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The Relentless School Nurse: If we don’t ask, the answer is always NO!

Author(s): By Robin Cogan

School nurses have an unprecedented opportunity to request funds from the American Rescue Plan be allocated for school health services. School districts across the country are tasked with submitting plans for this influx of federal dollars to their state Departments of Education (DOE). The timeline is tight, but it is not too late to submit your recommendations. If we don’t ask, the answer is always no…

We can also take this important moment to promote The Future of Nursing Report and how investing in school nursing democratizes access to care for students who have been underserved.  

Future of Nursing 2020-2030: “an expert committee supported through the Robert Wood Johnson Foundation partnered with the Institute of Medicine. The committee’s recently released report will extend the vision for the nursing profession into 2030 and it will chart a path for the nursing profession to help our nation create a culture of health, reduce health disparities, and improve the health and wellbeing of the U.S. population in the 21st century.”

  • School and public health nurses play a vital role in advancing health equity.
  • Adequate funding for these nurses is essential if they are to take on that role.
  • School nurses are front-line health care providers, serving as a bridge between the health care and education systems and other sectors.  They are specialists that address both the physical and mental health of students in the context of educational environments.
  • They serve as both essential care providers for individuals and links to broader community health issues through the student populations they serve.
  • Access to a school nurse is a health care equity issue for some students, especially in light of the increasing number of students who have complex health needs. environments/neighborhoods.
  • School nurses are essential for healthy kids, healthy schools, and healthy communities.
  • School nurses also are well-positioned to work with students and families in their neighborhoods and homes to address individual and family social needs, such as access to care, healthy food, and safe and healthy environments/neighborhoods.
  • More school nurses need the practice authority to address in creative ways the complex health and social needs of the populations they serve.
  • School nurses are a particularly critical resource for students experiencing such challenges as food insecurity, homelessness, and living in impoverished circumstances, for whom the school nurse may be the only health care professional they see regularly.

The New Jersey State School Nurse Association (NJSSNA) was given the opportunity to submit recommendations to the NJ DOE. We crafted 3 “asks” and submitted them in support of our most pressing school nursing concerns. While we don’t yet know the outcome, contributing to the conversation is an important step.

Let’s generate momentum by sharing school health services needs with our district leaders across the country. Imagine the power of more than 95,000 school nurses flooding email in-boxes in each of our school districts with what we NEED to provide the best care possible to our students, staff and families. We need to be present and speak out loudly, in terms that everyone understands.  Feel free to edit these “asks” if they speak to the needs of your school nursing practice!

Schools will be submitting plans to their State Boards of Education as to how they will be allocating their funding from the American Recovery Plan (ARP). Please reach out to your district administrators to make sure they are investing in Professional School Nurses.

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American Recovery Plan Funding: School Nurses’ 3 ASKs

#1-Now is the time to address inequities that have persisted in our schools

  • Invest in professional school nurses. Our practice is grounded in an evidence-based model of care. The National Association of School Nurse Framework for 21st Century School Nursing Practice™ includes the Whole School, Whole Community, Whole Child model components. There are school nurses who also hold national certification, NCSN, a mark of excellence.
  • NJSSNA encourages districts to hire CERTIFIED school nurses – specially trained to support student’s physical and emotional/mental health at all ages and stages.

#2-Addressing the “school nurse shortage”  

  • Recognize their professional experience with appropriate compensation. Most school nurses come to the specialty field after years of professional nursing practice, but this is often not recognized in public education systems.
  • Encouraging districts to hire professional school nurses at a salary commensurate with experience.  Schools are known to start nurses at step 1 because they have no experience as school nurses, but come with a wealth of pediatric, ER, and professional nursing experience.  This includes paying substitute nurses a fair wage.  Guidance/support from the State Department of Education or Department of Health would have weight.
  • Encourage the State Board of Education to become more involved with assisting counties in developing recruitment strategies for full-time, part-time, and substitute nurses.  There are many open positions and after the year we just experienced, there will be a lot more vacancies. Having professional school nursing staff in place to work at recruitment fairs would be advantageous to fill open positions with qualified candidates.
  • Encourage districts to hire staff based on student health acuity AND numbers.  Many schools hire one nurse to deal with over 1,000 students with no assistance, but yet expect covid screening, contact tracing, mandatory screenings, mental health assistance, referrals, and chronic health management.
  • School nurses are the Chief Well-Being Officers in schools. Support an infrastructure for school nurse staffing to allow release time for school nurses to actively participate in school committees that focus on student well-being. Cross-sector teams led by school nurses will be instrumental in addressing the challenges of school re-entry this fall.

#3-Update antiquated health screening equipment and invest in electronic health records

  • There has been much advancement in the health office equipment – audio and vision machines that would expedite the screening process which would assist in limiting the amount of missed class time to have screening performed.  It’s time to make a one-time investment in high-tech health office screening devices and electronic health records.

Long before the pandemic, budget lines for school health services were painfully small.  This remains true today. Yet, the school health office and its staff care for EVERY student in the school district. It should not take a pandemic for school districts to recognize that keeping students physically and mentally ready to learn should be a priority not an aside to education. To paraphrase former United States Surgeon General Joycelyn Elders, “You can’t educate a child who is not healthy or keep a child healthy who is not educated.”

On behalf of the students in our district (or state), we respectfully request that this infusion of federal funding be invested in ways that will most effectively achieve the goals of safer classrooms and schools, improved student physical and mental health, and academic readiness.

This is OUR TIME to ask for what we need, what our students and families need. Remember, if we don’t ask, the answer is always NO! You can ask from your health office as an individual, through your district as a team of colleagues, or from your state organization. The point is to raise your concerns, the funding is flowing and now is our chance to get the necessary support we need to do the best job we can for our school communities.

Special appreciation to the Executive Board of NJSSNA, President Donna Pleus, President-elect Eileen Gavin, and Executive Director Marie Sasso for crafting our “asks.”

Robin Cogan, MEd, RN, NCSN is a Nationally Certified School Nurse (NCSN), currently in her 20th year as a New Jersey school nurse in the Camden City School District. She serves on several national boards including The American Foundation for Firearm Injury Reduction in Medicine (AFFIRM), a gun violence prevention research non-profit organization and the National Board of Certification for School Nurses (NBCSN). Robin is the Legislative Chair for the New Jersey State School Nurses Association (NJSSNA). She is proud to be a Johnson & Johnson School Health Leadership Fellow and past Program Mentor.

She has been recognized in her home state of New Jersey and nationally for her community-based initiative called “The Community Café: A Conversation That Matters.” Robin is the honored recipient of multiple awards for her work in school nursing and population health. These awards include 2019 National Association of School Nurses (NASN) President’s Award; 2018 NCSN School Nurse of the Year; 2017 Johnson & Johnson School Nurse of the Year; and the New Jersey Department of Health 2017 Population Health Hero Award. Robin serves as faculty in the School Nurse Certificate Program at Rutgers University-Camden School of Nursing, where she teaches the next generation of school nurses. She was presented the 2018 Rutgers University – Camden Chancellor’s Teaching Excellence Award for Part-time Faculty.

Robin writes a weekly blog called The Relentless School Nurse. You can also follow her on Twitter at @RobinCogan.

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