. A variety of

exceptions/waivers available. School districts exceptions/waivers available. School districts

provisionally enroll a student in certain circumstances. provisionally enroll a student in certain circumstances.

Bill applies 2008

Bill applies 2008--09 school year. 09 school year. http://coolice.legis.state.ia.us/Cool http://coolice.legis.state.ia.us/Cool- -ICE/default.asp?Category=billinfo&Service=Billbook&m ICE/default.asp?Category=billinfo&Service=Billbook&m enu=false&ga=82&hbill=HF906 enu=false&ga=82&hbill=HF906

(7)

Barb Smith

Medication Administration Course

http:www.iowaschoolmeds.com

(8)

Assuring Safe, High Quality Health Care

Pre

-

_-

K

_K

−

12 Educational Settings

_{12 Educational Settings}

American Nurses Association (ANA)

Position Paper

March 16, 2007

Congress on Nursing Practice & Economics

Adopted by: ANA Board of Directors

http://www.nursingworld.org/readroom/po

sition/practice/AssuringSafeHealthCarePr

eK.pdf

(9)

Purpose

Children should be healthy to learn

and learn to be healthy.

Education has a central role in

teaching students to improve their

health & reduce health

-

risk

behaviors, to optimize learning &

achievement.

(10)

The school nurse secures health,

safety and

lives

_lives

of children (and

_{of children (and}

adults) in educational settings

Educational settings include

classrooms, field trips, sporting

events & other school

-

activities

(11)

Summary

20% of combined US population of children and

adults are in schools on a weekday (AHA, 2004).

To best serve health needs of students & staff in

educational settings, ANA supports a

collaborative school health model requiring

cooperation & participation of school nurse,

students, families, teachers, school

administrators & staff, other health care

professionals, & community.

In the model, school nurse serves as manager &

coordinator of care, information, education,

personnel & resources to take best advantage of

schools

schools’’ unique position in addressing studentsunique position in addressing students’’ safety & health care needs.

(12)

School nurses are essential in

promoting health, injury prevention &

providing direct health services to

school students & staff.

To assure children

’

s safety, it is

essential that other responsible

individuals (both health care & non

-

-health care personnel) in school setting

health care personnel) in school setting

receive education & practice in various

health care activities, under direction of

school nurse.

(13)

Public policy must guarantee a central

health care professional

--

educated,

knowledgeable with up

-

to

-

date skills

--

to

be available daily to students in

educational setting, to best protect

fundamental public health & educational

priority our nation

’

s children represent.

The central health care figure best

prepared to serve in this role is the

registered school nurse.

(14)

Recommendations

1. ANA supports assignment & daily availability

of a registered school nurse for management

& implementation of school health services at

recommended ratio of one nurse for every 750

students, with an ultimate goal of at least one

nurse in every school.

nurse in every school. ““Daily availabilityDaily availability””

requires onsite registered nurse for at least a

portion of every day & otherwise available for

immediate collaboration or consultation by

alternate means of communication. If school

nurse is assigned to more than one facility,

total number of students the nurse serves

should not exceed 750.

(15)

2. ANA supports a modified ratio of fewer

students per nurse, dependent on number &

severity of disabilities within student

population.

3. ANA supports safety assurances for all

children, requiring individuals other than

school nurses, when performing health care

related tasks in educational setting, to follow

guidelines and protocols taught to them led

by school nurse.

4. ANA supports development & dissemination

of instructional curricula to assist school

nurses in educating non

nurses in educating non--healthcare healthcare

providers to competently perform delegated

tasks in an educational setting. Examples

provided.

(16)

5. ANA supports dissemination of consistent

information on delegation to school nurses

reflecting both legal requirements of their

state & professional standards required of

them as professional RNs.

6. ANA continues its advocacy for public policy

& funding to provide at least one registered

nurse for every 750 students in educational

settings.

(17)

References

Nursing

Nursing’’s Social Policy Statement 2nd ed. s Social Policy Statement 2nd ed. (2003)

(2003)

Code of Ethics for Nurses with Interpretive

Statements (2001)

School Nursing: Scope and Standards of

Practice (2005)

Principles for Delegation (2005)

Delivery of Care in Schools for Children with

Diabetes (2005)

(18)

California

K.C. et al. v. Jack O

’

Connell, et al.

Diabetes Management in Schools

http://www.cde.ca.gov/ls/he/hn/diabetesmgmt.asp

K.C. Settlement Agreement & Legal Advisory

Q & A

Q & A -- K.C. Settlement Agreement & Legal K.C. Settlement Agreement & Legal Authority

Authority

Helping Student with Diabetes Succeed: A

Guide for School Personnel (Outside Source)

(19)

Children With Diabetes Win Assurance

of Legally Required Services at School

California Department of Education (CDE)

and American Diabetes Association (ADA)

Agreement

-

In

-

School Care for Students

OAKLAND

—

8/8/07 announced

agreement ensuring California students

classified as disabled because of diabetes

will be safe at school & enjoy same legally

required educational opportunities as

their peers.

The agreement clarifies rights of eligible

students with diabetes in every school

district throughout the state.

(20)

Lawsuit, filed as a class action October 2005, against Lawsuit, filed as a class action October 2005, against

CDE & two Bay Area school districts (San Ramon CDE & two Bay Area school districts (San Ramon

Valley Unified & Fremont Unified) under federal Valley Unified & Fremont Unified) under federal

disability civil rights & special education laws. Each disability civil rights & special education laws. Each

district entered into a separate agreement with district entered into a separate agreement with

plaintiffs detailing care it will provide its students with plaintiffs detailing care it will provide its students with

diabetes. diabetes.

Litigation filed by four families & ADA in federal district Litigation filed by four families & ADA in federal district

court, San Francisco alleged some California school court, San Francisco alleged some California school districts were not providing insulin administration & districts were not providing insulin administration &

other services to students with diabetes

other services to students with diabetes--related related disabilities who were legally entitled to at school. disabilities who were legally entitled to at school.

"A lack of resources, uncertainty about how services "A lack of resources, uncertainty about how services

are best delivered & lack of clarity about state & are best delivered & lack of clarity about state &

federal requirements have in some instances caused federal requirements have in some instances caused

hardship to parents of children with diabetes. No hardship to parents of children with diabetes. No

parent should have to put a job at risk to administer parent should have to put a job at risk to administer

legally required diabetes treatment to their child during legally required diabetes treatment to their child during

the school day." the school day."

(21)

Under agreement, each local educational agency Under agreement, each local educational agency

(LEA) will manage delivery of care in best possible (LEA) will manage delivery of care in best possible

way for students whose Individualized Education way for students whose Individualized Education

Programs (IEP) or 504 Plans require administration Programs (IEP) or 504 Plans require administration of insulin & related services during the school day. of insulin & related services during the school day.

CDE issued a Legal Advisory to all California school CDE issued a Legal Advisory to all California school districts providing guidance on health care services districts providing guidance on health care services for students with diabetes & outlining rights of these for students with diabetes & outlining rights of these

students under federal anti

students under federal anti--discrimination & special discrimination & special education statutes

education statutes——Section 504 of Rehabilitation Section 504 of Rehabilitation Act of 1973, Americans with Disabilities Act, &

Act of 1973, Americans with Disabilities Act, &

Individuals with Disabilities Education Act (IDEA). Individuals with Disabilities Education Act (IDEA).

The Advisory explicitly states school

districts have an obligation to provide insulin

administration & related services to eligible

students who need assistance.

(22)

Who May Administer Insulin in California

to Students with Diabetes as a Related

Service Under Section 504 and IDEA

California Law:

Business &

Professions Code

section

2725(b)(2) & California

Code of

Regulations

, Title 5, section 604

authorize following types of

persons to administer insulin in

California

’

_’

s public schools

_{s public schools}

pursuant to Section 504 Plan or

IEP:

(23)

1.self administration, with authorization of

student

’

s licensed health care provider &

parent/guardian;

2.school nurse or school physician employed

by LEA;

3.appropriately licensed school employee (i.e.,

RN or licensed vocational nurse) who is

supervised by a school physician, school

nurse, or other appropriate individual;

4.contracted RN or licensed vocational nurse

from private agency or registry, or by

contract with a public health nurse

employed by local county health

department;

(24)

5. parent/guardian who so elects;

6. parent/guardian designee, if parent/guardian

elects, who shall be a volunteer who is not

an employee of LEA;

7.unlicensed voluntary school employee with

appropriate training, but only in

emergencies as defined by law

(Section 2727(d) of (Section 2727(d) of

Business & Professions Code

Business & Professions Code epidemics or public disasters).epidemics or public disasters).

When no expressly authorized person is available under categorie

When no expressly authorized person is available under categories 2s 2--4, supra, 4, supra, federal law

federal law -- the Section 504 Plan or the IEP the Section 504 Plan or the IEP -- must still be honored and must still be honored and implemented. Thus, a category #8 is available under federal law:

implemented. Thus, a category #8 is available under federal law:

8.voluntary school employee who is

unlicensed but who has been adequately

trained to administer insulin pursuant to

student

’

s treating physician

’

s orders as

required by Section 504 Plan or IEP.

(25)

Federal Law

Federal law under Section 504 &

IDEA provides administration of

insulin can be determined to be a

related service that must be

provided to a student pursuant to

Section 504 Plan or IEP to ensure

FAPE.

CDE

_CDE

’

_’

s

_s

Program Advisory

_{Program Advisory}

recognized students

’

rights under

Section 504 & IDEA are distinct from

state legal requirements. (See

http://www.cde.ca.gov/ls/he/hn/medadvisory.asp

(26)

Reconciliation of State & Federal Law

When federal & state laws are reconciled, it

is clear that it is unlawful for an LEA to have

a general practice or policy that asserts it

need not comply with IDEA or Section 504

rights of a student to have insulin

administered at school simply because a

licensed professional is unavailable. In such

situations, federal rights take precedence

over strict adherence to state law so

educational & health needs of student

protected by Section 504 Plan or IEP are met.

(27)

Q&A on Diabetes Case Settlement

What does this settlement agreement do?

Spells out legal LEA responsibilities when student is identified

Spells out legal LEA responsibilities when student is identified, by , by IEP or 504 team, for special education and/or related services a

IEP or 504 team, for special education and/or related services as a s a result of diabetes & requires insulin during school day.

result of diabetes & requires insulin during school day.

Makes clear school districts are obligated to provide insulin

administration & related services to eligible students not able

administration & related services to eligible students not able to to self

self--administer. administer.

Spells out who may administer insulin at a school & requires LEA

to provide training in diabetes management to a volunteer, non

to provide training in diabetes management to a volunteer, non- -licensed staff member when school nurse or other -licensed

licensed staff member when school nurse or other licensed

professional is not available.

Makes clear a district must meet individual education needs of

each child who has a disability involving diabetes & may not

operate on basis of blanket policy regarding administration of

health services, such as across

health services, such as across--thethe--board limitations on types of board limitations on types of services district will provide.

services district will provide.

Makes clear districts ensure eligible students are administered

insulin during school day as required by IEP or 504 plan.

(28)

Which students are affected by

the settlement?

A student with diabetes who is disabled

under Section 504 of Rehabilitation Act of

1973 and/or IDEA and whose IEP or Section

504 Plan requires health services related to

the disability of diabetes.

Under settlement, LEAs must affirmatively

seek to find & evaluate all students eligible

for services under federal law.

(29)

What if a student requires insulin

administration and no school nurse is

available?

Financial burden or other difficulty to a LEA is not a Financial burden or other difficulty to a LEA is not a

valid defense for not providing school health services valid defense for not providing school health services

required under a child

required under a child’’s IEP or Section 504 Plan. The s IEP or Section 504 Plan. The

district must either contract for nursing services or train district must either contract for nursing services or train

voluntary school personnel to provide such services. voluntary school personnel to provide such services.

May LEA require a parent or other relative

to come to school to administer insulin?

No. A district must provide services needed by child No. A district must provide services needed by child during course of regular school day & during school during course of regular school day & during school-

-sponsored activities, pursuant to one of eight legally sponsored activities, pursuant to one of eight legally

recognized approaches set forth in Legal Advisory. recognized approaches set forth in Legal Advisory.

(30)

How will CDE ensure students with

diabetes get special educational

services they need?

CDE will notify school districts of these

legal responsibilities & monitor

districts for compliance, according to

terms of settlement agreement.

(31)

http://www.cde.ca.gov/ls/

he/hn/diabetesmgmt.asp

(32)

Iowa School Nurse Mailing List

Iowa School Nurse (iowasn) Mailing List is a communication

linking tool for Iowa School Nurses & Department of Education.

Iowa School Nurses may request information, advice, share news,

initiatives and receive news. School nurses joining the list wil

initiatives and receive news. School nurses joining the list will l add their email address to online school nurse mailing list and

add their email address to online school nurse mailing list and

may send messages to all members at any time. When messages

are posted, message automatically goes to everyone on the list.

To join the mailing list, send a blank email to:

Join

[email protected] [email protected]

To cancel the mailing list send a blank email to:

leave

[email protected] [email protected]

To send a message to other school nurses on the list, type title

To send a message to other school nurses on the list, type title in in subject, message in the body, and send to:

subject, message in the body, and send to:

[email protected]

No other commands are necessary and joining is free.

School Nurses on the list request nurses asking questions to sum

School Nurses on the list request nurses asking questions to summarize marize responses received & post the summary on the list.

(33)

School Leader Update

http://www.iowa.gov/educate/content/view/

854/1006/

August issue:

Lead and Dental Screening

Common registration issues

Attendance issues

Medicaid

(34)

Dates to Note

August 21

-

Bully/Harassment ICN, 1pmBully/Harassment ICN, 1pm--3pm3pm

August 25

-

Iowa CitizensIowa Citizens’’ SummitSummit--Childhood ObesityChildhood Obesity http://www.shapingamericasyouth.org/Default.aspx

http://www.shapingamericasyouth.org/Default.aspx

October 10

-

School Nurse Workshop, IWCCSchool Nurse Workshop, IWCC

November 14

-

15

15 -

-

University of Iowa, School University of Iowa, School Nurse Conference, West Des Moines

(35)

Charlotte Burt

Consultant

Iowa Department of Education

400 E 14

thth

_Street

Des Moines IA 50319

-

0146

515

515 -

-

281

281 -

-

5327

[email protected]

(36)

PowerPoint Presentations

Medicaid and School Nursing ICN

session

PowerPoints

posted at

http://www3.iptv.org

/iowa_database/even

t

-

_-

detail.cfm?ID=8110

_{detail.cfm?ID=8110}

(37)

School Nurse SPR

282

282−−Iowa Administrative Code Iowa Administrative Code 14.140(11), paragraph 14.140(11), paragraph ““bb””

b. Requirements for a statement of professional recognition (SPR) for school nurses. If a person has passed the registered nurses examination and is licensed by the Iowa board of nursing, the person may obtain a

statement of professional recognition (SPR) from the board of educational examiners.

(1) An applicant will be issued an SPR if the applicant:

1. Has passed the registered nurses examination, is licensed by the Iowa board of nursing and has a baccalaureate degree.

2. While employed by an accredited K-12 school district, maintains licensure with the Iowa board of nursing.

(2) Renewal requirements for the SPR are as follows:

1. The applicant must apply for renewal every five years.

2. The applicant must maintain continual licensure with the Iowa board of nursing.

3. The applicant must complete continuing education as required by the Iowa board of nursing.

(3) The school nurse SPR shall be valid for five years.

(4) All fees are nonrefundable. The fee for issuance of the SPR certificate shall be the same as for a standard license.

(5) The holder of an SPR is authorized to promote the health and safety of the students in an accredited school district, including providing medical

treatment as allowed under the authority granted by virtue of holding a license from the Iowa board of nursing.

(6) A school district may require an SPR, but the board of educational

(38)

Iowa Board of Educational

Examiners (BOEE)

http://www.boee.iowa.gov/forms/SPRNurse.pdf

or

http://www.boee.iowa.gov/ChooseNew.html

Select Statement of Professional Recognition

School Nurse

(39)

9/13 the State Board of Education will be

asked to amend

asked to amend subrulesubrule 281 IAC 12.4(12) :281 IAC 12.4(12) : 12.4(12)

12.4(12) NursesNurses.. Each Each TheThe board that board that employs

employs of each school district shall employof each school district shall employ a

a school school nursenurse, and, and shall require a current shall require a current license to be filed with the superintendent or

license to be filed with the superintendent or

other designated administrator as specified

in

in subrulesubrule 12.4(10).12.4(10).

This will conform to section 4 of SF 277,

which adds nurses back into the Code, for

districts. The only accreditation issue is that

the district must "have" a school nurse, so

that's all the rule can say.

____ means omit