| HISTORY:
Since the inception of school nursing in the United States, school nurses have advocated for the improved health of students. In 1903, the first experimental program in New York to determine if school nurses could decrease absenteeism was very successful in documenting that school nurses made a difference. This led to school districts across the country beginning to hire nurses to work in schools. The health needs of students and their families encountered by the early school nurses are the same as those encountered today: the need for adequate health care, nutrition, health education, and support within the community. However, activities designed to meet these health needs have changed, paralleling the changes in society and delivery of health care during the last 100 years (Maughan, 2003; Zaiger, 2000).
DESCRIPTION OF ISSUE:
Today school nurses advocate in local, state, and national governmental arenas by staying informed on current issues, writing letters and e-mails, and speaking to individuals and groups regarding current issues and key policies and regulatory areas that impact the standards of practice for school nurses. Specific areas of advocacy include:
Advocacy with Policy Making
- Local public health policies and regulations
- Local school/medical advisory board regulations
- State nurse practice acts, rules, regulations, and declaratory rulings
- State and federal laws regarding minors’ consent to treatment, confidentiality, professional liability, and other school health services issues
Advocacy with Health and Education Associations
- National association policy statements (e.g. American Academy of Pediatrics Policy Statement, “Role of the School Nurse in Providing School Health Services” (Wolfe & Hootman 2003)
- National Education Association (NEA) and American Federation of Teachers (AFT)
Advocacy with Specific Legislation
- Elementary and Secondary Education Act (ESEA)
- State and Federal Child Health Insurance Program (SCHIP)
- Individuals with Disabilities Education Act (IDEA)
- Americans with Disabilities Act (ADA)
- Section 504, Rehabilitation Act of 1973
- Family Educational Rights and Privacy Act (FERPA)
- Health Insurance Portability and Accountability Act (HIPAA)
The school nurse serves as an advocate for the school nursing specialty and the provision of student health services. It is the responsibility of school nurses to strengthen their role by informing policy makers about the needs of students and the scope of current nursing services that impact the educational community. Students are affected by legal and ethical concerns (Igoe, 2000). For example, school nurses can seek to strengthen the language of the Individuals with Disabilities Education Act (IDEA) by specifically including school nurses in the list of providers (Costante, 2001b).
The National Association of School Nurses has a contracted position called the Governmental Affairs Consultant. Two of the position’s duties are to “enhance the awareness level of members of Congress, federal regulatory agency staff, and federal policy makers, of the value of services provided by the professional school nurse” and to “assist in monitoring and reporting on federal agency and public policy activity, in order to identify opportunities for the improvement of health and education of children (NASN, 2002).” This individual’s efforts can be enhanced by advocacy efforts by school nurses at the grassroots level.
RATIONALE:
Through advocacy and the provision of health care by school nurses, students’ developmental and learning potential are facilitated. School nurses, in particular, can have a positive impact on the health needs of students who are at risk due to lack of health insurance, special health needs, episodic needs, and racial and cultural differences by participating in the governmental relations arena on their behalf (Igoe, 2000). For example, the U.S. Supreme Court ruling that school nursing services must be provided by schools, including one-on-one school nursing services, enables students with disabilities to access special education services (Cedar Rapids Community School District v. Garret F., 1999).
School nurses can provide data demonstrating that educational outcomes of students are improved by school nurse interventions to legislators and policy makers in their school district. When school budget conditions are tight, school nurse positions could be in jeopardy if school nurses fail to inform various governmental entities about the outcome-based services provided to our changing society of students, staff, and families. Data and information are increasingly driving decision-making in society (Ryberg, Keller, Hine, & Christeson, 2003).
School nurses strengthen their advocacy position for students and families by partnering with other organizations and associations focusing on children’s health and/or education. These include state health and education agencies as well as professional associations both inside and outside the nursing profession (Igoe, 2000). School nurse advocacy can be enhanced through efforts by an individual or state, and/or national organization.
CONCLUSION:
It is the position of the National Association of School Nurses that school nurses need to demonstrate advocacy efforts established on evidence-based practice; develop partnerships with others focusing on children’s health and education; and participate in public policy, legislative, and regulatory issues. Failure to accept this responsibility may result in detrimental changes to the school nursing specialty and the overall accessibility of school nurses to students. To continue receiving allocations to support school nursing services, school nurses need to educate legislators and policy makers about the improved academic and health outcomes that result from having school nurses in our nation’s schools.
References/Resources:
Bergren, M.D.(2001). HIPAA hoopla: Privacy and security of identifiable health information. Journal of School Nursing, 17(6), 336-341.
Cedar Rapids Community School District v. Garrett F., 119 S. Ct. 992, 29 IDELR 966(U.S. 1999).
Costante, C.C. (2001a). School health nursing: Framework for the future, part I. Journal of School Nursing, 17(1), 3-11.
Costante, C.C. (2001b). School health nursing: Framework for the future, part II. Journal of School Nursing, 17(2), 64-72.
Dickey, S.B., Kiefner, J., & Beidler, S.M. (2002). Consent and confidentiality issues among school-age children and adolescents. Journal of School Nursing 18(3), 179-186.
Hootman, J. (2003). Inaugural address: Building tomorrow today. Journal of School Nursing, 19(4), 191-194.
Igoe, J.B. (2000). School nursing today: A search for new cheese. Journal of School Nursing, 16(5), 9-15.
Maughan, E. (2003). The impact of school nursing on school performance: A research synthesis. Journal of School Nursing, 19(3), 163-171.
National Association of School Nurses (March 13, 2003). Legislative Alert. IDEA reauthorization legislation. Castle Rock, CO: Author.
National Association of School Nurses (April 19, 2003). Legislative Alert. Good news for health promotion. Castle Rock, CO: Author.
National Association of School Nurses (April 19, 2003). Legislative Alert. Resolution and legislation regarding the role of the school nurse in response to bioterrorism. Castle Rock, CO: Author. Available at http://www.nasn.org/Default.aspx?tabid=100
National Association of School Nurses (April 19, 2003). Legislative Alert. SCHIP changes throughout the country and by federal regulation. Castle Rock, CO: Author. Available at http://www.nasn.org/Default.aspx?tabid=99
National Association of School Nurses (May 01, 2003). Legislative Alert. Legislation granting an extension to make use of expiring schip funds. Castle Rock, CO: Author. Available at http://www.nasn.org/Default.aspx?tabid=101
National Association of School Nurses (2002). Operating Guidelines. Castle Rock, CO and Scarborough, ME: Author.
National Association of School Nurses Issue brief (2003). School health nurse’s role in education: Privacy standards for student health records. Journal of School Nursing, 19(2), 119-123.
Pohlman, K. & Schwab, N. (2001). Consent and release. Journal of School Nursing, 17(3), 162-165.
Ryberg, J.W., Keller, T., Hine, B., & Christeson, E. (2003). Data speak: Influencing school health policy through research. Journal of School Nursing, 19(1), 17-22.
Stock, J.L., Larter, N., Kieckehefer, G.M., Thronson, G., & Maire, J. (2002). Measuring outcomes of school nursing services. Journal of School Nursing, 18(6), 353-359.
Wolfe, L.C. & Hootman, J. (2003). American Academy of Pediatrics Policy Statement. Journal of School Nursing, 19(3), 127-129.
Zaiger, D.S. (2000). School nursing services: The early years. Journal of School Nursing. 16(3), 11-19.
Adopted: June 1998
Revised: November 2003 |