Being a school nurse: Challenges and How to Resolve Them

School nursing

  School nurses play a multifaceted role in supporting students and communities with their health needs and this is just one of their many responsibilities. They serve in a pivotal role that bridges healthcare and education. Most key responsibilities of school nurses have risen as a response to the local need. School nurses are part of several school health activities like combatting chronic absenteeism, physical and mental health care, health promotion, educating staff, attending child protection conferences, administering vaccinations, and addressing bullying issues.    Health promotion (96%)   Educating school staff (94%)   Attending child protection conferences (82%)   Administering vaccinations (73%)   Addressing bullying issues (65%)    Besides providing emergency care, school nurses also   Act as case managers for students’ continuing health care needs at school   Coordinate height, weight, vision, hearing, and dental screenings   Administer medications   Perform procedures and assessments   Communicate with health care providers, therapists, parents, and school staff   Provide health education to students, school personnel, and families   Provide a career shadowing experience for nursing students      Challenges of school nurses   When a school nurse is present to meet student healthcare needs, parents and school administrators know that children and youth can focus on learning. Despite being a motivated and dedicated workforce, school nurses face multiple challenges in a school setting.    NASN data shows only 39% of public schools have a school nurse all day, 35% have a school nurse who works part-time, leaving 25% of schools without a full-time school nurse. The most frequently reported school-based challenges school nurses face are having limited resources and a high caseload. They also faced barriers like communication challenges, multiple documentation requirements, conflicting needs and points of view, and working in isolation.     Limited resources and a high caseload: School nurses are heavily dependent on the school’s budget and resources when it comes to providing healthcare. The department is a small fraction of the school’s budgetary concerns. When working in a limited budget and high caseloads, school nurses may have to adjust their approach to healthcare.    Communication challenges: School nurses sometimes face challenges in communicating effectively with school administration, parents, doctors, pharmacies, health care bodies regarding student health because they have too many priorities and limited resources that enable them to meet these expectations.   Multiple documentation requirements: School nurses have the responsibility of updating student health records and maintaining them. This isn’t an easy task and can be time-consuming to the extent that it keeps them from doing what they were meant to do – taking care of students and communities.    Conflicting needs and points of view: Providing healthcare is not the primary objective in an academic environment. School nurses must contend with competing interests and points of view when caring for students in a school setting. In certain instances, while nurses would recommend that a child’s healthcare be prioritized, school administrators may want to keep a student in school instead of addressing their healthcare needs.   Working in isolation: School nurses will work in relative isolation as compared to the traditional healthcare environment. They’ll no longer be able to depend on the advice and support or colleagues. In some cases, school nurses are the only healthcare professional on the campus, which can create feelings of loneliness and seclusion.    Overcoming the challenges   While the disciple of school nursing has come a long way, there is much there is to be done for their betterment. The NASN recently submitted a petition for funding 10,000 school nurses to join for the upcoming school year. The school nurse is more important than ever and expanding their presence in the school setting is essential. They help students grow and thrive. And a professional school nurse is needed for every school because school nursing is the foundation of students’ physical and mental health.    To support them in their activities, they need infrastructure that enables them to do their best work. School nurses must be an integral part of school healthcare policy creation and amendments because they are actively involved in student healthcare and would be able to provide expert suggestions for improving the health of the student community. School nurses need to work in collaboration with school administration and faculty to ensure student health is given due priority. They also need to educate the teaching community about the dangers of overlooking unusual student behavior and student health concerns, and why it needs to be addressed for the student’s overall health.    School nurses also need to be familiarized with digital health records systems to simplify student health documentation requirements. They need to be relieved of the paperwork and enabled with digital systems that simplify medicine administration, immunization tracking, and more. EduHealth is a comprehensive educational healthcare solution for school nurses to collect, track, and manage student health information. Designed by school nurses, it has features connecting the entire schooling community of students, parents, administrators, school nurses, and more. Nurses can access student health history and immunization and health-related documents in a single button click, making their jobs and lives infinitely easier.    EduHealth also enables easy communication with the healthcare community during student health emergencies. The portal allows them to connect with doctors and pharmacies. This simple solution allows them to overcome several challenges related to student health-related documentations, communication with schooling and healthcare community, medicine administration, medical history record maintenance. And enables them to spend more time doing their jobs and caring for students.   Schools nurses contribution to the well being of students must not be overlooked School nurses play an important role in the health and wellbeing of children, with a broad range of duties, from health promotion to support individual pupils with specific conditions. The work of school nurses is essential in supporting children to have a full, active and healthy school life. With such an important role to play, it is vital that more school nurses are recruited and given the given the necessary power and infrastructure to ensure they have the capacity to making the positive contribution to children’s health. EduHealth is a tool that enables them to achieve this. 

School nurse with mask

COVID 19: How FERPA and HIPAA apply to student records

covid-19 resources

  School administrators have to face multiple questions around privacy as COVID 19 continues to spread globally. Administrators must form a strategy on how to inform communities about infections that are spreading among students and their close circles, how to respond to such cases, and most importantly, how to manage keeping students’ privacy safe in such cases. The School Superintendents association has put together a detailed report drawing from the USED guidance on how FERPA applies to schools in the context of COVID 19.   Student health is protected by the Family Educational Rights and Privacy Act (FERPA) and not the Health Insurance Portability and Accountability Act (HIPAA). If there is a need to disclose personal information, authorities will typically have to take consent to protect the health of others in an emergency.    FERPA and HIPAA  ( How they usually apply ) FERPA protects personally identifiable information (PII) in students’ health records maintained by an educational agency or institution. Schools can disclose FERPA-protected information only if they have consent from a parent unless an exception to FERPA’s general consent rule applies. In the case of COVID 19, the most applicable exception to consent is FERPA’s health or safety emergency exception.  HIPAA applies when a school’s health services are funded, administered and operated by or on behalf of public or private health, social services, or other non-educational agencies or individuals. HIPAA prohibits the disclosure of protected health information (PHI) without consent and requires entities subject to the law to establish appropriate privacy policies to protect PHI from unauthorized disclosure. HIPAA, however, has an emergency provision allowing disclosure of PHI in certain cases.   How they apply to student records during COVID 19 pandemic  Here’s how schools can share information about students while protecting their privacy during a public health emergency.  If a student has COVID 19, what information from educational records can the school share with the community?  Occasions where FERPA does not apply  Schools can disclose that a student may have COVID 19 as long as the school does not directly or indirectly identify that student.   Administrators must ensure messages to the community don’t identify the student directly or indirectly.    E.g., “A student on the soccer team or a student who recently attended a soccer game tested positive for COVID 19.     When personally identifiable information needs to be released, FERPA applies  If the school determines that certain students had close contact with an affected student during a potentially contagious period.  When there is an articulable and significant threat to the health or safety of a student or other individuals and when someone needs PII from education records to protect the student’s or other individuals’ health or safety.  Actions the school might take during a period of risk:  1. Articulable and significant threat of a health or safety emergency: Articulable and significant threat means that the school should be able to explain, based on all the information available at the time, what the threat is and why it is significant.   In the FERPA and COVID 19 guidance, US Department of Education (USED) states that if local public health authorities determine that a public health emergency, such as COVID 19, is a significant threat to students or other individuals in the community, an educational agency/institution in the community may determine that an emergency exists too.    The 2009 FERPA and H1N1 guidance from USED notes that an emergency could include sharing information when necessary during the early stages of a pandemic.   2. Disclosure is necessary to protect health and safety of students and others:   The school decides that the affected student’s teachers, classmates and their parents, or students with whom the student spent significant amount of time know about the affected student in order to protect their health.  3. Only disclose the minimum amount of information required to address the issue at hand:  The school can choose to disclose to the classmates of an affected student that one of their classmates has COVID 19 without identifying who it is. In this case, FERPA would not apply.  If the school needs to directly or indirectly identify the student, they should make sure they provide the minimum information necessary. Perhaps details like the COVID 19 positive status and a window of time of the infection.  4. School officials should be sure to document when they release PII in this exception:   The health or safety emergency exception requires the school to list the following information in the student’s record: the articulable and significant threat that formed the basis for the disclosure and the parties who received the information.  If the school suspects that a student has COVID 19, what information can the school share with the community?  School administrators can proactively warn parents and students about COVID 19 in the school community to facilitate prevention efforts and ensure that people have information necessary to address a potential outbreak.  It is not necessary to identify the symptomatic individual.  Do not identify the student exhibiting symptoms unless the community needs to know that information, and perhaps share CDC-recommended preventative measures or other resources as part of a message that can help protect parents and students.  Do not make notifications about a student exhibiting symptoms to elicit fear.  FERPA does not cover teachers. So, if a teacher is affected, a school could share that information without violating FERPA. However, state laws regarding employee confidentiality might apply.   If a school suspects that a student may have COVID 19, can school officials contact the student’s primary care physician?  If a school cannot reach a student or parents and suspects that the student might have COVID 19, they can reach out to the student’s primary care physician to ask if the physician can confirm so the school can notify the community.  The school could obtain the parent’s or eligible student’s consent to contact the physician; use FERPA’s health or safety emergency exception.  However, HIPAA may not allow the physician to disclose any information back to the school. HIPAA contains an emergency exception that allows health care providers to disclose protected health information without patient authorization “as necessary to prevent or lessen a serious and imminent threat to the health or safety of the individual, another person, or the public.  If a provider identifies the risk, they would be permitted to disclose the minimum information necessary to the school.  If a student has COVID 19 and the school’s health records…