Hanover Public Schools Health Services

1. Hanover Public SchoolsHealth Services School Health Update 2007-2008 Prepared by Jean Hight R.N., BSN Nurse Leader February 2008

2. Mission Statement The primary mission of the Hanover Public Schools Health Services is to support educational achievement for all students. The Hanover School Nurses strive to accomplish this goal by providing quality holistic health care to all students. Through health education and promotion we encourage the establishment of healthy behaviors and healthy life choices. “A healthy child is a better learner”Author Unknown

3. Sept. 2007 - Jan. 2008 Health Office Visits

4. Health Screenings *2006 - 2007 • Vision Screening – 2,474 – 71 Referrals • Hearing – 2,294 – 107 Referrals • Postural Screening – 895 – 36 Referrals • Heights and Weights – 1,027 * Please note: These are in addition to Health Office visits

5. Body Mass Index (BMI) Percentiles*2006 - 2007

6. Impact of Obesity Obesity puts children at risk for debilitating or life threatening health problems such as type 2 diabetes, heart disease, high blood pressure, and stroke.

7. Medications Sept. 2007 - Jan. 2008 • Total Medication Orders: 204 (approximately 7.5% of students) • Total Medications Administered: 4,579 • Staff Medications: 137

8. Medical Conditions 2006-2007 This does not include other medical conditions such as mental health (depression, bi-polar, anxiety), Down Syndrome, Celiac Disease, Migraines, Orthopedic Problems, Cystic Fibrosis, Cancer, Genetic Disorders, and others.

9. Nursing Procedures Sept. 2007 - Jan. 2008 3,251 Nursing Procedures Total • Blood Glucose Testing – 1,029 • Insulin Pump Care - 212 • Respiratory Procedures – 263 • Blood Pressure Monitoring – 40 • Wound Care - 695 • Orthopedic Procedures – 110 • Head Checks for Pediculosis – 265 • Other - 637

10. Dismissals Sept. 2007 - Jan. 2008

11. Communications Sept. 2007 - Jan. 2008 • 1,752 Parent Phone Conferences • 1,105 Meetings/Conferences With Staff • 144 Communication with Community Agencies • 102 Referrals to Primary Care Physician • 5 Other Referrals

12. Staff Health Sept. 2007 - Jan. 2008 • 117 Visits For Illness Assessments • 137 Medications • 55 Visits For First Aid

13. Education Laws and Regulations 603 CMR 7.11 Professional Support Personnel Licenses School Nurse (Levels:All) (a) Initial License. • Valid license to practice as a Registered Nurse in Massachusetts. • A bachelor’s or masters degree in nursing. • A minimum of 2 full years of employment as a Registered Nurse in child health, community health, or other relevant clinical nursing.

14. Laws and Regulations (continued) 4.Completion of an orientation program based on the requirements for delivery of school health services as defined by the Department of Public Health. 5. Passing score on the Communication and Literacy Skills test.

15. Laws and Regulations (continued) (b) Professional License • Possession of an Initial License. • 3 years of employment as a school nurse. • Completion of one of the following: a. Achievement and maintenance of certification or licensure from a nationally recognized association as a school nurse, community health nurse, or pediatric/family/school nurse practitioner. b. A master’s degree program that may include credits earned in master’s degree program for the Initial license in community health, health education, nursing, or public health.

16. Documentation • All Health events must be documented by the school nurse. • Health Records are a critical component for the documentation of health events. • All medications • Immunization Status • Vision, Hearing, Scoliosis Screening Results • Health History • Physical Exams

17. Documentation (continued) • ALL students with a special health condition (e.g. diabetes, asthma) MUST have a nursing Care Plan – Massachusetts General Laws (“M.G.L.”) 244 CMR 3.02 • Each medication order MUST have a written medication administration plan per M.G.L., 105 CMR 210.005

18. What does the School Nurse do? • Stocks and maintains health care office. • Episodic assessment and nursing care. • Writes Individual Health Care Plans (IHCP) for each student with special needs, i.e. Life Threatening Food Allergy (LTA), Diabetes, Cystic Fibrosis, Cancer, Asthma, etc. • Communicates with administration and staff about health needs. • Does screenings and makes referrals. • Acts as a resource. • Provides individual and group health education and promotion to students, staff, and parents. • Communicates with physicians and community agencies on an as needed basis to promote the health of students. • Documents care and events. • Much more…

19. What does the Nurse Leader do? • Plans and coordinates district-wide health services program. • Communicates and collaborates with local board of health, school physician, and Massachusetts Department of Public Health (MDPH). • Collaborates with school personnel and supports team approach for student physical, social, mental, and emotional health. • Attends quarterly MDPH School Nurse Leader meetings • Attends regional Nurse Leader Meetings. • Does Monthly Activities Report for MDPH – electronic submission. • Does Annual reports for MDPH. • Participates in Continuous Quality Improvement Program (CQI). Currently doing Vision CQI. • Co-chairs Health Advisory Council, a diverse group from the schools and the community that promotes wellness and healthy behaviors.

20. Nurse Leader (continued) • Chairs Healthy Schools Committee which evaluates and manages school facilities for environmental, safety, and health issues. • Assists in maintaining school health management system (Healthmaster) which enables ongoing data analysis. • Promotes the use of the new MDPH “School Health Manual”. • Collaborates with Superintendent and others to develop health policies, i.e. Life Threatening Allergy (LTA) and Emergency Preparedness. • Maintains Automated External Defibrillators (AEDs) and provides CPR/AED training opportunities. • Supervises and manages school nurses. Holds monthly meetings. • Orients, trains and supervises substitute nursing staff. • Collaborates with school business manager in preparing school health supplies budget and Essential School Health Services (ESHS) “Program Budget Plan”.

21. Nurse Leader (continued) • Does yearly review of school nurse procedure manual. • Promotes school nurse networking in community with private, collaborative, and vocational schools. • Ensures that these schools receive information from the MDPH (weekly e-mails and alerts) as well as other health information. • Member of groups promoting health and safety within the community, i.e. the Hanover Alliance for the Prevention of Substance Abuse (HAPSA) and the Regional Emergency Management Systems (REMS) task force.

22. Recommended RatioSchool Nurse to Student In the 1998 Report to the Massachusetts Legislature, “Options for Developing School Health Services in the Commonwealth of Massachusetts”, the Department of Public Health recommended the following: • One fulltime equivalent (FTE) licensed school nurse for each building (both public and nonpublic) with 250 to 500 students; • An additional 0.1 FTE for each additional 50 students in buildings with more than 500 students; and • 0.1 FTE for each 25 students in buildings with fewer than 250 students. When developing staffing plans, other factors to consider include the number of children with special health care needs, the number of buildings, and the distance and/or travel time between buildings.

23. Hanover Schools Enrollment

24. Closing Summary The goal of the Health Services is to support education by keeping students healthy, in school and ready to learn. Student health needs have grown increasingly complex through the advancement of medical technology and requires professional nursing staff for school attendance. Student health complexities have increased the demand for continuous documentation. The need for nursing staff and a nurse leader is evidenced by the volume and complexity of health office visits and the volume and complexity of health issues encountered in our schools today.