Report to the OregonState Board of Education
Updated School Nurse Task Force
June, 2008
The School Nurse Task Force was created as a result of House Bill 2773 during the last legislative session.
The Task Force was charged to study and assess the availability of nursing services in Oregon schools and the feasibility of expanding existing services. The Task Force was also charged withrecommending a plan to establish mandated school nurseservices in all Oregon schools.
The followinglist describes the membership in the Task Force as dictated in HB2773:
- One member of a labor organization representing nurses:
Laurie Wimmer Wayland, Oregon Education Association;
- One member of a school district board or a school administrator:
Dr. Karen Grey, Superintendent, ParkroseSchool District;
- Three members experienced in issues relating to school health:
William Lace, M.D. (pediatrician);
Dr. Jan Hootman, Director, Student Health Services, Multnomah ESD, and Co-chair of the Task Force;
Marilyn Hudson, RN,OregonState Board of Nursing;
Representative Tina Kotek;
- One member shall be a school nurse:
Virginia Brollier, RN Klamath County Schools;
Nina Fekaris, RN, BeavertonSchool District, Co-Chair of the Task Force;
Margay Garrity, RN, Southern Oregon ESD.
In addition to the members listed above, the following ODE staff members provide support to the Task Force:
- Leslie Currin, School Health Specialist;
- Brad Victor,Sexuality Education Programs Specialist;
- Bobbi King, support staff;
- Steve Woodcock,Director of Interagency Educational Services.
The Problem:
Schools and school nurses in Oregon have been aware that the number of school nurses hasdeclined over the past 15 years as school budgets and subsequent resources become less flexible and school resources get tighter.
Current Status of School Nurses in Oregon:
- At present, the approximate ratio of school nurse to student is 1:2,000.
- Many school districts have no school nurses.
- In many school districts, a lone school nurse serves 4 to 8 schools over a geographic area that covers many miles.
- At the same time that school nurse services have decreased, the number of students in need of these services has increased due to an increase in uninsured children, the onset of family poverty, and the burgeoning epidemic in Oregon of chronic diseases such as asthma and diabetes.
- A child who is out of school due to illness is not able to access educational services; a child who is in school, but ill, cannot benefit maximally from his education.
Examples of disease in Oregon students:
- It is not unusual at all, in any given kindergarten student population, to see 1/4 to 1/3 of the students who have teeth rotted to below the gum line, due to lack of prophylactic care, which has traditionally been arranged by the school nurse. This sort of dental situation leads to severe health problems in later school years, due to chronic infection, pain, and lack of ability to chew and digest nutrients.
- There is obesity in Oregon schools, as well as across the nation. This is estimated to affect about 1/3 of Oregon students (Oregon Health Division). Obesity is, of course, a condition that leads to disease in later life, such as heart disease and diabetes. Obesity is reversible, but most children need some concentrated help to affect a change in food intake and exercise.
- There is diabetes in Oregon schools. Nationally, the numbers of children with insulin-dependent diabetes has soared in the past 10 years. This affects nearly every school in Oregon. Diabetes is a complicated medical condition, and for a diabetic child to function well at school, a health care person needs to be available to assure optimal health for that child during the school day. There are schools in Oregon where complex diabetic situations are being handled by school secretaries due to the lack of a school nurse.
School nurses work with these and other children to achieve better health and disease control. School nurses have the knowledge base, expertise, and community contacts to effectively work for change in the area of health.
School Based Health Centers (SBHC’s) are part, but not all, of the answer. School based health centers are clinics. The staff are not employees of the school district, and as such, they cannot work with school staff directly.Theyare unable to do the preventative work that the school nurse is able to do. School Based Health Centers do not answer to FERPA but to a different set of rules (HIPAA). Also, 70% of SBHC’s charge student insurance for their services. School nurses do not charge student insurance, which is an important detail as the number of uninsured children in Oregoncontinues to rise.
The Task Force:
The Task Force has been meeting for six months to conduct the study and assess the availability of nursing services in Oregon schools. Upon completion, this document upon completion will describe the status of school nursing in Oregon and will make recommendations for Legislativeaction.
The Task Force has worked to gather accurate information regarding the situation with Oregon school nurses. Two surveys have been completed: the first survey of nurses working in Oregon schoolsreports data on where they are working and of the content of their practice;the second survey targets school administrators and superintendents,and was designed to elicit health personnel needs from a school administrator’s view. Statewide data on these subjects have not been previously available. Both surveys achieved a very high return rate (school superintendents responded at better than 90%.)
The Document:
The document, which is in progress, will address the following areas:
- Provision of school nurse services for all Oregon students, in a gradually increasing manner. One approach to this would be to create an Oregon ratio of one nurse to 750 students, which is the ratio endorsed by the Centers for Disease Control, the American Academy of Pediatrics, and the National Association of School Nurses; The Task Force will be exploring this option.
- An addition of 1.0 FTE Position at ODE to support statistical work on school health and school nursing;
- An endorsement that ODE will gather statistics on school nurses in Oregon(for instance, who has them, how many hours, how they are funded, and so on). At present, this information is anecdotal; it is difficult to quantify and solve a problem without accurate numbers.
The Nurse Task Force will submit a report concerning its findings to the interim committees on education no later than September 1, 2008.
The impact of the Nurse Task Force report forOregon schools is unclear at this point, since the report is not finished. However, increasing school nurse services to schools will have a financial impact, as many schools will be asked to add nurse service provisions to their budgets.
The Nurse Task Force is clear that their recommendations can have an impact for the good on Oregon’s student population by decreasing absenteeism, increasing academic achievement, and increasing the health of Oregon’s school population.
74th OREGON LEGISLATIVE ASSEMBLY--2007 Regular Session
Enrolled
House Bill 2773
Sponsored by Representative KOTEK, Senator MONNES ANDERSON
CHAPTER ......
AN ACT
Relating to Task Force on School Nurses; and declaring an emergency.
Be It Enacted by the People of the State of Oregon:
SECTION 1. (1) As used in this section, “school” means any kindergarten through grade12 school that receives public funds.
(2) There is created the Task Force on School Nurses, consisting of eight members appointedby the Superintendent of Public Instruction as follows:
(a) Two members shall be chosen from among persons recommended by the Departmentof Education;
(b) One member shall be a member of a labor organization representing nurses;
(c) One member shall be a school nurse;
(d) Three members shall be experienced in issues relating to school health; and
(e) One member shall be a member of a school district board or a school administrator.
(3) The task force shall:
(a) Study and assess the availability of nursing services in Oregon schools and the feasibilityof expanding existing services; and
(b) Recommend a plan to establish school nurses as a mandated service in all schools inOregon.
(4) A majority of the members of the task force constitutes a quorum for the transactionof business.
(5) Official action by the task force requires the approval of a majority of the membersof the task force.
(6) The task force shall elect one of its members to serve as chairperson.
(7) If there is a vacancy for any cause, the Superintendent of Public Instruction shallmake an appointment to become immediately effective.
(8) The task force shall meet at times and places specified by the call of the chairpersonor of a majority of the members of the task force.
(9) The task force may adopt rules necessary for the operation of the task force.
(10) The task force shall submit a report concerning its findings to the interim committeeson education no later than September 1, 2008.
(11) The Department of Education shall provide staff support to the task force.
(12) Members of the task force are not entitled to compensation or reimbursement andserve as volunteers on the task force.
(13) All agencies of state government, as defined in ORS 174.111, and school districts aredirected to assist the task force in the performance of its duties and, to the extent permittedby laws relating to confidentiality, to furnish such information and advice as the membersof the task force consider necessary to perform their duties.
SECTION 2. Section 1 of this 2007 Act is repealed on the date of the convening of thenext regular biennial legislative session.
SECTION 3. This 2007 Act being necessary for the immediate preservation of the publicpeace, health and safety, an emergency is declared to exist, and this 2007 Act takes effecton its passage.
Passed by House March 29, 2007Received by Governor:
...... M.,...... , 2007
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Chief Clerk of HouseApproved:
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Speaker of House
Passed by Senate May 15, 2007......
Governor
...... Filed in Office of Secretary of State:
President of Senate
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...... Secretary of State