The Relentless School Nurse: A Perspective on The Future of School Nursing

 

I appreciate the readers of my blog! They often reach out and send messages or leave public comments on the website. One of my most loyal readers is veteran school nurse Linda Morse, who retired from the New Jersey Department of Education (NJDOE) several years ago. She has a deep knowledge of school nursing from her wide-angle lens as one of the few school nurses at the state level. Linda sent the email printed below after reading my most recent blog post; “Where Have All the School Nurses Gone?  Her ideas, while focusing on New Jersey, are actionable in any state. The only thing I vehemently disagree with Linda on is her comment, “Maybe my time has passed and I should simply enjoy retirement…” No, Linda, we need your perspective, experience, and institutional knowledge. We welcome your contributions and inspired suggestions.

Robin, 

I wonder if it is time for New Jersey to consider another “model” for the delivery of school health services. While the state is geographically small, it is burdened by a large number of school districts, disparate in size and need. In addition, the requirement to have a “school medical inspector” for every district places a burden on every Board of Education to approve policies and procedures that may differ from other local districts. At the high school level, there are trainers who often deal with another physician for policies and procedures and who see themselves as separate from school health services.  

Furthermore, the lack of a voice at the New Jersey State Department of Education, and thus a  liaison to other State agencies that deal with a myriad of health-related issues, complicates the issues before schools and the nurses they employ. The lack of a clear line of communication and synergy amongst the many agencies and organizations that impact children’s health is troubling and only makes the issues faced at the local level more difficult. 

For many years, we have struggled to maintain certification as the gold standard for school nursing practice in New Jersey. I fear we may lose that battle if the current situation does not improve. There has always been support at the NJDOE for “a nurse is a nurse” and there are some who would gut the certification programs in a heartbeat. Be advised there are very few people left from my days at NJDOE so there is no solid history there (I hear that is a real problem across the board, by the way). 

Perhaps then we, as experienced school nurses, need to discuss presenting to policymakers and influencers a different model that addresses current and future needs, eliminates waste,  and ensures that children get the same quality care in every New Jersey district. While this may not address the immediate needs, it may be our last opportunity to ensure fully credentialed school nurses have a place in every school and district. 

Some ideas to kick around might include: 

1. Codify standardized protocols and orders to be used in every district (rather than having  every “school physician” do their own thing;” frees up money and ensures equity across  that state; the actual procedures do not get codified, just the process 
2. Create county-based advisory groups comprised of school nursing leaders, local  physicians, and public health personnel that look at staffing issues across the county and  region and advise school administrators and school boards (not sure what role they might  play in this model) 
3. Develop a mentorship program (similar to teachers) for school nurses in years 1-3 to help  increase the pipeline and provide support; perhaps all these retired nurses could play a part  in each county 
4. Develop a cadre of school nurse leaders who oversee county-based services and those in  larger school districts (I have never been a fan of the county health department taking over  but in some counties, that model may be necessary) 
5. Develop a better system to collect data on services provided that is consistently used to  improve staffing (think that the county advisory group uses it not the county education office);  the current report is cursory at best and there is no real standard for data collection) 
6. Look at a tiered system where the CSN is “in charge” with a state-defined role for others  who work with the CSN (LPN, aides, secretaries, EMT and paramedics, paraprofessionals)
7. Require every district to use the same reporting and data systems for school health  services and services provided by any other “medical’ entity in the district (e.g. trainer,  mental health providers, SAC); we can’t evaluate the system of care with every district  doing its own version of data collection 

I have a lot of ideas based on my years in districts and at the DOE. Not sure if they would help but maybe we should start thinking “out of the box” (to use a cliche) and be the ones up front with innovation rather than waiting for the axe to fall. 

Maybe my time has passed and I should simply enjoy retirement but I love reading your blog and I know we are in a really tough place. Let me know if there is any way I can help or if you and some others want to meet and brainstorm. I would be glad to facilitate or participate in any way. 

Keep on plugging! 

Linda Morse