Superintendent s Education Update

Transcription

1 Superintendent s Education Update DATE: October 19, 2017 District Nurse Report (By Kevin Bogatin) Over the last few years, we have had discussions regarding the growing medical needs of our students and the need for additional support. As part of those conversations, I asked our district nurses to compile data and a report summarizing the current work and more clearly defining the needs district-wide. Attached is the most recent report; it includes data requested by the board following public comment given at the October 12, 2017, board meeting. Please feel free to contact me should you have any questions.

2 Corvallis School District Nurse Report ~ 1 ~

3 TABLE OF CONTENTS Medically Fragile Services Report information. 3 Corvallis School District Data..4 District Nurse Activities. 5 Staff Training and Education...6 Health Screenings 6 Requests for Donated Services 6 Referrals to Other Services...7 District Nurse Goals...7 Medicaid Billing...7 Nurse to Student Ratio 8 Appendix: Guidance for Assessing Student Health Conditions for Annual Oregon Department of Education School Nurse Data Collection 10 ~ 2 ~

4 Denise Diller, MSN-PH, RN and Trish Pokrzywa, BSN, RN each continued in their positions as 1.0 FTE District Nurses (2.0 FTE total) for the school year. Denise will be leaving the district after the school year is complete due to family relocation. Her replacement is Jen Coppock who was hired in May. She has been shadowing Denise as her current work schedule allows. Donna Cowger increased her hours to 3 ½ hours per day as administrative assistant to the nurses for the school year. She is retiring after the school year is complete. Denise and Trish completed ODE s Medically Fragile Services Report on 6/12/17 and Dental Screening Report on 5/23/17. MEDICALLY FRAGILE SERVICES REPORT Definitions for counts as detailed in the Guidance for Assessing Student Health Conditions for Annual Oregon Department of Education School Nurse Data Collection dated 3/3/16 (attached at end of report, contains more detailed definitions): General Student Population (1:750 nurse-student ratio recommended*) Students with normal growth and development or intermittent acute illness/injury events; if a condition exists, it is uncomplicated and predictable. Nursing Assessment: No identified/ongoing nursing intervention at school; no health plan necessary. Medically Complex Students (1:225 ratio mandated*) Students who may have an unstable health condition and who may require daily professional nursing services (ORS ) Nursing Assessment: Needs more than a first aid response; a health plan may or may not be in place. Note: ORS allows school districts to satisfy the nurse ratio requirements for medically complex students by providing personnel trained and supervised by registered nurse or school nurse (ORS (4)(b).) Medically Fragile Students (1:125 ratio mandated*) Students who may have a life-threatening health condition and who may require immediate professional nursing services. (ORS ) Nursing Assessment: Licensed nurse is readily available for assessment and/or intervention. Nursing-Dependent Students (1:1 ratio) Students who may have an unstable or life-threatening health condition and who may require daily, direct, and continuous professional nursing services. (ORS ) Nursing Assessment: Student requires direct and continuous care by a license nurse (1:1). *Oregon HB ~ 3 ~

5 CORVALLIS SCHOOL DISTRICT DATA School Year General Student Population Number of Students in Need of Nursing Care Medically Complex Students Medically Fragile Students Nursing-Dependent Students Registered Nurse Count: 5 (includes three contracted nurses providing 1:1 care and two district nurses) School Nurse Count: 0* *The Oregon Department of Education defines school nurse as a RN who has additionally received a certificate from the Teacher Standards and Practices Commission. School Year Number of Students with Specific Health Conditions Asthma Food Allergies Other Seizures Diabetes Other total EpiPen allergies total emergency ongoing w/epipen treatment medical not counted We continue to work with the schools on refining the use of Student Information System flags to more accurately reflect the district s health conditions. This is reflected in some of the big year-to-year changes in health condition numbers. ~ 4 ~

6 1 DISTRICT NURSE ACTIVITIES Daily management and maintenance of 465 Medical Protocols and/or Emergency Action Plans for students with health conditions. Delegations to school staff, such as tube feedings, diabetes care and nebulizer treatments. Extended time with several diabetic students with higher than usual needs. Preparation and collaboration with administrators and parents to develop IEPs/504s. Consults with other health professionals: physicians, nurses, PT/OT/ST, dieticians, diabetes educators Health room assessments/consultations/health log management Immunization issues: ensure immunization law is followed in the district, provide information related to immunizations to schools and families, liaison between school district and health department for immunization issues Work on ensuring district compliance with new Dental Screening Law regarding Certification forms and data collection. (HB 2972) Treatment guides for head lice, bed bugs, spider bites, injuries, allergic reactions and rashes Field trip planning with parents and teachers to ensure each student with a health condition has an opportunity to participate. o Participation in Mary s Peak field trips when high-medical needs students are on trip. o Extended field trip planning, including: Franklin 7 th grade 9-day Washington DC trip Wilson 5 th grade 3-day Outdoor School Cheldelin 8 th grade week-long Washington DC trip Jefferson 5 th grade 3-day Outdoor School Adams 5 th grade 3-day Outdoor School Hoover 5 th grade 3-day Outdoor School Lincoln 5 th grade 3-day Outdoor School Others as scheduled, i.e. robotics, music, etc. Health education: information taught and given to school staff, classroom teachers, students and their parents regarding multiple health issues including seizures, severe food allergies, bleeding disorders and diabetes. Consults with school office/health room staff regarding health and safety issues with several students involving DHS Child Protective Services Communicable Disease Surveillance o Consultations with schools and Benton County Health Department regarding: Norovirus, Pertussis (whooping cough), Influenza, Hand-Food-and-Mouth Disease, Chickenpox, Strep, Impetigo, Scabies, Mono ~ 5 ~

7 2 TRAINING AND EDUCATION A total of 325 district staff members received training from the nurses at 40 individual classes held throughout the year. Training # of Trainings Held # of Employees Trained Epi-Pen Glucagon 9 67 Non-injectable medications Diastat/seizures 9 56 Core diabetes training HEALTH SCREENINGS Vision screenings were conducted at all elementary schools, College Hill and for 7 th and 10 th graders. Vision screening is conducted in partnership with the Lions Club using SPOT screeners. These screen for six different vision issues (myopia, hyperopia, anisometropia, astigmatism, anisocoria and strabismus) students had vision screens. 299 students were referred for vision needs. Dental screenings were conducted at all elementary schools and College Hill. Dental screening is conducted in partnership with the Benton County Health Department and the Johnson Dental Clinic at the Boys and Girls Club. Approximately 2716 students had dental screens. Estimated 240 students were referred for dental needs. 4 REQUEST FOR DONATED SERVICES Thousands of dollars donated in vision services by Corvallis Lions Club and Lions Sight and Hearing Foundation (KEX program). Vision vouchers were offered by the local Elks Chapter, the Lions Club and the KEX program for distribution to students throughout the district to use for eyeglasses and vision exams. Donated eye exams provided by Eyecare Associates, All Family Vision Care, Kings Circle Optical and Valley Eyecare via referral from Elks Club. ~ 6 ~

8 5 REFERRALS TO OTHER SERVICES Multiple referrals to these community and school resources: Johnson Dental Clinic at Corvallis Boys and Girls Club Community Outreach Benton County Health Department, Lincoln Health Center and Family Planning Clinic Carolyn Hinds Corvallis School District Homeless Advocate Old Mill Center Corvallis Lions Club Vision Assistance Program Corvallis Elks Chapter for Vision Lions Sight and Hearing Foundation 6 DISTRICT NURSE GOALS District-wide Food Allergy Policy with ever-increasing numbers of food allergies, we need consistency across the district with food allergy management. More frequent (at least monthly) check-ins with parents of students with chronic needs, especially those in Life Skills. Add prevention activities for the district s students, families and staff. More frequent oversight and auditing of medications at schools. More in-school time. Evaluation of district health policies, i.e. effectiveness, use of evidence-based practice, incorporation of equity principles 7 MEDICAID BILLING In our schools there are nursing procedures performed by both nurses and delegated school staff that are potentially billable to Medicaid. This is particularly true in the chronic medical needs student population. In order to appropriately bill for nursing procedures done by CSD school staff, there needs to be specific documentation that is needed from Medical Doctors, District Nurses, and the delegated school staff. The District Nurses have begun to identify gaps of missing documentation that needs to be in place to obtain reimbursement of funds by Medicaid. Our next goal is to create documents and processes that capture the needed missing information. Each nursing procedure needs its own specific documentation. The CSD District Nurses long range plan is work with CSD, LBL ESD, Oregon Department of Education, Oregon Health Authority, Oregon School Nurse Association, National School Nurse Association, and Oregon Department of Human Resources to learn more about billing for these nursing tasks that are taking place multiple times per day in our schools. This reimbursement of Medicaid funds over time could be a substantial savings to the school district. ~ 7 ~

9 8 NURSE TO STUDENT RATIO As is seen in this report, there is a significant amount of work performed by the two full-time nurses. This leaves us very limited in our response to and availability for the day-to-day needs at our schools. Oregon HB 2693 (2009) states: Each school district shall ensure that the district has access to a sufficient level of nursing services to provide: a. One registered nurse or school nurse for every 225 medically complex students. b. One registered nurse or school nurse for every 125 medically fragile students. c. One registered nurse or school nurse, or one licensed practical nurse under the supervision of a registered nurse or school nurse, for each nursing-dependent student. In addition to the requirements listed above, each school district is encouraged to have one registered nurse or school nurse for every 750 students in the school district. A school district may satisfy the requirements described above by using the most cost-effective means available: a. Subsection (a.) and the 1:750 recommendation may be satisfied by: Providing personnel trained and supervised by a registered nurse or school nurse. As of this school year, our district s nurse to student ratio is approximately 1:3300. National average is approximately 1:1472. Oregon s nurse to student ratio is approximately 1:4664 as of 2015, one of the highest ratios in the country. So while our ratio is lower than Oregon as a whole, there is still much room for improvement. Currently we have two nurses covering 13 schools. Trish is assigned to six schools and Denise (with Jen replacing her Aug.2017) is assigned to seven. In a survey conducted in 2015 by the National Association of School Nurses, 51% of responding nurses cover one building, 16% cover two, with further percentages seen in the pie chart below. The results indicated an average of covering three Buildings Covered, 2015 buildings. The entire survey results are available at: If a third full-time nurse were added to the district, our ratio would be down to around 1:2200 and number of buildings covered would be significantly down. While still high, the ratio would be much safer for the district s students. Currently, we are very limited in what we can provide training-wise for staff other than scheduled monthly trainings. Having an additional nurse would give us the ability to provide more trainings at our individual schools as the need arises. Our proposal would be: Trish keep the three schools with Life Skills (Jefferson, LPMS, CHS) and WINGS. o Life Skills students take up a significant amount of nursing time, making it very difficult to meet the needs of other schools. Trish s nursing history and skills make her ideal for these students. Jen keep College Hill, CV, Cheldelin, Mt. View and Wilson. A third nurse would take over Lincoln, Garfield, Adams, Franklin and Hoover. ~ 8 ~

10 This change would greatly increase nurse flexibility for managing the day-to-day medical needs for our students. It would also increase our ability to focus more effectively on achieving our goals. Respectfully submitted, Denise Diller, MSN-PH, RN Patricia Pokrzywa, BSN, RN Corvallis School District Nurses Donna Cowger District Nurse Administrative Assistant ~ 9 ~

11 Appendix A Guidance for Assessing Student Health Conditions for Annual Oregon Department of Education School Nurse Data Collection This document is provided as guidance for completing the Annual Oregon Department of Education School Nurse Data collection. It is recommended that district administration review all laws, administrative rules, and guidance documents when making decisions affecting nursing ratios. General Student Population (1:750 recommended) Description: Students with normal growth & development or intermittent acute illness/injury events; if a condition exists, it is uncomplicated and predictable. Asthma Example: Student identified on registration forms as having asthma. No known events at school, no contact from parents/staff/student. Student may have rescue inhaler at school. Asthma is well managed, no exacerbations or hospitalizations in past year. Seizure Example: Student with history of febrile seizure(s). No further seizure activity, no antiepileptic medication. Well-controlled with medication with rare breakthrough seizures outside of school setting. Severe Allergic Reaction (SAR) Example: Student has penicillin allergy Behavioral example: On medication for depression or other mental health diagnosis with stable dosing of long-term medication. Medication example: Over the counter (OTC), non-prescription medications available at school (acetaminophen, ibuprofen, cough drops, etc.); self-administration of medications Miscellaneous Example: Student with muscular dystrophy but no ongoing nursing needs at school. RN chooses to monitor student annually Nursing Assessment: No identified/ongoing nursing intervention at school; no health plan necessary. Medically Complex (1:225 mandated) Definition: Medically complex students means students who may have an unstable health condition and who may require daily professional nursing services. (ORS ) Asthma Example: Frequent use of rescue inhaler: multiple times per week. Frequent health room visits and/or PMD/hospital visits require assessment and intervention by nurse. Student may/may not have nebulizer. Seizure Example: Student has occasional breakthrough seizures at school. SAR Example: Student with identified allergy and has medication ordered for treatment (antihistamine or epinephrine), may be life-threatening Diabetes Example: Diabetic student with blood glucose monitoring supplies and Glucagon at school. Student may/may not be independent self-manager Behavioral Example: Student on medication for depression or other mental health issue with frequent medication dosage changes and staff symptom monitoring. Student discharged after emergent hospitalization for eating disorder, long history of cutting and emergent hospitalizations Medication Example: Daily medication given at school by school staff, may require student/family education and/or side effects monitoring Miscellaneous Example: Student requires clean intermittent catheterization daily at school; student has a long-term G-tube feeding at school Concussion example: Student with a recent concussion that needs monitoring and interventions to help with their recovery and academic success. Nursing Assessment: Needs more than a first aid response; a health plan may or may not be in place Note: ORS allows school districts to satisfy the nurse ratio requirements for medically complex students by providing personnel trained and supervised by registered nurse or school nurse. (ORS (4) (b).) ~ 10 ~

12 Medically Fragile (1:125 mandated) Definition: Medically Fragile students means students who may have a life-threatening health condition and who may require immediate professional nursing services. (ORS ) Asthma Example: Student uses rescue inhaler 3-4 times in 24 hour. Peak flows are 65% or less of student s expected normal. Hospitalizations and/or emergent ED visit(s) have occurred in past year Seizure Example: Severe seizure disorder requiring immediate intervention with VNS and/or rectal Diastat; student has frequent cluster seizures making it difficult for unlicensed staff to identify beginning and/or end of seizure activity. Student often has prolonged post-ictal phase SAR Example: Severe and/or multiple life-threatening allergies necessitating wide-ranging accommodations in the school setting Diabetes Example: Student with highly variable blood glucose levels, and/or student requiring insulin administration at school, and/or non-compliant student, and/or student with cognitive impairment, and/or newly diagnosed student Behavioral example: Suicidal ideation requiring frequent monitoring/assessment by school staff Miscellaneous example: Multiple complex conditions that combined put the student at risk of a life-threatening event Nursing Assessment: Licensed nurse is readily available for assessment and/or intervention Nursing Dependent (1:1) Definition: Nursing-dependent students means students who may have an unstable or lifethreatening health condition and who may require daily, direct, and continuous professional nursing services. (ORS ) Example: Student with tracheostomy that requires nursing assessment & care to maintain airway Example: Student with multiple health conditions e.g. compromised airway, severe seizure disorder, GT feedings, etc. that requires skilled nursing assessment and intervention Nursing Assessment: Student requires direct and continuous care by a licensed nurse (1:1) For questions please contact: Ely Sanders, MPA Sexual Health and School Health Specialist Oregon Department of Education Office: ely.sanders@ode.state.or.us ~ 11 ~

13 Corvallis School District Nurse Report ~ 1 ~

14 TABLE OF CONTENTS Medically Fragile Services Report information. 3 Corvallis School District Data..4 District Nurse Activities. 5 Staff Training and Education...6 Health Screenings 6 Requests for Donated Services 6 Referrals to Other Services...7 District Nurse Goals...7 Medicaid Billing...7 Nurse to Student Ratio 8 Appendix: Guidance for Assessing Student Health Conditions for Annual Oregon Department of Education School Nurse Data Collection 10 ~ 2 ~

15 Denise Diller, MSN-PH, RN and Trish Pokrzywa, BSN, RN each continued in their positions as 1.0 FTE District Nurses (2.0 FTE total) for the school year. Denise will be leaving the district after the school year is complete due to family relocation. Her replacement is Jen Coppock who was hired in May. She has been shadowing Denise as her current work schedule allows. Donna Cowger increased her hours to 3 ½ hours per day as administrative assistant to the nurses for the school year. She is retiring after the school year is complete. Denise and Trish completed ODE s Medically Fragile Services Report on 6/12/17 and Dental Screening Report on 5/23/17. MEDICALLY FRAGILE SERVICES REPORT Definitions for counts as detailed in the Guidance for Assessing Student Health Conditions for Annual Oregon Department of Education School Nurse Data Collection dated 3/3/16 (attached at end of report, contains more detailed definitions): General Student Population (1:750 nurse-student ratio recommended*) Students with normal growth and development or intermittent acute illness/injury events; if a condition exists, it is uncomplicated and predictable. Nursing Assessment: No identified/ongoing nursing intervention at school; no health plan necessary. Medically Complex Students (1:225 ratio mandated*) Students who may have an unstable health condition and who may require daily professional nursing services (ORS ) Nursing Assessment: Needs more than a first aid response; a health plan may or may not be in place. Note: ORS allows school districts to satisfy the nurse ratio requirements for medically complex students by providing personnel trained and supervised by registered nurse or school nurse (ORS (4)(b).) Medically Fragile Students (1:125 ratio mandated*) Students who may have a life-threatening health condition and who may require immediate professional nursing services. (ORS ) Nursing Assessment: Licensed nurse is readily available for assessment and/or intervention. Nursing-Dependent Students (1:1 ratio) Students who may have an unstable or life-threatening health condition and who may require daily, direct, and continuous professional nursing services. (ORS ) Nursing Assessment: Student requires direct and continuous care by a license nurse (1:1). *Oregon HB ~ 3 ~

16 CORVALLIS SCHOOL DISTRICT DATA School Year General Student Population Number of Students in Need of Nursing Care Medically Complex Students Medically Fragile Students Nursing-Dependent Students Registered Nurse Count: 5 (includes three contracted nurses providing 1:1 care and two district nurses) School Nurse Count: 0* *The Oregon Department of Education defines school nurse as a RN who has additionally received a certificate from the Teacher Standards and Practices Commission. School Year Number of Students with Specific Health Conditions Asthma Food Allergies Other Seizures Diabetes Other total EpiPen allergies total emergency ongoing w/epipen treatment medical not counted We continue to work with the schools on refining the use of Student Information System flags to more accurately reflect the district s health conditions. This is reflected in some of the big year-to-year changes in health condition numbers. ~ 4 ~

17 1 DISTRICT NURSE ACTIVITIES Daily management and maintenance of 465 Medical Protocols and/or Emergency Action Plans for students with health conditions. Delegations to school staff, such as tube feedings, diabetes care and nebulizer treatments. Extended time with several diabetic students with higher than usual needs. Preparation and collaboration with administrators and parents to develop IEPs/504s. Consults with other health professionals: physicians, nurses, PT/OT/ST, dieticians, diabetes educators Health room assessments/consultations/health log management Immunization issues: ensure immunization law is followed in the district, provide information related to immunizations to schools and families, liaison between school district and health department for immunization issues Work on ensuring district compliance with new Dental Screening Law regarding Certification forms and data collection. (HB 2972) Treatment guides for head lice, bed bugs, spider bites, injuries, allergic reactions and rashes Field trip planning with parents and teachers to ensure each student with a health condition has an opportunity to participate. o Participation in Mary s Peak field trips when high-medical needs students are on trip. o Extended field trip planning, including: Franklin 7 th grade 9-day Washington DC trip Wilson 5 th grade 3-day Outdoor School Cheldelin 8 th grade week-long Washington DC trip Jefferson 5 th grade 3-day Outdoor School Adams 5 th grade 3-day Outdoor School Hoover 5 th grade 3-day Outdoor School Lincoln 5 th grade 3-day Outdoor School Others as scheduled, i.e. robotics, music, etc. Health education: information taught and given to school staff, classroom teachers, students and their parents regarding multiple health issues including seizures, severe food allergies, bleeding disorders and diabetes. Consults with school office/health room staff regarding health and safety issues with several students involving DHS Child Protective Services Communicable Disease Surveillance o Consultations with schools and Benton County Health Department regarding: Norovirus, Pertussis (whooping cough), Influenza, Hand-Food-and-Mouth Disease, Chickenpox, Strep, Impetigo, Scabies, Mono ~ 5 ~

18 2 TRAINING AND EDUCATION A total of 325 district staff members received training from the nurses at 40 individual classes held throughout the year. Training # of Trainings Held # of Employees Trained Epi-Pen Glucagon 9 67 Non-injectable medications Diastat/seizures 9 56 Core diabetes training HEALTH SCREENINGS Vision screenings were conducted at all elementary schools, College Hill and for 7 th and 10 th graders. Vision screening is conducted in partnership with the Lions Club using SPOT screeners. These screen for six different vision issues (myopia, hyperopia, anisometropia, astigmatism, anisocoria and strabismus) students had vision screens. 299 students were referred for vision needs. Dental screenings were conducted at all elementary schools and College Hill. Dental screening is conducted in partnership with the Benton County Health Department and the Johnson Dental Clinic at the Boys and Girls Club. Approximately 2716 students had dental screens. Estimated 240 students were referred for dental needs. 4 REQUEST FOR DONATED SERVICES Thousands of dollars donated in vision services by Corvallis Lions Club and Lions Sight and Hearing Foundation (KEX program). Vision vouchers were offered by the local Elks Chapter, the Lions Club and the KEX program for distribution to students throughout the district to use for eyeglasses and vision exams. Donated eye exams provided by Eyecare Associates, All Family Vision Care, Kings Circle Optical and Valley Eyecare via referral from Elks Club. ~ 6 ~

19 5 REFERRALS TO OTHER SERVICES Multiple referrals to these community and school resources: Johnson Dental Clinic at Corvallis Boys and Girls Club Community Outreach Benton County Health Department, Lincoln Health Center and Family Planning Clinic Carolyn Hinds Corvallis School District Homeless Advocate Old Mill Center Corvallis Lions Club Vision Assistance Program Corvallis Elks Chapter for Vision Lions Sight and Hearing Foundation 6 DISTRICT NURSE GOALS District-wide Food Allergy Policy with ever-increasing numbers of food allergies, we need consistency across the district with food allergy management. More frequent (at least monthly) check-ins with parents of students with chronic needs, especially those in Life Skills. Add prevention activities for the district s students, families and staff. More frequent oversight and auditing of medications at schools. More in-school time. Evaluation of district health policies, i.e. effectiveness, use of evidence-based practice, incorporation of equity principles 7 MEDICAID BILLING In our schools there are nursing procedures performed by both nurses and delegated school staff that are potentially billable to Medicaid. This is particularly true in the chronic medical needs student population. In order to appropriately bill for nursing procedures done by CSD school staff, there needs to be specific documentation that is needed from Medical Doctors, District Nurses, and the delegated school staff. The District Nurses have begun to identify gaps of missing documentation that needs to be in place to obtain reimbursement of funds by Medicaid. Our next goal is to create documents and processes that capture the needed missing information. Each nursing procedure needs its own specific documentation. The CSD District Nurses long range plan is work with CSD, LBL ESD, Oregon Department of Education, Oregon Health Authority, Oregon School Nurse Association, National School Nurse Association, and Oregon Department of Human Resources to learn more about billing for these nursing tasks that are taking place multiple times per day in our schools. This reimbursement of Medicaid funds over time could be a substantial savings to the school district. ~ 7 ~

20 8 NURSE TO STUDENT RATIO As is seen in this report, there is a significant amount of work performed by the two full-time nurses. This leaves us very limited in our response to and availability for the day-to-day needs at our schools. Oregon HB 2693 (2009) states: Each school district shall ensure that the district has access to a sufficient level of nursing services to provide: a. One registered nurse or school nurse for every 225 medically complex students. b. One registered nurse or school nurse for every 125 medically fragile students. c. One registered nurse or school nurse, or one licensed practical nurse under the supervision of a registered nurse or school nurse, for each nursing-dependent student. In addition to the requirements listed above, each school district is encouraged to have one registered nurse or school nurse for every 750 students in the school district. A school district may satisfy the requirements described above by using the most cost-effective means available: a. Subsection (a.) and the 1:750 recommendation may be satisfied by: Providing personnel trained and supervised by a registered nurse or school nurse. As of this school year, our district s nurse to student ratio is approximately 1:3300. National average is approximately 1:1472. Oregon s nurse to student ratio is approximately 1:4664 as of 2015, one of the highest ratios in the country. So while our ratio is lower than Oregon as a whole, there is still much room for improvement. Currently we have two nurses covering 13 schools. Trish is assigned to six schools and Denise (with Jen replacing her Aug.2017) is assigned to seven. In a survey conducted in 2015 by the National Association of School Nurses, 51% of responding nurses cover one building, 16% cover two, with further percentages seen in the pie chart below. The results indicated an average of covering three Buildings Covered, 2015 buildings. The entire survey results are available at: If a third full-time nurse were added to the district, our ratio would be down to around 1:2200 and number of buildings covered would be significantly down. While still high, the ratio would be much safer for the district s students. Currently, we are very limited in what we can provide training-wise for staff other than scheduled monthly trainings. Having an additional nurse would give us the ability to provide more trainings at our individual schools as the need arises. Our proposal would be: Trish keep the three schools with Life Skills (Jefferson, LPMS, CHS) and WINGS. o Life Skills students take up a significant amount of nursing time, making it very difficult to meet the needs of other schools. Trish s nursing history and skills make her ideal for these students. Jen keep College Hill, CV, Cheldelin, Mt. View and Wilson. A third nurse would take over Lincoln, Garfield, Adams, Franklin and Hoover. ~ 8 ~

21 This change would greatly increase nurse flexibility for managing the day-to-day medical needs for our students. It would also increase our ability to focus more effectively on achieving our goals. Respectfully submitted, Denise Diller, MSN-PH, RN Patricia Pokrzywa, BSN, RN Corvallis School District Nurses Donna Cowger District Nurse Administrative Assistant ~ 9 ~

22 Appendix A Guidance for Assessing Student Health Conditions for Annual Oregon Department of Education School Nurse Data Collection This document is provided as guidance for completing the Annual Oregon Department of Education School Nurse Data collection. It is recommended that district administration review all laws, administrative rules, and guidance documents when making decisions affecting nursing ratios. General Student Population (1:750 recommended) Description: Students with normal growth & development or intermittent acute illness/injury events; if a condition exists, it is uncomplicated and predictable. Asthma Example: Student identified on registration forms as having asthma. No known events at school, no contact from parents/staff/student. Student may have rescue inhaler at school. Asthma is well managed, no exacerbations or hospitalizations in past year. Seizure Example: Student with history of febrile seizure(s). No further seizure activity, no antiepileptic medication. Well-controlled with medication with rare breakthrough seizures outside of school setting. Severe Allergic Reaction (SAR) Example: Student has penicillin allergy Behavioral example: On medication for depression or other mental health diagnosis with stable dosing of long-term medication. Medication example: Over the counter (OTC), non-prescription medications available at school (acetaminophen, ibuprofen, cough drops, etc.); self-administration of medications Miscellaneous Example: Student with muscular dystrophy but no ongoing nursing needs at school. RN chooses to monitor student annually Nursing Assessment: No identified/ongoing nursing intervention at school; no health plan necessary. Medically Complex (1:225 mandated) Definition: Medically complex students means students who may have an unstable health condition and who may require daily professional nursing services. (ORS ) Asthma Example: Frequent use of rescue inhaler: multiple times per week. Frequent health room visits and/or PMD/hospital visits require assessment and intervention by nurse. Student may/may not have nebulizer. Seizure Example: Student has occasional breakthrough seizures at school. SAR Example: Student with identified allergy and has medication ordered for treatment (antihistamine or epinephrine), may be life-threatening Diabetes Example: Diabetic student with blood glucose monitoring supplies and Glucagon at school. Student may/may not be independent self-manager Behavioral Example: Student on medication for depression or other mental health issue with frequent medication dosage changes and staff symptom monitoring. Student discharged after emergent hospitalization for eating disorder, long history of cutting and emergent hospitalizations Medication Example: Daily medication given at school by school staff, may require student/family education and/or side effects monitoring Miscellaneous Example: Student requires clean intermittent catheterization daily at school; student has a long-term G-tube feeding at school Concussion example: Student with a recent concussion that needs monitoring and interventions to help with their recovery and academic success. Nursing Assessment: Needs more than a first aid response; a health plan may or may not be in place Note: ORS allows school districts to satisfy the nurse ratio requirements for medically complex students by providing personnel trained and supervised by registered nurse or school nurse. (ORS (4) (b).) ~ 10 ~

23 Medically Fragile (1:125 mandated) Definition: Medically Fragile students means students who may have a life-threatening health condition and who may require immediate professional nursing services. (ORS ) Asthma Example: Student uses rescue inhaler 3-4 times in 24 hour. Peak flows are 65% or less of student s expected normal. Hospitalizations and/or emergent ED visit(s) have occurred in past year Seizure Example: Severe seizure disorder requiring immediate intervention with VNS and/or rectal Diastat; student has frequent cluster seizures making it difficult for unlicensed staff to identify beginning and/or end of seizure activity. Student often has prolonged post-ictal phase SAR Example: Severe and/or multiple life-threatening allergies necessitating wide-ranging accommodations in the school setting Diabetes Example: Student with highly variable blood glucose levels, and/or student requiring insulin administration at school, and/or non-compliant student, and/or student with cognitive impairment, and/or newly diagnosed student Behavioral example: Suicidal ideation requiring frequent monitoring/assessment by school staff Miscellaneous example: Multiple complex conditions that combined put the student at risk of a life-threatening event Nursing Assessment: Licensed nurse is readily available for assessment and/or intervention Nursing Dependent (1:1) Definition: Nursing-dependent students means students who may have an unstable or lifethreatening health condition and who may require daily, direct, and continuous professional nursing services. (ORS ) Example: Student with tracheostomy that requires nursing assessment & care to maintain airway Example: Student with multiple health conditions e.g. compromised airway, severe seizure disorder, GT feedings, etc. that requires skilled nursing assessment and intervention Nursing Assessment: Student requires direct and continuous care by a licensed nurse (1:1) For questions please contact: Ely Sanders, MPA Sexual Health and School Health Specialist Oregon Department of Education Office: ely.sanders@ode.state.or.us ~ 11 ~