WHEREAS,   Over a million children spend roughly seven hours daily for 180 days annually in schools, and many of these children have special health care needs requiring medical management during the school day, and

WHEREAS,   Schools are required by various laws, such as but not limited to Individuals with Disabilities Education Act (IDEA), to provide health services within schools to allow all children, including, but not limited to those with special health care needs, to obtain “a free and appropriate education” in a safe and “least restrictive” setting, and

WHEREAS,   registered professional nurses (RN) are trained as to provide acute and chronic health care to school-aged children and adolescents such as but not limited to direct health assessment, emergency and routine health management, and health counseling, as well as ongoing implementation of medical aspects of health programs in schools as developed by the school medical director, which may include programs such as, but not limited to athletic programs with potential medical risks to student athletes, public health, safety, and welfare of the entire school community in infectious disease outbreaks including during Pandemics, Public Access Defibrillator Programs, emergency medical sites for widespread community disasters, as well as daily and emergency care and medication delivery systems, and

WHEREAS,   The American Academy of Pediatrics and the American Medical Association support that a registered professional nurse (RN) should be present in all schools with coverage supported by the National Association of School Nurses, and be it therefore

RESOLVED, The Medical Society of Virginia supports registered professional nurses (RN) to be present in all schools as recommended by the National Association of School Nurses.

Fiscal Impact: None

Existing Policy: None

7 replies
  1. TMOFFATT
    TMOFFATT says:

    207

    who’s paying for this? 1 nurse for every 3-4 schools now – or so. We’ll need a lot! I suppose it’s OK for a “wish list.”

    • 101974
      101974 says:

      Who’s paying for this?

      If we were talking about child abuse or neglect, it is our job as physicians to be aware of what is in a child’s best interest, to be asutely observant, and to refer for further investigation. It is not our job to be the police, the investigators, the judge, or the jury, or the lawmakers to figure out how to fund jails for perpetrators found guilty. Similarly, it is my firm belief that as a professional society of physicians, it is our role to identify and set the gold standard of medical care and best practices for children and adolescents in any setting, especially when we identify potential risk or negligence that could lead to bad outcomes. As a pediatrician, I look to prevention first. It is not our purpose to try to figure out how to fund it. However, it is our job to advocate for it, year after year if necessary, and to educate those who do the funding why we know it is important that schools have RN in buildings as recommended by the National Association of School Nurses.  

  2. msv10689
    msv10689 says:

    RN presence in schools

    This subject falls under the concept of a single entity within the state to manage healthcare.  This entity could place pediatricians in schools on salaries to serve the children including making house calls if they are absent.  Providing RN’s is the first step.  I wholeheartedly agree with this proposal.

  3. MSV51243
    MSV51243 says:

    RN in school

    Why not LPN?  RNs are not really necessary; very expensive to hire and not all that available in many areas.  

    • 101974
      101974 says:

      Why not LPN instead of RN?

      The best RN who go into school health are actually former ER or ICU nurses because a school setting requires independence and self-direction. In VA especially where the presence of medical directors may be limited to physicians who come in simply to conduct periodic army barrack type physical examinations, there may be little backing and support for the school nurse. The nurse herself may be assigned many buildings and may be required to try to write emergency care plans for life-threatening conditions that they attempt to train non-medical individuals to implement in their absence when they leave to travel to another buidling. It is important to remember the scope of practice of nurses. An RN functions independently under the direct orders of a physician or nurse practitioner. An LPN scope of practice typically has a dependent role and one that must function under the direct or close indirect supervision of an RN. While a health care team could certainly be successfully developed within a school division that employs LPN and even certified health aides who work under the RN who are all overseen by a medical director/school physician, that would be determined based on the needs within the building. A building that houses a high number of students with significant high risk health concerns or students with medical fragile conditions would not be a building where an LPN operating alone is suitably placed. School division liability becomes very real in situations where the adage of penny wise and dollar foolish takes precedence over evidence based best practice. Cindy Devore

  4. 101974
    101974 says:

    Rationale for supporting this proposal

    Students come to school with chronic health conditions and mental health concerns that need to be managed for them to be healthy, safe, and ready to learn. Students may also have individual social needs and social determinants of health and learning that adversely impact their health, well-being and learning. 

    School nurses connect students and families to both in school and out of school community resources that not only provide assistance to them, potentially balancing social, health, and even economic disparities for certain student groups, but also reducing barriers to learning. The latter has been shown to occur, for example, when nurses closely follow and properly refer students with chronic school absences not based on bona fide health problems. This can be to appropriate medical health care or mental health care  professionals or social services for intervention. School nurse intervention has been shown to improve attendance, and improved attendance can enhance school performance which in turn can increase graduation rates. Simply stated, the presence of nurses in schools helps to promote healthier students.

    It was a school nurse in NYC who recognized a cluster of students ill with a flu-like illness that she reported to her local public health department that soon was identified as the H1N1 epidemic. Now during COVID-19 and school reopening, it is hard to imagine a school building attempting to operate without the expertise of a school nurse working under the oversight of a school physician. School nurses, specifically RN, are able to coordinate student health  care by working collaboratively with students, families, medical homes and education personnel to translate medical care into the school setting within classrooms and other educational spaces. They are able to be on-site thereby supporting student well-being and increasing student engagement. 

     There may be some who say this proposal is a good idea, but it is too expensive and will never pass the legislature. To that I say that the role of a medical society such as ours is not to be bookkeepers or accountants of the state budget. It is to set the gold standard of excellence in medical care, especially for our children and adolescents. It is to make the soundest and most evidence-based recommendations we can of what is the right thing to do to assure that the health and safety of our children and adolescents is optimal. If we have to go back year after year and keep saying the same thing before  our politicians get the message that they need to appropriate funds to secure their safety, then that is what we need to do. But we should never compromise medical recommendations of what is needed as best practice in anticipation of or for fear that a politician may not vote for it.

     As former Surgeon General Dr. Jocelyn Elders once said, you cannot educate a child who is not healthy, and you cannot keep a child healthy who is not educated. 

     The Role of the 21st Century School Nurse- https://www.nasn.org/advocacy/professional-practice-documents/position-statements/ps-role

    Cost Benefit Analysis- https://www.nasn.org/research/cost-benefit-analysis

     The Case for School Nursing- https://higherlogicdownload.s3.amazonaws.com/NASN/3870c72d-fff9-4ed7-833f-215de278d256/UploadedImages/PDFs/Advocacy/advocacy_The_Case_for_School_Nursing.pdf

    Cindy Devore, MD, MS, MA, FAAP

  5. MMARTIN3434
    MMARTIN3434 says:

    Healthy Students are Better Learners

    A growing body of research demonstrates that school nurses can improve attendance by reducing illness rates through education about preventive health care, early recognition of disease processes, improving chronic disease management, and increasing return-to-class rates.  Of the students seen by the school nurse for illness or injury,  studies have shown that up to 95% were able to return to the classroom. Without a school nurse, unlicensed personnel who are uncertain what to do medically are at risk of sending children home from school or to the emergency department needlessly.  While cost can be a barrier to implementing, it should not be, as the cost of not having nurses is likewise expensive for families and the health care system.

    This position has been supported by the national AAP for many years and is supported by the Virginia Chapter of the AAP.  Given the ongoing pandemic, it is even more imperative  that we have medically trained nurses in the schools to help administrators and teachers navigate the challenges ahead as schools re-open.  

    Michael Martin, President of the VA-AAP

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