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DiversityNursing Blog

The School Nurse Shortage is Raising Concern

Posted by Erica Bettencourt

Fri, Sep 17, 2021 @ 10:37 AM

GettyImages-1325774293

The School Nurse shortage is not a new issue. The pandemic highlighted the importance of having School Nurses. As schools across the nation open back up,
concerns are again rising.

The US Centers for Disease Control and Prevention (CDC) recommends schools have one full-time Nurse for every 750 students.

The latest data from a study, published in the Journal of School Nursing in 2018, found approximately 39% of schools employ full-time Nurses and about 35% employ part-time School Nurses, while 25% do not employ School Nurses.

With out School Nurses, teachers and staff with no medical training would be responsible for providing care such as dispensing medication, managing allergies and asthma, and monitoring blood glucose levels.

Not only are School Nurses responsible for providing care, they also play a vital role in the management of COVID-19 safety protocols and updating staff and parents.

According to a survey from the National Association of School Nurses (NASN), 78% of School Nurses say they took time to review data to see new trends in COVID infections. The survey shows 43% of Nurses spent time updating and developing school health policies and nearly half said they were spending time answering phone calls from parents and the community.  

“I spend most of my day dressed up as a ghostbuster in personal protective equipment,” Rhonda Cranford, a School Nurse at Northside Elementary with 34 years of experience, shared. “I’m answering the phone constantly with questions regarding isolation and quarantine. I spend hours documenting and sending emails. Ninety-five percent of my day is consumed by COVID activities.”  

Many schools have a tight budget and can lack the funding needed to hire a School Nurse.

Laurie G. Combe, NASN President said, “When budgets are tight, administrators make decisions to hire Teachers over Nurses, but what many administrators don’t understand is that having a Nurse on staff can actually save dollars."

A glimmer of hope arose in May when the Biden administration announced the American Rescue Plan. The Plan includes dedicated funding of at least $500 million to hire School Nurses to help schools safely reopen and remain open for in-person instruction.

It’s important to remember there is a Nursing shortage across the country. School districts are competing against healthcare organizations for Nursing applicants where wages in hospitals and other settings tend to pay more.

Between the Delta variant, mask protocols, and vaccine mandates, schools need Nurses now more than ever. 

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Topics: school nurse, nursing shortage, COVID-19, face masks, school nurses, school nurse shortage

School Nurses Play A Vital Role In The Fight Against COVID

Posted by Erica Bettencourt

Fri, Sep 25, 2020 @ 03:44 PM

schoolnurseSchool Nurses have become the main point of contact for any and all things COVID-19 related. They are a key component in making sure schools stay open.

The American Academy of Pediatrics (AAP) recommends that every school have a Nurse on site.

But, according to the National Association of School Nurses, before the pandemic, a quarter of American schools did not have a Nurse.

Now states are scrambling to hire School Nurses as students go back to school.

“Most school Nurses are the only health care experts in their school community able to understand infection control and do disease surveillance,” said Linda Mendonca, president-elect of the National Association of School Nurses (NASN). “But not every school has a Nurse who’s going to look after the children and staff. You need that expertise as a resource to safely reopen schools.”

COVID has made the role of a school Nurse even more complex, adding many challenges and new responsibilities for keeping children and staff safe.

They're responsible for complying with applicable federal, state, and local laws, regulations, ordinances, executive orders, policies, and any other applicable sources of authority, including any applicable standards of practice.

Nurses will also have to create plans for how high-risk students will return to school. They'll also help with screening protocols, creating safe classroom setups, hand washing and sanitation stations, and PPE distribution.

The school Nurse should collect and share school data in compliance with state and federal confidentiality regulations.

Once a coronavirus case is identified, school Nurses and local public health officials will work together to determine which students or staff might have been exposed to the infected person.

Face masks will be one of the main ways of limiting the spread of the virus in schools this fall. However, with younger students there's a risk of children trading masks or not keeping them on.

Social distancing is another key factor in keeping everyone safe, NASN guidelines suggest, staggered start times, small group and outdoor activities, no sharing of musical instruments, and meals in classrooms.

Liz Pray, MSN-Ed, RN, NCSN, School Nurse for the Moses Lake School District in Washington State and President of the School Nurse Organization of Washington said, "If I could offer any words for nurses feeling overwhelmed, I would encourage them to allow themselves and others a little grace. Everyone is struggling. Tempers are short, people are on edge and it’s been very difficult for students, parents and team members to adjust to these changes. Remember to take a step back, take a deep breath and take care of yourself."

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Topics: school nurse, COVID-19, coronavirus, school nurses, covid

Funny Parody About The Life Of A School Nurse [VIDEO]

Posted by Erica Bettencourt

Wed, May 10, 2017 @ 02:40 PM

547021d7-eacc-4b41-ace0-096306e8d797-large16x9_ScreenShot20170509at5.37.11PM.jpgIt’s Nurses Week and we always want to show our thanks for everything you do. This School Nurse wanted to show her thanks, especially to other School Nurses, for taking care of our kids. 

She created this comedy sketch based on Adele’s song, Hello. We thought it was hilarious and we hope you do too!

Hello, it's me—and you should pay attention because school nurse has something to say. 

To celebrate "School Nurse Day," Kelli Petersen, who works at an elementary school, penned a beautiful rendition of Adele's "Hello," only this time it's all about the life and times of a school nurse. "Happy School Nurse day to all my fellow school nurses! May you know how truly valued you are! And to nurses everywhere, you're amazing!," Petersen wrote on YouTube.

It's a creative celebration of countless bandaids, hurt tummies and gross bathrooms that Adele would most definitely be proud of. 

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Topics: school nurse

School Nurses Can Be Mental Health 'Detectives' But They Need Help

Posted by Erica Bettencourt

Thu, Sep 08, 2016 @ 01:03 PM

SchoolNurseFinal.pngSchool Nurses are playing an important role in identifying students with mental health disorders. They believe by asking students the right questions they may be able to help before a tragedy occurs like suicide or a school shooting. Do you think school Nurses should be able to get better mental health training?
 
Two 5-year-old girls, best friends, hold hands in her office at Van Ness Elementary School in Washington, D.C., one complaining she doesn't feel well. Tolson, the school nurse, asks, "How long has your stomach been hurting?"

It just started, but this little one says her head hurt last night, too. Tolson knows she has a history of fevers, so she checks her temperature and asks her more questions: What did she eat? Has she gone to the bathroom? Does her head still hurt?

Schools function as the mental health system for up to 80 percent of children who need help, according to the American Association of Pediatrics.

And school nurses? They play a critical role in identifying students with mental health disorders.

It could be that these two little girls that went to Patricia Tolson's office are fine. Or maybe there's something else going on. And that's what school nurses have to gauge every day.

"School nurses are the detectives in that school," says Donna Mazyck, the executive director of the National Association of School Nurses. "They're the eyes and ears of public health."

She says nurses look for patterns, "so if a student comes back with the same symptoms every single day that week, that school nurse is going to begin to connect the dots."

All of which is great if there's actually a school nurse. Some schools share nurses. Some districts have just one for all of their schools.

On top of that, school nurses generally get very little training when it comes to mental health. Mazyck says she was overwhelmed when she was a school nurse. She saw depression, trauma, anxiety, grief and "students who didn't even know what to do to calm themselves down," she says. "They didn't know how to cope."

So Mazyck went back to school for a graduate degree in counseling and now she focuses on getting nurses more training. Mental health is routinely ranked one of the top issues all school nurses deal with, and many want to be better at it.

Nurses feel like they might open a Pandora's box if they ask students certain questions about their mental health, says Sharon Stephan who co-directs the National Center for School Mental Health at the University of Maryland. Her team trains school nurses all over the country. She says that nurses can feel overwhelmed when they aren't sure if there's anyone in the community to help students outside the school.

Stephan says no one expects nurses, or even teachers for that matter, to be therapists or psychiatrists. But she tells nurses there are two simple questions to ask themselves to see if a child needs help:
Is the student acting or behaving differently than they were before?
Are they somehow far outside the norm of what you would expect?

What frustrates her is that often, the only time everyone pays attention is when there's a tragedy, like a school shooting.

The idea is "Can we catch the one student who might harm others?" or "How can we identify the one student who might be suicidal?"

But she says there are so many more kids who need help, and the first person who might notice is the school nurse.

Talking back, getting into fights and being distracted in school: "Is that just kids being kids? Or signs of a child struggling with mental health?" she says she asks herself.

Increasingly it's the school nurse's job to make that call.
 
 
Have a question about school Nursing or have a general question you want answered? Just ask one of our Nurse Leaders! 

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Topics: school nurse

7 Surprising Facts From a School Nurse

Posted by Erica Bettencourt

Mon, Aug 18, 2014 @ 01:05 PM

By: American Profile

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School nursing started out as a practical solution for Beth Mattey: The mom of three liked the hours. Now, 27 years later, she says it was the perfect career choice—creative, independent and full of meaning. “As Maya Angelou said, ‘People never forget how you made them feel,’” Mattey says. “That’s the connection that school nurses make.” We asked Mattey what parents might be surprised to know about her job—and their kids.

1. Sadness is one of the most common illnesses she sees in students. “Kids are anxious and want to do well,” she says, noting a 2012 National Association of School Nurses report that the top five health conditions of U. S. children are mental health- related, issues that school nurses spend about a third of their time helping students cope with.

2. Every kid should carry a water bottle. Dehydration is often the cause of headaches, another common complaint among kids, Mattey says. Also a culprit? Lack of sleep.

3. School nurses need to know your secrets. In addition to any chronic conditions your student is coping with, update your school’s nurse on any big family news like an illness, death or divorce. Your instinct might be to keep such facts private, but the nurse can offer your child valuable support.

4. Your kids aren’t eating the lunch you pack. “I often ask teens what they had for lunch, and they say, ‘Chips.’ We need to help them understand the value of nutrition and to make good choices,” Mattey says.

5. A “mental health day” is not a stress solution. Allowing your anxious teen a day off won’t get to the root of the cause. “If a kid is too stressed to go school, find out why,” Mattey says. “Is she being bullied? Did she not do her homework?”

6. Teens need vaccines. Make sure yours is up to date on the Tdap or tetanus, diphtheria, pertussis; meningitis—one at age 11, the second at age 16; and the HPV (human papilloma virus).

7. A school nurse can be a teen’s— and parent’s—best friend. Mattey sees herself as supporting students, physically and emotionally. After all, she’s there day after day, year after year. “School nurses provide a safety net,” she says.

Source: www.tauntongazette.com

Topics: school nurse, school, kids, patients, list, students

What is the Priority?

Posted by Alycia Sullivan

Fri, May 02, 2014 @ 11:29 AM

By Teresia Odessey of Bloomfield College

As a nursing student, I have had the privilege of observing many nurses in different units; pediatrics, maternity, the burn unit, hospice, medical surgical, ICU, CCU, wound rounds, and psychiatry. I’ve realized from these experiences that school nurses are by far the most unappreciated and de-valued. As I gathered information on the role of school nurses, and shadowed an elementary school nurse for my senior capstone project, I discovered the challenges faced by school nurses. 

Contrary to popular belief, the school nurse’s role is critical to the well-being of students’ health and academic achievements. The scope of practice for the school nurse includes supervision of school health policies and procedures; promotion of health education; health services; competence of interventions; facilitation of health care screenings; making referrals to other healthcare providers; patient advocacy and maintenance of the appropriate environment to promote health. This role requires the nurse to be knowledgeable and competent in various skills and interventions. School nurses provide care, support and teaching for diabetes, asthma, allergies, seizures, obesity, mental health, and immunizations to all students (Beshears & Ermer, 2013).  The role of the school nurse as defined by the National Association of School Nurses is as follows: “a specialized practice of professional nursing that advances the well-being, academic success and lifelong achievement and health of students” (Board, Bushmiaer, Davis-Alldritt, Fekaris, Morgitan, Murphy &Yow, 2011). 

Clearly, it is not just about Band-Aids and ice packs but still 25% of US schools have no nurse present and 16% of students have a medical condition that warrants a skilled professional (Taliaferro, 2008).  One in every 400 children under 20 years is diagnosed with diabetes; 10% of students nationwide have asthma; prevalence of school allergies have increased drastically; 45,000 students are diagnosed with seizures each year; obesity rate has tripled among children 6 to 11 years, and more than tripled for children 12 to 19; and one in five students have mental health issues (Beshears & Ermer, 2013).  

Despite having laws allowing disabled children to attend school, increasing the workload on the nurses, there are no laws that mandate a nurse to student ratio. The national recommendation for nurse to student ratio is 1:750 but on average some nurses are responsible for up to 4,000 students (Resha, 2010). Nwabuzor (2007) mentioned that parents and stakeholders cannot truly advocate for more school nurses because most of them do not comprehend the role, responsibilities, and advantages of having a school nurse. The major reason for the school nurse shortage is the lack of legislation on school nursing; not enough funding, and no laws forcing schools to hire nurses. Therefore, many educational facilities have opted to hire unlicensed assistive personnel (UAP) instead. 

 Yes, it is likely more cost effective to hire UAP’s instead of Registered Nurses but that does not make it acceptable. It is my belief that we have different titles and scopes of practice for a reason. I find it mind boggling that some schools do not have school nurses. How is it that some parents are comfortable with sending their children to a school without a nurse? Is it that they don’t inquire about the presence of a school nurse? Or could it be that maybe they assume that every school has a full-time nurse? I wonder if some parents are aware of the nurse to student ratio at their child’s school. Yes, there are budget cuts due to many reasons but why do these schools say they don’t have enough funding to hire a school nurse but they have six assistant coaches for any one of the sports? So yet my question remains unanswered: what is the priority?

 

References

Beshears, V., & Ermer, P. (2013). SCHOOL NURSING: It's Not What You Think!. Arkansas

Nursing News, 9(2), 14-18. 

Board, C., Bushmiaer, M., Davis-Alldritt, L., Fekaris, N., Morgitan, J., Murphy, K., &Yow, B. (2011, April). Role of the school nurse. Retrieved from http://www.nasn.org/PolicyAdvocacy/PositionPapersandReports/NASNPositionStatementsFullView/tabid/462/ArticleId/87/Role-of-the-School-Nurse-Revised-2011

Nwabuzor, O. (2007, February). Legislative: "Shortage of Nurses: The School Nursing Experience." Online  Journal of Issues in Nursing Vol12 No 2. doi:10.3912/OJIN.Vol12No02LegCol01

Resha, C., (2010, May 31) "Delegation in the School Setting: Is it a Safe Practice?" OJIN: The

Online Journal of Issues in Nursing Vol. 15, No. 2, Manuscript 5. doi:

10.3912/OJIN.Vol15No02Man05

Topics: school nurse, education, health care, underappreciated, senior capstone

For school nurses, it’s far beyond Band-Aids

Posted by Alycia Sullivan

Fri, May 17, 2013 @ 01:19 PM

describe the imageThe peak times for student visits to Ronda Kissling’s office are at the start of the school day and around lunch and recess time, but Kissling doesn’t get much downtime.

Kissling is the nurse serving three elementary schools: Croninger, St. Joseph Central and Shambaugh. She began her day Friday at Croninger to see

schoolnurse

 the students who got off the busdescribe the image not feeling well. By late morning, she was headed to Shambaugh to give insulin to thehandful of diabetic students there. Shortly after noon she returned to Croninger to give students insulin and just in time to catch any students injured during recess.

Between student visits and charting throughout the day, Kissling checked on an uninsured student who had broken his arm; urged a doctor’s visit for a student with a particularly suspicious-looking rash; and worked on a letter to send home to parents about immunization changes for next school year.

She said most people don’t realize what school nursing is all about.

“They think we sit around all day and just give out ice packs and Band-Aids,” she said. “There’s so much more to it nowadays.”

Increase in ailments

Much has changed in school nursing in the past 10 to 15 years, said Chris Amidon, a registered nurse serving Crawfordsville Community School Corp. and president of the Indiana Association of School Nurses.

One area in particular is the increase in students’ mental health problems.

“A lot of us were not prepared to deal with that,” she said, because of nurses’ inexperience in psychiatry.

She estimates about 32 percent of school nurses’ time is devoted to providing mental health services, whether they realize it or not. Often mental health problems can show up as physical ailments like head or stomach aches, she said.

According to a 2011-12 survey by the Centers for Disease Control and Prevention, about 165,000 Hoosier children have emotional, developmental or behavioral problems that require treatment or counseling, and 41 percent of those children do not receive mental health services.

Children born prematurely or with other challenges now live and attend school.

“There’re so many children with time-consuming needs,” Amidon said, such as tube feedings or students who need help using the restroom. Thirty years ago, she said, these children probably wouldn’t have even attended school.

Rates of overweight and obese children as well as the number of children with food allergies are also increasing.

Mary Hess, head nurse for Fort Wayne Community Schools, said more than 13,000 students in the district report having allergies. That includes food allergies, such as to peanuts, and being allergic to bee stings and latex.

About 760 of those students report severe or anaphylactic symptoms if exposed to a certain allergen, she said.

“There’s been a huge increase in allergies from when I started 15, 16 years ago,” Hess said.

Hess reports allergies and diabetes among the top four reported chronic illness of students in FWCS, now the largest district in the state with about 30,600 students. Asthma and seizure disorders also top the list.

“We see an increase every school year with students reporting some chronic health condition,” Hess said.

According to the National Association of School Nurses, the incidence of obesity in the past 30 years has doubled for 2- to 5-year-olds; tripled among 6- to 11-year-olds; and more than tripled for 12- to 19-year-olds. In Indiana, 32 percent of children ages 10 to 17 are overweight or obese, according to the CDC survey.

A disease such as diabetes requires extra effort to manage as treatments have advanced. Diabetic children used to get insulin in the morning, and their blood sugar levels were simply monitored during the day.

“There was not the constant fine-tuning we see in today’s plans,” she said.

Many children require insulin when they eat, which could be twice a day if the child eats breakfast at school.

FWCS to hire nurses

Students’ insulin needs are what led the Crawfordsville schools to make it a priority to provide funding for a full-time nurse in each of its school buildings, instead of its old policy of staffing based on just a few students in certain buildings.

“We used to do that, but it got to the point where there’s at least one child in each building with diabetes or even food allergies,” she said.

Unlike Crawfordsville, not every school in Fort Wayne Community Schools is staffed with a full-time nurse. This year, about 24 nurses split their time among the district’s 51 school buildings. Some nurses, like Kissling, are responsible for three schools, Hess said.

“My nurses have been stretched very thin,” she said.

Northrop High School is one of the district’s busiest schools with more than 2,000 students. The school’s full-time nurse fields 650 to 850 student visits a month.

“Their traffic flow is extremely busy, but I wouldn’t say that’s particularly new,” Hess said. “I’ve felt for some time we’ve needed more nurses.”

FWCS plans to hire additional nurses for next year, bringing the total number of nurses to 30 with no nurses serving more than two buildings.

Ten years ago, Southwest Allen County Schools employed clinical aides, or someone who has medical training but isn’t licensed, in some of its schools instead of a registered nurse.

Amidon said many districts have moved away from using clinical aides, although some districts like Huntington Community School Corp. still use them or other unlicensed staff instead of registered nurses. And in FWCS if a nurse isn’t available, secretaries and other staff receive special training like CPR and medication dispensing.

Southwest Allen changed its policy when it became clear that student health was becoming more challenging and “too medically intense,” said Phyllis Davis, director of human resources in the district.

“In many schools we have children with severe disabilities and who are very unique, medically,” she said.

Southwest Allen employs 11 nurses, with at least one nurse working full time at each school. Others float among schools to give the full-time nurse assistance.

“I can assure you, they’re very busy,” Davis said.

Manic Mondays

A student sat on the cot in Kissling’s small clinic Friday waiting patiently for her to finish her phone call with a parent. He had come in because his eyes were red and itchy. After some questions, Kissling determined it wasn’t pink eye, a highly contagious infection, but that the student’s symptoms were caused by his allergies.

“It’s that time of year,” she said.

She offered him a cold cloth for his eyes and sent him on his way. He was the second student within an hour to complain about allergy-related symptoms.

Amidon said research shows that if students see a school nurse, they are more likely to have their problems addressed and to stay at school. Someone unlicensed who is providing care is more likely to send a student home.

School nurses are an important component in helping students achieve academically, Davis said.

“Our nursing staff is an important part of our school district’s success for our students,” she said.

They’re also an important part of children’s health care. Amidon said for many students who don’t have health insurance, school nurses are primary health care providers. She said Mondays are often busy times with students who’ve been sick all weekend, and their parents send them to the nurse to determine how serious the sickness is.

According to the CDC survey, nearly 12 percent of Hoosier children lacked consistent health care coverage last year.

For all they do, school nurses receive their own special day a year. Wednesday is National School Nurse Day, set aside to celebrate the more than 74,000 school nurses across the country.

“It is a very, very rewarding kind of nursing,” Amidon said.

Source: The Journal Gazette 

Topics: school nurse, full-time, mental health, diabetic, allergies, health coverage

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