The Relentless School Nurse: School Health Chat – A Virtual Roundtable

Pediatricians and school nurses are powerful partners when we collaborate.  Intentionally building relationships will bear the most fruitful outcomes to improve the health and well-being of our students.  We are far more effective working in concert than in our silos.

School nurses on Twitter have been connecting individually and through informal #SchoolNurseChats. Recently we decided to create an opportunity for school nurses and #Tweetiatricians (pediatricians who Tweet) to join together for a #SchoolHealthChat. It was not sanctioned or sponsored by an organization. It was an organic, grass-roots effort to enhance communication, bridge the gap between the pediatricians’ office and the school health office.

The #SchoolHealthChat was held on February 28th at 8:00 pm. This Tweet illustrates the need for more robust communication with our Pediatricians. It is an invitation to connect, collaborate and create meaningful linkages for improved student health outcomes.Dr. Deborah Greenhouse took action to address her self-identified lack of understanding of our scope of practice. She asked to be connected to the South Carolina School Nurses Association. In a wonderful twist of serendipity, the President of that organization was the school nurse at her children’s elementary school! No telling where this new collaboration will go, and what impact it will have on student health outcomes.

Here are some of the questions and answers from our first #SchoolHealthChat. We had participation from school nurses and #Tweetiatricians from NJ, CO, IN, FL, NE, MA, TX, MN, SC, MD, DE, PA, NY, NH, VT, WA. If you were on and your state is not mentioned, please message me and I will add you!

• Cluster Nurses here communicate with the docs, and we make our cellphones available for them to contact us 24/7/365.
• HCP’s can call me any time of day. Like when I call them, a message can be left and I will@return the call ASAP.
• Screen for days missed each year and have created templates for well visits for all the family medicine providers in my practice. Have given talks on #Absenteeism to MDs and NPs. Always highlight the #schoolnurse as a resource.
• School attendance affects a student’s academic achievement. Current data suggests that about 1 in 3 children miss more than a month of school for various physical, social, economic, environmental, and health reasons.
• Would love to see those numbers broken down. Are most of the absences for physical health, mental health, socioeconomic reasons? Knowing that breakdown should be the first step towards fixing the problems.
• So according to research done in my state, students most often miss school due to illness. Next most common reason for absences related to lack of transportation – missed the bus..
• Wow, never would have guessed transportation was such a big issue. That’s eye-opening.
• @schoolnurses have access to health and attendance data making it possible to more clearly define the problem of chronic absenteeism.
• Seems like chronic absenteeism would be a perfect topic for some real collaboration between @schoolnurses and @AmerAcadPeds .
• Help with outreach to students/families to meet individual needs; help student/family access to physical or mental healthcare providers; ensure students feel safe at school; provide student & family support during the school day.

• Please tell your staff we can contact you if we have a question about order/form or note.
• Many school districts seek pediatricians to provide a medical consult with the nurses on s monthly basis. It is an opportunity to educate each other and build relationships.
• I actually do meet with my school physician monthly. She is then my liaison to other pediatricians in the area.
• I’ve heard from #schoolnurses that it’s sometimes hard to get through to many physicians. Im in a huge clinic do wonder if I need to start changing THAT aspect of the system first!
• Sharing professional development would be another way to build relationships! Invite School nurses to a PD and learn together!
• Hi all, I’m in nursing prof dev and totally agree. Incorporate care collaboration topics into synergistic learning. Make it multidisciplinary and include all care settings to the education.
• Talk to the local @AmerAcadPeds chapter. Ours has a #schoolhealth committee. Ask to work on projects. Our annual meeting last year was #schoolhealth. This year we’ll invite #schoolnurses again to our meeting on #Advocacy!!
• #schoolnurses are uniquely positioned to collaboratively assess needs in the community, collect data to formulate a plan, advocate for better health, and evaluate outcomes. Check out more info: http://ow.ly/HvJ130nSwi7 
• MDs, NPs, PAs speaking at SN staff meetings; visiting schools to speak to students and make time to speak to school nurse. A gap in care certainly exists between school nurse and peds office.
• I’ve been trying to start simple when I’m “meeting” school nurses. I find that asthma is a GREAT starting place. Bidirectional communication. Call me for Med Administration forms or to tell me the plan needs updating!

• I would have them experience the quick and rapid flow and triage skills and critical thinking that occurs every day!
• I would love #pediatricians to be School board members! We need health advocates!
• Makes me think pediatricians might like to see our data? We do have data banks & they speak volumes about communities/kids/families.
• 1)please advocate for a licensed nurse in every school and educate that school clinics are more than bandage and ice pack dispensaries. 2) please come give a brief in-service twice a year, with updates re: regional health/wellness concerns, tips. 3) feed us.
• Due to privacy many docs were hesitant to speak with me, but many times I just needed them to listen but couldn’t establish a line of communication. Simply listen would be my number 1.
• Support the need for a registered professional school nurse in every school #alldayeveryday #4studenthealth Educate parents about the role of the school nurse. Establish working relationships with school nurses in the area of your practice.
• It helps us a lot. But I utilize my social worker and interpreters frequently to help my families get the paperwork completed. Still an uphill battle to get families into the primary health system.
• A huge support would be for peds to actively advocate to school boards to have up-to-date health policies such as head lice policy, ID policy (conjunctivitis).
• We believe care coordination must be tailored to include all those who interact w children in the school & larger community. This requires the collaboration of multiple stakeholders & a unified vision.
• I wish I could spread school awareness of #AntibioticStewardship and the harm of treating viral conjunctivitis with antibiotics. I understand fears of #conjunctivitis spreading through #school & #earlyed but asking docs to prescribe #antibiotics against better judgment isn’t ok.

• Our district includes a paragraph on every clinic form a parent/guardian signs (health plan, med. authorization, etc) that gives consent for the school nurse to call the doctor regarding concerns or for clarification.
• Our winter chapter AAP meeting focuses on CATCH (Community Access to Children’s Health). Seems like the perfect setting for a presentation like this.
• CATCH grants are community health grants for pediatricians and pediatric residents across the country.
• Call your pediatric office to work on emergency room and hospital follow-up planning. You may know more than they do, or they may have more data! Build that relationship on shared data!
• Great appreciation for your support, engagement and clear understanding of the impact of collaborating with school nurses. Imagine the streamlined care we could all render if our data was shared. This is within our reach. We need an #Informatics student in search of a capstone!
• Hmm. Let’s brainstorm this idea! When I finish my thesis in the next few months, I’ll work with you on it. Would be happy to reach out to my school of public health and others if we put together a proposal! General impact of the #collaboration, impact on #absenteeism…
• From the AAP: Pediatricians should establish a working relationship w #schoolnurses who care for their patients with chronic conditions to ensure individual patients’ health plans are executed effectively within school. #SchoolHealthChat http://ow.ly/m8YR30nSx53 . (cont.)In addition, #pediatricians‘ communications with #schoolnurses concerning their patients should be sufficiently clear and detailed to guide school nurses in overseeing the care of individual children. http://ow.ly/HUWz30nSx6v  #SchoolHealthChat
• invite #pediatricians to an in-service. We could present & bring lunch. Invite them to socialize. Get your professional groups together! Joint meetings.
• I think it’s really important to have a point person in the office with a direct number for the nurse to contact. That facilitates easy communication and makes it easier for the school to get in touch with the doctor.
• We have like 5 major doctor affiliations in our city with many offices- if each of the major affiliations would have an office nurse to collaborate with us that would be huge and a game changer on both side I would think.
• Agree completely! A point person is important. A relationship can be established. I love the idea of sharing information through professional development too.
• I’d love if practices and schools coordinated their release forms and also told each other their policies. A great example is Vanderbilts. Some go to school nurse, SAC, direct to teacher. Some won’t use fax . Communicate best ways for personal health info.
• We are exploring ways to add electronic consent at time of school registration, giving #SchoolNurses permission to share info w/peds or family docs!
• I was just lurking on #schoolhealthchat but as the @SC_AAP spokespig, I can see some great collaboration between #tweetiatricians and school nurses in SC in our future!
• Bringing @KerryseaseKerry and @Saul1Robert in the loop. Brainstorming a CATCH meeting presentation on the collaboration between school nurses and pediatricians in SC. Thoughts?

• Mostly would like info on kids with chronic conditions like asthma, ADHD. Checklists, albuterol use, etc. Routine stuff or screenings not so needed.
• Are there checklists that you use for asthma? Like a Vanderbilt for ADHD? Share those with the school when sending orders for rescue inhalers!
• This is a screening tool used in peds practices, school nurses could use it as well and share with #pediatricians: Asthma Control Test – age 12 and up. (ACT)
• On the flip side, if school nurses used ACT a few times per year, they might identify kids with poor asthma control before they end up in the ER, allowing us to see them and tweak meds. Could make for an interesting CATCH grant.
• I’m not sure #pediatricians and #schoolnurses even know which screenings are required in each environment. Perhaps the best thing would be an intro letter saying “We screen for X so call if you’d like to get info on your patient”.
• I’ve learned more in the past year about #school nurses than in the prior 24+. My new position helped and #twitter has been amazing for learning thx to many of YOU!
• Many school nurses do the following screenings annually: Growth assessments: Ht/Wt and BP Vision & Hearing annually through primary grades then alternating Scoliosis (in NJ starting age 10 every other year) Oral health (preschool – in NJ anyway)
• Hearing screening and vision screening is such a great way to start the ball rolling. Hate to say it, but I’m happy when a kid who hasn’t had a well visit comes in because they failed a screen!
• Wow, if our local districts are doing these screenings, they’re certainly not sharing the results with us. Unless all of my patients are passing every screen every year.
• Great opening for better understanding of our role and even more reason to have electronic HR exchange of info. Referrals often get lost in the shuffle between school & home!

A very special shout-out of appreciation to Dr. Mary Beth Mioto,  for her on-going support and engagement with school nurses across the #Twittersphere! Dr. Deborah Greenhouse and Dr. Scott Krugman are also collaborative #Tweetiatricians who have joined in our #SchoolHealthChat. We hope this is the first of many! Welcome also to Dr. Peg the Ped who joined in towards the end.

Great appreciation and friendship to the Lisa Kern, Tonja Frank, and Chris Amidon for their pioneering spirit in co-creating these #TweetChats with me! This is shared leadership at its finest.

I have tried to capture as much of the #SchoolHealthChat as I could. For those who are interested in reading more of the responses, you can search Twitter using our unique hashtag: #SchoolHealthChat. Choose the Latest or Top tab and you can look read threads of Tweets that correlate with the Questions as long as they are tagged.

Please comment in this post if you are interested in having another #SchoolHealthChat. The feedback has been great and we hope to coordinate another one soon. In the meantime, look for the next #SchoolNurseChat in the Spring!