Annual School Nursing Activities

A sample calendar of activities that are outlined by month to assist in planning and evaluation of school health services.
The calendar of activities on the following pages is useful for the registered school nurse and the school administrator to review, plan, and incorporate health activities into the regular academic school calendar. Planning should be done in spring, when the school calendar for the following year is being developed and it is most appropriate to review the health services budget and approved expenditures.
The dates and months of the following activities are only a guide. The actual months of these activities may need to be adjusted according to individual school systems.

The broad scope of school nursing is to support students’ physical, emotional, social, intellectual, and spiritual well-being. The registered nurse’s educational background provides a theoretical base for the skills to devote to holistic well-being, not solely to address physical illness and injury. However, school nurse time is often limited; therefore, the district must make use of the nurse in the most effective and efficient manner.

Prioritization: Health services may be limited based on the school district’s capacity to provide registered nursing services. Priority must be given to situations that represent a safety risk to the student. Mandated services are required by law to be completed during the school year. However, some mandated services, although important to student health, do not necessarily represent a potential emergency situation for a student. It is prudent for the school district to explore other options to use unlicensed school staff to perform (under nursing oversight) some mandated services that do not require a registered nurse (e.g. vision and hearing screenings). The district might also consider providing clerical support to assist the nurse to complete mandated documentation and reports.

1. Case Finding: Identify and prioritize students with special health care needs:

• Review new health registration forms.
•Compile and document health problems in student database.
•Prioritize health problems:
Students with life threatening conditions (such as diabetes, epilepsy, anaphylaxis, and asthma).
Students with emergency medications.
Students who need Emergency Care Plans and/or Individualized Health Plans.

 

2. Assess status of students who require continuous access to licensed nursing care:

•Determine staffing requirements to meet student needs.

•Contracting for additional licensed nursing care may be needed.

   (See Staff Model for the Delivery of School Health Services for guidance)

 3. Plan, develop, revise, and/or update Emergency Care Plans (All students with life threatening conditions including diabetes must have an ECP):

•Contact parents to obtain or update health condition assessment.

•Obtain medication and/or treatment authorization form.

•Obtain emergency medications and/or other equipment detailed in authorization forms.

•Develop/update Emergency Care Plans.

•Distribute Emergency Care Plans to appropriate staff (teachers, playground staff, bus drivers, coaches, etc.) and provide related training.

4.  Notify food services personnel about students with anaphylaxis to avoid exposure to food allergens during meals, snacks, field trips, parties etc.

5. Set up health room:

• Check and put away supplies.

•Prepare health room visit documentation and train first aid staff about legal documentation.

• Distribute supplies to classrooms and playground staff (plastic bags, non-latex gloves, Band-Aids etc.

6.  Plan for Emergency Drills:

Remember to set up systems for emergencies and drills (e.g. fire drills) to evacuate emergency care plans, medications, student medical supplies, and equipment from the building. In a real emergency it is critical for students with special health care needs to have access to their equipment and medications.

7. General training for school staff for non-delegated nursing tasks:.

•Annual training on diabetes, asthma, anaphylaxis, and other life-threatening student health needs.

•Training on evacuation plan for students with special health care needs (i.e. medications, supplies, and equipment) during fire and other safety drills.

•Provide or facilitate staff training for first aid and CPR.

• Provide or facilitate blood-borne pathogen training.

•File staff training documentation.

(See Washington State School Staff Training Guide)

8.  Detailed, specific training and delegation for selected school staff (delegation in the school setting may only be provided by a registered nurse per Washington State Nursing Care Quality Assurance Commission Advisory Opinion)

•Train staff on student-specific Emergency Care Plans (be sure to consider staff such as Counselors, Librarian, Music teacher, Resource Room, Before & After School Program personnel, Nutrition personnel, Bus drivers, etc.).

•Delegation of nursing tasks:

Delegate emergency medication administration.

Delegate routine medication administration.

Delegate nursing procedures (Gastrostomy tubes, clean intermittent catheterization).

Documentation of delegated activities (nurse and delegate signature and date) and file.

9. Immunizations:

•Consult with secretarial staff regarding immunizations (pre-school, kindergarten, new vaccine requirements, new to district). Send out reminders that students will not be able to start school until vaccinations are up to date.

1. Review medication system:

•Medication count of all scheduled drugs coming to school.

•Assure medical orders are obtained and correct for all medications.

•Prepare documentation for medication administration.

• Provide information to teachers about specific students taking medications if appropriate.

2. Ensure that students with inhalers and/or epinephrine auto-injectors are capable of self-carry and/or self-administration:

•Identify students with inhalers and/or epinephrine auto-injectors.

•Obtain family permission and licensed health care provider authorization for student to self-carry and self-administer inhalers and/or epinephrine auto-injectors.

•Evaluate competency and responsibility of student to self-carry and self-administer inhalers and/or epinephrine auto-injectors.

•Document and file evaluation and recommendation of registered nurse for student to (or not to) self-carry and/or self-administer inhalers and/or epinephrine auto-injectors.

•Feedback to parent regarding nurse decision and plan for student to self-carry and/or self-administer.

3.  Continue to develop and/or update Emergency Care Plans (ECPs) and Individualized Health Care Plans (IHPs):

•Care Plans for students with diabetes (all students with diabetes must have both an ECP and an IHP).

•ECPs for those students with potential emergency health needs during school.

•IHPs for students with delegated nursing tasks (Gastrostomy tube, CIC, etc.).

•IHPs for students with special health care needs, prioritized by registered nurse.

6.  Registered school nurse must keep school administrator(s) informed of the status of any unmet student health needs particularly life-threatening health conditions.

1. Vision and hearing – facilitate vision and hearing screening.  (See Visual and Auditory Health Screening)

(Note: Although vision and hearing are mandated services, the registered nurse should prioritize time to address the most critical health needs of students. Completing emergency care plans and ensuring that staff is prepared to respond in an emergency are the highest priorities).

2. Immunizations:

•Continue consultation for central registration, building registrars, and/or front office staff,
pre-school and K-12.

•State immunization report finished and reviewed by end of October.

Meningococcal and Human Papilloma Virus (HPV) disease and vaccine information to be provided to families of students in Grades 6 through 12 per state mandate.

1. Immunizations:

•Ensure completion and submission of state immunization reports for preschool and K-12 to DOH by date specified for the current school year.

•Encourage adult health immunization program for staff, students and families (influenza, etc.)

2. Vision and hearing:

•Continue follow-up and referrals as needed.

1.Vision and hearing:

·Continue follow-up and referrals as needed.

1. Vision and hearing:

•Continue follow-up and referrals as needed.

2. Review need for retraining/new training of Emergency Care Plans:

Reminder: Middle School and High School students will most likely have a new set of teachers in the second semester and will need copies of ECPs and training.

3.  Reminder:  Ongoing supervision of all delegated nursing tasks is required and should be documented appropriately.

4.  Reminder:  Registered school nurse must keep school administrator(s) informed of the status of any unmet student health need particularly life-threatening health conditions.

2. Health room supplies:

•       Conduct inventory for ordering supplies.

•       Ensure adequate stock of printed forms (Medication administration forms, emergency care plan forms, field trip forms, etc.)

 

3. Health education:

•       Provide, assist, or consult with school staff regarding the health education curriculum.

 

4. Kindergarten registration or Child Find:

 

•       Develop/review procedures to identify health concerns for incoming students at time of registration, and to meet families to assess health conditions and educate about health care at school.

1. Field trips (See Field Trips, Off campus Activities, and After Hours section)

•Remind teachers, secretaries, and principals that the registered nurse must train any staff that accompany children who have emergency care plans or may need medication or medical treatments.

•Ensure system is in place for nurse to be notified in a timely manner at least 2 weeks BEFORE field trips are scheduled.

2. Overnight Field Trips and Camps, BEGIN EARLY

•For large annual camps when students will be staying overnight, begin preparations early! If it is an out-of-state field trip, check with the nursing commission in the state that students are visiting to determine if your nursing license and related delegation is accepted or if other arrangements are needed. 

4. Immunization

•Prepare mailing for 6^th graders to obtain necessary vaccine(s) for student entry into 7^th grade.

•Prepare information for parents regarding meningococcal disease and HPV vaccines to be distributed at the beginning of every school year for students grade six and above. (Can be by letter, in school newsletter, district or school website, etc.)

 5. Health education:

•Provide classes OR consult when requested regarding human growth/development/comprehensive sexual health education

•Work with administration to ensure annual HIV/AIDS curriculum requirements have been met.

 6. Information Management:

•Complete the District Assessment

1. Field trips:

•Remind staff to notify nurse at least 2 weeks before field trip is scheduled.

•Provide training/delegation to staff that will accompany students on field trips, including transportation staff.

2. Spring camps (overnights):

•Continue to prepare staff for student needs on overnight trips. If it is an out-of-state field trip, check with the nursing commission in the state that students are visiting to determine if your nursing license and related delegation is accepted or if other arrangements are needed. 

3. Kindergarten Registration:

•As above.

4. Begin planning with administration for next year:

•Schedule an appointment with administration.

•Review the budget report and recommendations.

•Review and update policies and procedures as necessary to submit for School Board approval.

•Provide written and oral review of summary of year with focus data from the District Assessment, student outcomes and any specific recommendations for coming year.

1. Preparation to develop Emergency Care Plans for students with life threatening conditions:

•Notify families of the need to have emergency care plans in place at school before the first day of the following school year.

•Send packet or direct families to website for forms to complete and return before the next school year. Include:

Form for parent to update specific health condition history.

Consent to share emergency information with school staff.

Medication authorization form.

Consent to allow exchange of information with health care provider (if needed).

Self-carry forms for inhalers and epi-pens

Diet prescription form for students with anaphylaxis

•Remind families to set up an appointment with the school nurse one week before the beginning of the following school year to finalize the Emergency Care Plan.

2. Field trips and spring camps (overnights):

•Remind staff to notify nurse at least 2 weeks before field trip scheduled.

•Provide training/delegation to staff that will accompany students on field trips, including transportation staff.

3. Immunizations:

Notify families of 6^th grade students about vaccines necessary for 7^th grade entry. 

•Send letter to graduating seniors, with a copy of their CIS, encouraging them to update immunizations as needed.

4. Health room equipment:

•Ensure equipment is functioning appropriately.

•Calibrate audiometer annually.

•Check vision equipment.

•Calibrate sphygmomanometers (as necessary).

•Calibrate scales (as necessary).

•Replace/order batteries/bulbs for examination lights (otoscopes if applicable).

5. Plan for summer school or extended year session:

•Identify students with special health care needs who will attend summer or extended school session.

•Notify administration of student needs for routine health care and emergency safeguards necessary during summer school or extended year session.

•Provide for health care during summer school or extended year session according to administration decision regarding registered nurse availability.

1. Field trips/overnight trips:

•Remind staff to notify nurse at least 2 weeks before trip scheduled.

•Provide training/delegation to staff that will accompany students on field trips, including transportation staff.

2. Medications:

•Notify families of students with medication at school to pick up medications.

•Sign out all medication released to families (including count and family signature).

• No medication should remain in the building over the summer unless needed for summer school.

•Notify families that they must obtain authorization from health care provider (include medication authorization form) for medications and/or treatments to be given at school the following school year. This may be done by letter, website or other communication resources.

•Ensure medication related forms on the website are up-to-date for the coming school year.

3. Information management:

•Compile documentation forms and arrange for filing, storage, and/or archives

(e.g. medication logs, health room passes).

•Store personal notes only for nurse access.

•Prepare plans to accompany students who will transfer to another building or school district (obtain signed family permission if student leaving district).

•Check and transfer health files, especially for special education students.

4. Schedule and plan for next school year with school administration:

General staff training (faculty, secretaries, bus drivers, playground staff, etc.).

Delegation training (as above as needed).

Health screenings (vision, hearing,).

Health education for students, especially to include required HIV/AIDS curriculum.

Any known school outings (annual spring camp, field trips, etc.).

Summer school coverage.

Plan and budget for focused professional development opportunities for school nurse and other staff who deliver school health services based on staff evaluation and professional goals.

Be present in school buildings as much as possible and on-call for emergencies (not necessarily for minor first-aid).

To work efficiently, the nurse may need to have a quiet workspace to allow him/her to address the most critical student health care needs. 

Schedule regular meetings with administration:       

Consider frequent meetings with building administrators and periodic meetings with district administrators:

•Give current information on activities and issues of health services delivery.

•Always give some positive information, especially progress on completion of mandated services.

•When presenting problems, offer recommendations for solutions and resolutions.

Schedule regular meetings with:

•School staff who deliver health services for feedback and evaluation.

•School staff who provide delegated nursing tasks.

 The training, supervision, and monitoring activities of school staff for all delegated nursing tasks including medication administration may include:

 Identify new students with health problems:

•Assessments

•Plans

•Interventions

•Training of staff

 Immunizations:

•Identify conditional students and discuss resolution with family.  Work with school staff members on resolving conditional status of students

 Monitor at-risk students:

•Collaborate with care teams, teachers, etc.

•Collaborate with community teams, mentors, CPS, etc.

Communication and networking with school/district team:

•Students

•Faculty and staff

•Families

•Building and district administration

•Coordinated School Health or School Health Advisory Committee team(s)

• Community services/agencies (stakeholders in health and education)

• Local Health Jurisdiction

•Health care provider offices, clinics, hospitals, specialty services

•Medical assistance

•Child Protective Services

•Other as needed or specific to district and/or community

Documentation:

•Electronic health record system

•Medication logs

•Health room documentation system

•Individual health care plans

•Emergency care plan

•Delegation activities

Work with School Teams, Special Education Services, Counselor, and 504 Coordinator to:

•Provide health/nursing assessments and interventions for students with special health care needs.

•Participate in social-emotional screening as needed.

•Participate in development of IEPs.

•Participate in development of 504 plans.

 Work with school personnel to provide or to assist with health education classes:

•Hand-washing and hygiene for health promotion.

•Wellness promotion.

•Stress reduction.

•Refusal skills.

Contribute nursing expertise to develop and implement health and safety policies and plans:

•Safety Committee

•Crisis Planning

•Wellness Policies

•School Improvement Plan (District and Building)

•Coordinated School Health Program

Attend parent meetings & Parent/Teacher conferences.

 Participate in professional development opportunities as appropriate.