Carrying Out Action Plans

Previously we have emailed Delegate Lionell Spruill Sr. and Delegate Rosalyn Dance, as well as, Senator Mark Warner and Senator Jim Webb.  Senator Mark Warner responded to our email and commented that he looks forward to reading our posts and encourages our support for this bill.  Senator Mark Warner stated that our voice is important to him and includes that faces enormous challenges as a Senator.  In his response, he invited us to sign up for his newsletter, and we encourage others to sign up for his newsletter at the following website http://warner.senate.gov.

We have created a Twitter account in order to bring this current healthcare issue to the public’s attention. Through Twitter we can follow other health organizations and health professionals, as well as, allow them to follow us. This enables our followers to get updated information regarding the bill and its progression as well as allowing them to see our position and current information.  Please follow us on Twitter @School_Nurse6

We have received multiple tweets reacting to our tweets regarding the school nurse to student ratio. One response was interested in the current ratio in Virginia. Another fellow tweeter, an RN and a blogger at Dr.Oz, responded with interest and mentioned us to Dr.Oz’s blog to help us spread the world. An additional follower stated that she felt that a school nurse was never around when she needed one and very encourages this bill. It is very important that the word is spread and that we hear about the issues that students have or had while they were growing up because these ideas can be passed on through this blog, tweets, and emails and can be used to impact the passage of this bill. We will continue to tweet and update the twitter and this blog with information about the bill.

Many fellow bloggers agree with the idea that the nurse to student ratio needs to be decreased. One blog comment brought up an interesting point regarding how the nurses feel about the current ratio. They stated that this large ratio could be overwhelming for the nurses and questioned about what would happen in an emergency situation. Therefore we will continue to tweet and encourage school nurses to follow us and state their feelings towards the bills’ issue.  An additional blog comment stated that they are currently blogging on this issue as well, and made a great suggestion about combining our ideas to further promote our information.

Our blog experience has been a positive influence on our nursing careers, by first providing ourselves with an additional means of professional communication, and second by promoting discussion about our blog as well as may others. It has also opened our eyes to the thought of being involved in healthcare issues as a nurse. Through this experience, we now realize that a nurse can have a strong political voice and really make a difference. We know that we are the primary advocates for patients and that our voice is very important. In addition, we have learned that nursing is not solely confined to a hospital but also involves the community as a whole and provides numerous opportunities to help vulnerable populations. Us nurses have the abilities to positively impact patients and vulnerable populations through our extensive knowledge and skills, and now, through this blog, we have evolved to provide support politically as well.

New Ideas

Since we created this blog, specifically since February 8, 2011, no progression has been noted and the bill remains in the House of Representatives, left in education. Although a progression as not be stated, we are currently continuing to research and gather information supporting our stance of this bill.

A blog from the Wall Street Journal, “The Juggle”, talks about the issue of having a qualified nurse at the school to take care of the children. This blog raises the question of whether or not all schools have a licensed school nurse. In some cases, the school secretary or an unlicensed volunteer play the role of a school nurse, rather than a licensed RN to tend to the children’s needs. If unlicensed personnel care for these children and a situation that they were uneducated about or an emergency was to occur, the proper care and safest care may not be provided. This blog also discussed that only 13 states have the appropriate student to nurse ratio that is recommended by the government.

The National Association of School Nurses (NASN) in 2007 commissioned a study on school nursing and student health. They investigated where school nursing services are located in the United States and where they are needed. Telephone interviews were conducted in 1055 schools that were randomly selected from 92,816 schools in 50 states. Of the schools interviewed, the average nurse to student ratio was 1:1151. Only 44.84% of schools have a full-time RN, which means that 55.17% of schools do not have a full time RN.

This leads into another question; what about the school children with chronic conditions? There have been vast changes in medicine in the past decade, one of which is that children with chronic conditions are able to go to public school. These “chronic conditions” include asthma, diabetes, and seizure disorders. While great strides have been made to help manage these conditions and help children live more normal lives, these children still need a continuous plan of care that involve medication and lifestyle changes, requiring critical nursing skills and teaching techniques that licensed personnel are trained in providing. Not having a trained nurse with skills to care for these student populations should be an issue of great concern because of the impact one episode or crisis could have on the health of these children without the proper care and immediate attention.

We are writing emails to key stakeholders. We contacted, via email, both Delegate Lionell Spruill Sr. and Delegate Rosalyn Dance inviting them to view our blog because they are the sponsor and co-sponsor of the bill we are supporting. We also emailed Senator Mark Warner and Senator Jim Webb, who are Senators of Virginia and are involved in bill approvals in Virginia, inviting them to read our blog. We have informed Delegate Lionell Spruill Sr., Delegate Rosalyn Dance, Senator Mark Warner, and Senator Jim Webb, of the blog significance to nurses as well as healthcare, because of their role in policy and decision-making about healthcare.

References:

National Association of School Nurses.  (2011). Press Room. Retrieved from: School nursing services in the U.S.: Where are we? Where do we need to go? at http://www.nasn.org/AboutNASN/PressRoom

The Wall Street Journal. The Juggle.  (2011). And Now a Call From the School Nurse, Um, Secretary. Retrieved from: http://blogs.wsj.com/juggle/2011/10/12/and-now-a-call-from-the-school-nurse-um-secretary/

The Impact of School Nurses on Students

The school nurse to student ratio is a very important issue that is currently being addressed as evidence by this bill attempting to be passed in Virginia. We, as nursing students, believe that the ratio of school nurses to students should be decreased, meaning that each school nurse should be responsible for less students.  This would be beneficial to parents, students, healthcare, teachers, nurses, and the public as a whole. There are examples of how each of these populations would benefit from the passage of this bill. Currently, most school nurses in Virginia are not only responsible for students in one school, but also students in multiple schools throughout the county. This could cause many problems for the students in the school when the nurse is not present and not readily available. Although school nurses are assigned to schools within a close proximity, travel times between schools in times of emergencies can be too long. For example, if a student has an asthma attack and the nurse is not present, the student may not have access to their inhaler. Also, if a student gets stung by a bee and needs an epi-pen, other individuals may not know how to provide the necessary care, which could be life threatening to the student. In a critical situation, if a non-trained person acts they may not have the critical thinking skills provided by a nurse to further the child's treatment. Teachers may have adequate knowledge regarding basic care of simple injuries including cleaning a scrape and providing an ice pack; however, as commented on a previous blog comment, it is “important that qualified staffing is available for the school age population”. Qualified staffing would help minimize the extent of injuries and the event could be handled in a smoother and more experienced manner. According to Guttu, Engelke, and Swanson in their 2004 article “Does the School Nurse-to-Student Ratio Make a Difference?”, there is a significant correlation between the increased presence of school nurses and the services  available for children with chronic illnesses, such as diabetes and asthma. There has also been a noted relationship between nurse availability that can provide counseling services and positive outcomes of children related to depression and unplanned pregnancy. With more school nurses, there is an increase in follow up care for the children that fail school screenings for vision and hearing (Guttu, et al, 2004).

Another comment posted, questioned whether or not RN’s would be willing to choose school nursing over hospital nursing. Throughout our research, we have discovered that there is more of an issue regarding money available to fund additional school nurses rather than they’re not being enough school nurses to fill the positions. School nursing can be appealing to nurses due to having summers and vacations off, as well as having these days off with their children if they are mothers. 

We plan to contact at least four key stakeholders and/or legislators in a professional manner in order to ensure them our support and invite them to visit our blog.  We will contact these professionals via e-mail. We will begin by contacting the sponsor of the bill, Delegate Lionel Spruill Sr., and the co-sponsor, Rosalyn R. Dance. We will then communicate with local school nurses and get their opinion about the bill or inform them if they are unaware of the present bill being addressed.  

A concern has been brought to our attention in a previous blog comment stating that although the passage of this bill will open up job opportunities, it will also require additional funding.  Do you think that increasing the school nurse availability could help the cost of healthcare decrease in the long run?

Source:

Gutto, M., Engelke, M., & Swanson, M. (2004). Does the school nurse-to-student ratio make a difference?. Journal of School Health, 1(74), 06-09. Retrieved from http://ehis.ebscohost.com/ehost/pdfviewer/pdfviewer?sid=0b4466f0-f963-4450-8ad3-ccb297d5cd1c@sessionmgr104&vid=4&hid=120

How Many Students Do You Think School Nurses Should Care For?

Do you think that nurses in the school makes a difference in the health of school aged children? If so how many students should be cared for by one nurse? According to a scholarly article "Does the School Nurse-to-Student Ratio Make a Difference?" by Martha Gutto, Martha Engelke, and Melvin Swanson, there has been little research to examine the benefits of a decrease in student to nurse ratio. In this article, it was stated that, "a significant correlation was found between the increased presence of school nurses and services provided to children [with chronic conditions]" (Gutto, Engelke, Swanson, 2004).

The goal of the health care bill is to mandate that there must be a ratio of one nurse to every one thousand students in any given school. There are no current laws regulating the number of students being cared for by one nurse. Today, one nurse can be responsible for up to eight thousand students covering multiple schools in the area. The government hope in reducing the nurse to student ratio is the prevention of further complications regarding student's health condition as well as preventive measures against developing diseases. One of the most important roles of the nurse is to provide education; therefore, if there are less students per nurse, the nurse can focus on education and prevention rather then simply treating symptoms.  Nurses provide education on nutrition, exercise, safe practices, proper hygiene, and the importance of health screenings and vaccinations to students as well as their parents. The use of education can decrease the number of health issues that students could develop later on, including type II diabetes, obesity, eating disorders, sexually transmitted diseases, unplanned pregnancies, vision and hearing problems, scoliosis, and lice.The education that the nurses would be available to provide to students and families could lead to a potential decrease in governmental health care costs.

Possible political influences can be brought to government attention from the parents, teachers, and nurses. The parents may complain about the lack of care that their child is receiving and the concern that their child may not be given their medication when needed. The teachers may contact the government and complain that their students are out of class for long periods of time, which can disrupt the teachers plans for group activities, as well as increasing the work load on the teacher because of having to re-teach the material. Nurses face problems with the high ratio of students to care for and feel like this could cause potential negative outcomes for the students health.

By setting a standard for the number of students per nurse in the school systems, the workload of school nurses will be decreased. This bill would allow great access for the students to preventive care, and ensure that they receive the care that they need. The health care system could potentially benefit by this bill by decreasing further health care costs.

What do you think? Have you or anyone you know been affected by a lack of school nurse presence?





Source:
Gutto, M., Engelke, M., & Swanson, M. (2004). Does the school nurse-to-student ratio make a difference?. Journal of School Health, 1(74), 06-09. Retrieved from http://ehis.ebscohost.com/ehost/pdfviewer/pdfviewer?sid=0b4466f0-f963-4450-8ad3-ccb297d5cd1c@sessionmgr104&vid=4&hid=120

Decreasing Nurse to Student Ratio

Delegate Lionell Spruill Sr. is a community activist who sponsored the bill HB 1896. He serves on the Virginia House of Delegates in the 77th district and has been elected as a member of the Democratic National Committee. In addition, he is currently active on the Health, Welfare, and Institution Committee, the Counties, Cities, and Towns Committee, and on the Privileges and Elections Committee.  This bill proposed to decrease the nurse to student ratio to 1: 1,000 in Virginia school systems. This bill would significantly increase the number of nurses in schools, which is currently only one nurse to every 8,000 students. This decrease in ratio could potentially influence students by improving healthcare provided to students, decrease non-life threatening ED visits, give students better health education, and increase attendance rates. Nurses could also benefit from this bill by increasing nursing employment opportunities and decrease stress on school nurses. An increase in the number of school nurses could act as a preventative method to children's health, which could decrease the amount of money spent on healthcare in the future.

The HB 1896 bill was offered to the House on January 11th, 2011 and remains in the House and is being reviewed by the Education Committee as of February 8th, 2011. The chief sponsor is Delegate Lionell Spruill Sr. and is co-sponsored by Rosalyn R. Dance. We will continue to track the progression of this bill.