SUMMARY
There is a difference between medical services and health services in the school setting. It is the position of the National Association of School Nurses that the school nurse plays a vital role in explaining the implications of the Garret F.Case, IDEA 1997, and IDEA 2004 on administrative decisions about policy, staffing, collaborative decision-making, and clinical nursing practice in the schools. Schools are responsible for providing required health services during the school day for students to access a free appropriate public education. Furthermore, the Registered Professional School Nurse is the appropriate provider of health services in the school setting.
HISTORY
The Education for All Handicapped Children Act (EHA), 1975, established national standards for free appropriate public education of children with disability-related learning problems in the least restrictive environment. Subsequent legislation, the Individuals with Disabilities Education Act (IDEA) in 1990, with amendments in 1997 and reform again in 2004, continues to support and develop IDEA standards. The 2004 reauthorization of IDEA, the Individuals with Disabilities Education Improvement Act, includes nursing services as one of the related services that a student with a disability is entitled to receive in order to participate in an individualized education program. Students with disabilities are served in educational programs and/or require specialized health services provided by or supervised by a Registered Professional School Nurse.
The United States Supreme Court decision in two cases - Irving Independent School District v. Tatro (1984) and Cedar Rapids Community School District v. Garret F. (1999) - held that IDEA requires school districts to provide nursing services when such supportive services are necessary in order for students to access and benefit from their education program.
In addition, the Rehabilitation Act of 1973 (Section 504) and subsequent revisions require any preschool, elementary, secondary, and adult education programs and activities that receive or benefit from Federal financial assistance to provide reasonable accommodation to a student with a disability. Reasonable accommodations include, but are not limited to, services provided by or supervised by a nurse such as medication administration, glucose monitoring, insulin administration, and other health-related procedures. Such services are designed to meet the individual educational needs of people with disabilities as adequately as the needs of others are met.
DESCRIPTION OF ISSUE
Students with disabilities are entitled to a free appropriate public education in the least restrictive environment. Some students with disabilities and/or chronic and acute health concerns require specialized health services to insure their inclusion in education programs and their safety in the school environment. These services may include the nursing skills of medication administration, developing accommodations and action plans to care for complex procedures such as respirator care, or administration of intravenous medications.
School districts may choose to employ physicians and/or other health care providers in an advisory or direct care setting. School districts may also choose to sponsor school/neighborhood health clinics where students can receive routine and specialized health care. Students may require additional school nursing support in the school setting to access educational opportunities. The question school districts face becomes what is "medical" and what is a "related service" to be provided by a "qualified school nurse or other qualified person" as a required "school health service." The Tatro and Garret F. Supreme Court decisions helped to clarify this determination. These landmark decisions solidify and reaffirm the central role that school nurses play in the delivery of related school health services under the IDEA and the obligation of school districts to pay for such services.
RATIONALE
Medical services in the school setting are those activities rendered by a physician and/or other healthcare provider.
Diagnoses diseases and other health impairments
Orders laboratory and other diagnostic tests
Prescribes medications for treatment of health problems
Issues health care intervention orders
Consults with appropriate school personnel concerning the health of a student
Participates on student assessment team when appropriate
Health services in the school setting are those activities rendered by a registered professional school nurse or other qualified person, which include, but are not limited to, implementation of the following IDEA and Section 504 requirements:
Assesses the child’s functional and physical health status in collaboration with the child, parent(s) and health care providers
Develops individualized health and emergency care plans in collaboration with the child, parent(s) and health care providers
Assists the team in developing an Individual Education Plan (IEP) that provides for the required health needs of the child and enables the student to participate in his/her education program
Assists the parent(s) and child to identify and utilize community resources
Assists the parent(s) and teachers to identify health-related barriers to learning
Provides in-service training for teachers and staff regarding the individual health needs of the child
Provides and/or supervises unlicensed assistive personnel to provide specialized health care services in the school setting, where permitted by the Nurse Practice Act
Evaluates the effectiveness of the health-related components of the IEP with the child, parent(s), and other team members, and makes revision to the plan as needed
Participates in the identification and evaluation of students who may be eligible for services under IDEA or Section 504
Develops student goals and objectives and nursing protocols to meet student-specific health needs during the school day, monitors student progress, and initiates an IEP or 504 assessment when indicated
Serves as the team liaison to the medical community
References/Resources:
Cedar Rapids Community School District v. Garret F., 119 S. Ct. 992, 29 IDELR 966 U.S. (1999).
Individuals with Disabilities Education Act (IDEA). (1975). 20 U.S.C. §§ 1400 et seq., as amended and incorporating the Education of All Handicapped Children Act (EHA), 1975, P.L. 94-142, and subsequent amendments; regulations at 34 C.F.R. §§ 300-303 [special education and related services for students, pre-school children, and infants and toddlers].
Lordi, S., & Bradley, B. (2000). Standards of professional school nursing practice: Applications in the field. Scarborough, ME: National Association of School Nurses.
National Association of School Nurses. (2002). Position statement: Case Management of Children with Special Health Care Needs. Retrieved February 20, 2006, from http://www.nasn.org/Default.aspx?tabid=208.
National Association of School Nurses. (2002). Position statement: Using Assistive Personnel in School Health Services Programs. Retrieved February 20, 2006, from http://www.nasn.org/Default.aspx?tabid=201.
National Association of School Nurses. (2003). Position statement: Individualized Health Care Plans. Retrieved February 20, 2006, from http://www.nasn.org/Default.aspx?tabid=226.
Public Law 105-17. (1997). Reauthorization of the Individuals with Disabilities Education Act.
Public Law 108-446. (2004). Reauthorization of the Individuals with Disabilities Education Act.
Rehabilitation Act of 1973, 29 U.S.C. 794 & 504; regulations at 34 C.F.R. pt. 104.
Schwab, N., Gelfman, M., & Cohn, S. (2001). IDEA: Current issues in dispute. Legal Issues in School Health Services: A resource for school administrators, school attorneys, and school nurses (pp. 405-409). North Branch, MN. Sunrise River Press.
Adopted: June 2001
Revised: June 2006