School nursing: It’s not just about Band-Aids!

School nursing is a complex and challenging specialty practice area that is sometimes poorly understood. The School Nurse Organization of Washington (SNOW) provides a valuable connection for school nurses in our state. SNOW’s mission is to “support school nurses in the delivery of health services designed to improve the health and academic success of students.” The role of the school nurse varies depending on school district demographics (urban, rural and suburban), the number of schools the nurse is responsible for, the number of students the nurse is responsible for and the complexity of health care needs as well as social determinants of health of the population served. Often, the school nurse is the only health care professional a student has access to.

One important role of the school nurse is the provision of care coordination for students with chronic health conditions. School nurses support student health and educational outcomes by training staff to recognize and respond to emergencies for students with chronic or life-threatening conditions, monitoring medication response for students with conditions like asthma, seizure disorders and diabetes, and teaching developmentally appropriate self-management of chronic health conditions. Although many school nurses provide day-to-day care for children with acute illnesses and injuries (and this is how school nurses are typically viewed by the public), that is only a small part of the school nurse role.

SNOW’s membership of more than 500 school nurses is representative of school districts across Washington state. Since school nurses often practice in isolation, this connection is invaluable. SNOW works to help school nurses speak with a unified voice to describe this unique practice area to the public and to policy makers.

School nurse independence in nursing practice

This legislative session, SNOW will be re-introducing legislation that will clarify that non-nurses are not allowed to supervise nursing practice in the educational setting. What this means is that while school principals and other administrators can supervise nurses regarding employment matters such as scheduling, they are barred from directing the nursing care of school nurses. This is important because while the RN’s ability to practice independently is clearly safeguarded in RCW 18.79 (Washington state’s Nurse Practice Act), it is not clear in school law. This has resulted in multiple instances in which school nurses have been reprimanded for not following the directions of a school administrator. Restating the RN’s ability to practice independently within the guidelines of RCW 18.79 in educational law will prevent this from happening.

Discrete funding stream for school nurses

Another legislative priority for SNOW is to establish school nurses as a discrete category in Washington’s Basic Education Funding Formula as it is being revised as a result of the McCleary decision. A recent SNOW survey indicated that most school nurse positions are funded with Basic Education Fund dollars. Without a discrete category for school nurses in this funding stream, similar to that proposed for school counselors, school nurse positions will continue to be funded in competition with other categories of school employees.

Delegation of nasal Midolazam administration

SNOW is currently working in partnership with the Epilepsy Foundation and Seattle Children's to facilitate the implementation of 2013 legislation governing seizure management in schools. This legislation allowed for RN delegation of the administration of nasal Midazolam to unlicensed school staff or, when that is not possible, the utilization of parent-designated adults (PDAs) to administer that medication. To date, very few school districts allow the delegation of nasal Midazolam, even fewer RNs have delegated even in the districts where policy allows it, and no provider has stepped up to offer PDA training as allowed in the law. SNOW is looking at the feasibility of requesting legislative funding for a workgroup that will bring stakeholders together to create guidance that includes a curriculum to teach non-licensed individuals how to administer this medication.

As the issues described above illustrate, school nursing is a complex and challenging specialty area. SNOW plays a critically important role in advocating for school nurses in order to improve the health and academic outcomes for all students. Healthy students show up to school ready to learn, and educated children grow up to have healthier families. School nurses play a large role in making that happen.