When you have a child in school with any kind of health concerns, there’s one person with whom parents should make an extra effort to build a relationship: the school nurse. School nurses are the first line of defense for managing health issues, both chronic and immediate, at school, and cooperative relationships with these important healthcare providers are essential aspects of a cohesive health care plan. Unfortunately, many schools and districts are doing away with school nurses, citing budget cuts, and that often creates situations in which EMTs have to respond to student needs when the school nurse would have been able to provide appropriate (and faster) care. It’s a complex situation at best, so we sat down with Las Vegas, NV-based school nurse, Keri Mossel, RN, MSN, and asked her about the ins and outs of school nursing. Here’s what she had to say.
“There will always be a need for licensed RN school nurses. The school nurse’s role is critical in the case management and coordination of care for students who are chronically ill, medically stable, or medically fragile. Every student with a chronic illness, or who is medically unstable or fragile, is entitled to a school nurse with the knowledge and capacity to effectively provide care and communicate with school staff, healthcare providers and families (NASN, 2012).
“The trend appears to be that RN school nurses will need to cover multiple school sites and rely on licensed practical or vocational nurses, or first-aid- and CPR-trained, unlicensed assistive personnel to cover the health office in their absence. As more chronically ill, and both medically stable and fragile students enter the school setting in the least restrictive environment, the need for a licensed RN school nurse assigned to a school is imperative for the success of the student. School nurses are required to gather important health information and develop medical alerts and/or individualized health care plans for each student with a chronic health problem, and then review with the parent/guardian. The health care plans must be distributed to teachers, bus drivers, or to those personnel who need to know about the student’s condition, and the signs and symptoms of what they need to be aware of specific to that student to keep him/her safe in the school setting. Student confidentiality is maintained in all written and verbal communications, in accordance with FERPA (Family Educational Rights and Privacy Act) regulations.”
What do parents of children with chronic health conditions (epilepsy, T1D, allergies) need to know about managing their children's care at school?
“Parents/guardians need to know that school nurses are advocates for their child. It is important to establish a partnership between the parent/guardian, school nurse, and the student’s licensed health care provider to help their child be as successful as possible in the school setting. However, we, as RN school nurses, have an obligation to make sure a child’s medical condition is properly and safely managed in the school setting based on physician orders, school district procedures and policies, State Nurse Practice Act, and State Board of Nursing rules and regulations. Many times, how a child’s medical condition is managed at home differs from how it must be managed in a school setting. School district policies also require parental consent for exchange of information between the school nurse and the licensed health care provider for clarification of administration of special procedures/medications and reporting of any issues encountered with the student’s health condition.”
What do kids need to know about working with the school nurse?
“Kids need to know that we are not their parents, and we are not trying to make managing their chronic illness or medical conditions more difficult. Depending on the student’s medical condition and intellectual abilities, the student needs to know that we are there to help foster independent decision making, promote healthy lifestyle choices, and manage self-care as they transition through the different stages of physical and emotional development, and eventually into adulthood.”
What conditions do parents often forget to inform schools about that they should definitely let the school nurse know?
“Often times, parents do not disclose enough or all of the information necessary when the school nurse needs to develop a medical alert or individualized health care plan specific to their child.
The parents should update their child’s health information every school year with as much detail as possible. It is recommended that if their child has a potentially life-threatening medical condition, i.e. diabetes, seizures, food allergies, or asthma, they make an appointment to meet with the school nurse and discuss the specific signs and symptoms that pertain to their child. For example, if their child has asthma, what are the triggers to an attack? What kind of inhaler, if any, do they use? If a student has an allergy to peanuts, we need to know the signs and symptoms that their child will develop if exposed to the allergen. If their child has seizures, we need to know what their seizures look like, how long they usually last, and if the student is able to feel a seizure coming on. Every child’s medical condition presents differently, and knowing the specifics of their child’s condition will help with the successful management of their child’s health in the school setting.
“In addition, it is crucial that the parent/guardian’s contact information is always current. There’s nothing worse than trying to make contact with a parent/guardian regarding their child and not being able to reach them because their phone numbers are not current. It is also important to make sure the parent/guardian have a current emergency contact list of family/friends on file in the event that the parent/guardian cannot be reached.”
What do you recommend parents do if their school has no nurse but their child has a chronic health condition?
“Every school may not always have an RN school nurse on site at all times, but a school nurse or health department personnel or administrator should be overseeing and managing the school’s health office as a whole. Based on school district procedures and policies, as well as their State Nurse Practice Act, and State Board of Nursing laws, rules, and regulations, a registered nurse may delegate some nursing tasks to a designated first-aid- and CPR-trained unlicensed assistive personnel on staff to provide students with basic first aid care and medication administration. Parents still need to meet with the RN school nurse or health department personnel overseeing the school’s health office. The unlicensed assistive personnel need to be made aware of the students with chronic medical conditions and follow the students’ individualized health care plans. The unlicensed assistive personnel must be able to have communication with the school’s assigned RN or with its health department personnel or administrator if any questions should arise or if a nurse needs to come to the school to care for the student.”
Do you think all schools should have AEDs, EpiPens, and Glucagon Pens/Kits stationed around the school?
“Immediate access to emergency medication is a high priority and is crucial to the effectiveness of these life-saving interventions (NASN, 2012). In addition, prevention is the key and having prevention programs in place at school would diminish the frequency and intensity of emergency intervention treatments at school. However, most schools do not have AEDs, EpiPens, and Glucagon kits stationed around the school.
“The American Heart Association has certain criteria that it uses to determine if a school meets the needs to have an AED in the school setting (NASN, 2012). It’s not as simple as just having an AED available on campus. Having an AED on campus requires having a complete AED program that includes designating an AED Coordinator, maintenance standards, and regular training of laypersons in CPR and AED response. Every school that has an AED needs to establish a team of responders in the event of an AED drill or true AED emergency.
“The administration of emergency medication, like all medications, is regulated by state laws and guidelines as well as local school district policies and protocols. Students with medical orders for life-saving medications are often required to have their own prescription-labeled medication provided by the parents/guardians. Depending on the student’s level of independence, the student’s licensed health care provider may allow the student to carry their life-saving medication on their person, i.e. EpiPen. However, most students’ life-saving medication is kept in a central location, usually in the health office. This allows consistency in knowing where emergency medication is located at all times. The student’s individualized health care plan, provided to teachers, needs to indicate where the student’s emergency medication is located.
“However, school nurses must remain accountable to physician orders, school district procedures and policies, as well as their State Nurse Practice Act and State Board of Nursing laws, rules, and regulations, including if they have the ability to delegate the administration of emergency medication (i.e. glucagon and EpiPens) by licensed practical or vocational nurses, or unlicensed assistive personnel. If the RN school nurse is able to delegate medication administration, the school nurse is responsible for training the licensed practical or vocational nurse, or unlicensed assistive personnel in the administration of emergency medication in the event the school nurse is not on campus when a life-threatening medical emergency occurs. RN school nurses must provide on-going verification of trainings to ensure and sustain the safe and accurate administration of medication. Please note that the delegation of nursing tasks is not allowed in all states.
“A health office needs to be staffed at all times, whether by a licensed registered, vocational, or practical nurse, or unlicensed assistive personnel, with a communication system available via walkie-talkies or telephone in the event an emergency medication is needed, which will allow the ‘health office’ to respond to the student’s location with their medication in a timely manner."
Special thanks to Keri Mossel, RN, MSN, for sharing her invaluable expertise with us here at Lauren’s Hope! And thank you to all the wonderful school nurses who do so much each day to help students all across the country!
National Association of School Nurses (NASN). (2012, January). Position Statement: Emergency Equipment and Supplies in the School Setting. Retrieved from: http://www.nasn.org/Portals/0/briefs/2012briefemergency.pdf
National Association of School Nurses (NASN). (2012, January). Position Statement: Medication Administration in the School Setting. Retrieved from: http://www.nasn.org/Portals/0/positions/2012psmedication.pdf