Massachusetts School Nurse Organization, Current Issues

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Table of Contents

Advocate at MDPH Regional Health Dialogues for the Allocation of Increased Funding for ESHS (Talking Points)	Kathy Hassey's Interview with NECN News (2/08)
MDPH Answers Questions about MRSA (10/07)	Education Personnel Information Management System (8/07)
School Nurses Now Eligible for PTS (9/07)	MA Health Care Reform Poses Problems for Some MA Residents (9/07)
Question of the Month: Delegation (7/07)	NASN News (10/06)
MA School Nurse Research Network	Update on MA School Nurse Research Network
Free or Affordable Health Care Programs in MA.	Nationwide Poison Help Number

Pioneer Valley Food Allergy Support Group

Advocate at DPH Regional Dialogues for the Allocation of Increased Funding for ESHS
Mimi Stamer MSNO President-Elect, Legislatve Committee
May 8, 2008

Talking Points About School Nursing and the Essential School Health Infrastructure Grant (ESHS)

School Nurses support DPH initiatives: "Helping People Lead Healthy Lives In Healthy Communities"

School Nurses are empowering and transforming communities

School Nursing eliminates racial and ethnic disparities

promoting access to health care

providing school health services to every child, exclusive of cultural background and socioeconomic or health insurance status

School Nursing promotes wellness in school, home, community, and workplace

School Nurses implement State mandated health screenings for children (Vision, Hearing, Growth, Postural Screening)

School nurses are the gate keepers regarding Immunizations

School Nurses are the “safety net” for children and families

School nurses manage chronic diseases of children and adolescents

>20 % students have chronic health conditions

School nurses promote children to reach their full potential for health

School nurses are dedicated to the health concerns of the neediest children in MA

School Nurses Promote the State’s initiative for Health Care Reform

School nurses provide informational materials and applications to families about Commonwealth Health Connector and referrals to MassHealth, Children’s Security Plan, or Commonwealth Care

Data is generated by school nurses as to how many families are referred and enrolled in a State Health Insurance

School nurses ensure that familes receive quality health care and live in a safe and healthy environment

School health services build partnerships to maximize access to affordable and high quality health care

ESHS Grants provide a support system that enhances the nursing services in public and non-public schools

Supports health services of School Nurses who are responsible for of 250-1,200 students per school

Supports school nurse services for an average of 40- 100 students in the health office per day

School Nursing in Massachusetts

School nurses are present in every school system and work to meet state mandates for immunizations and screening, administer medications and treatments, assist with educational planning for students with special health and education needs, serve on the front line as medical first responders for disasters and other public health emergencies, and coordinate care to primary care providers, often with School-based Health Center staff who also provide this care along with mental health services, monitoring health outcomes, and enrolling families into MassHealth, the Children’s Medical Security Plan, and Commonwealth Care.

School nursing and school health services reduce absenteeism, decrease the number of emergency room visits, and provide a full range of nursing and health care services. School Based Health Centers provide medical care and social support to underserved and difficult to reach children and youth. 91.1% of students seen in the school nurse office are returned to class.

Significant health disparities exist among Asian, Black and Latino children. Asian, Black and Latino children with asthma, diabetes, cancer and other chronic illnesses have less access to quality health care and health insurance.

The health of school children has become more complex. Children with severe allergies, asthma, diabetes, epilepsy, cancer and other special health care needs and chronic medical conditions are enrolled in our schools. In addition, there has been a rise of social problems among our youth such as substance abuse, depression, and violence.
Please attend the MDPH Third Round of Regional Health Dialogues and advocate and educate DPH Commissioner John Auerbach and a panel of local health partners about the value of ESHS in your school, community as they discuss public health priorities.

Please CLICK HERE to view Dates and Times of MDPH Regional Health Dialogues

MDPH Answers Questions about MRSA
Anne Sheetz, Director of School Health Services (MDPH)
October 20, 2007

We know you are being contacted by parents, superintendents, other administrators, athletic directors and students regarding MRSA. Here are the educational materials and Questions and Answers that may be useful-- this appears to be a teachable moment! We are so thankful you are there!

For further information, please visit: www.mass.gov.dph. The telephone number is 617-983-6800.

School Nurses Letter.pdf
MRSA General Q A.pdf
MRSA Soccer Poster.pdf
MRSA Skin Care.pdf
MRSA Hockey Poster.pdf
MRSA Hand Poster.pdf
MRSA Football Poster.pdf

Cleaning Athletic Equipment

The California DOH has a nice guideline for athletic programs at: www.cdph.ca.gov/healthinfo/discond/Documents/CAMRSAInfectionsGuidelineAthleticsDepartment.pdf.

Cleaning is important in itself, but if a disinfectant is used it should be appropriately labeled by EPA (www.epa.gov/oppad001/list_h_mrsa_vre.pdf) for the purpose, and used according to label instructions.

There is a Mary Custer in the Nursing Department at Simmons who lectures on this topic (www.simmons.edu/hygieneandhealth/ppt/MaryAnnCuster_MRSA.ppt). Any of the Epidemiology Program epidemiologists can provide specific advice and the subject matter expert on MRSA control is Kathleen Gilmore, health educator based in the West, who would be a good contact for questions. Kathleen Gilmore's telephone number is 413-586-7525 Ext 1149.

The following resource has some nice toolkits for schools, including custodian guidance. They also have a fact sheet specific for police officers.
Tacoma-Pierce County Health Department.

Association for Professional in Infection Control and Epidemiology, Inc.(APIC)
APIC

Manging Drug Resistant Organisms Guidelines 2006 (CDC)
Managing Drug Resistant Organisms Guidelines 2006

Multi-Drug Resistant Organisms in Non-Hospital Healthcare Settings (CDC)
Multi-Drug Resistant Organisms in Non-Hospital Healthcare Settings

Los Angeles County
Los Angeles County Public Health

Centers for Disease Control and Prevention
CDC Control and Prevention

Massachusetts Department of Public Health Antibiotic Resistance Web Page
MDPH's Antibiotic Resistance Web Page

Education Personnel Information Management System (EPIMS):
What MA School Nurses Need to Know
Marie DeSisto, RN, MSN (MSNO Past-President)
August 20, 2007

EPIMS is the Education Personnel Information Management System, which the MA Department of Education will be implementing, on mandatory basis, in all districts in the fall of 2007. The first statewide EPIMS data collection period will be from October 1–December 31, 2007. EPIMS will replace the DSSR (District School Staffing Report) which currently reports only aggregate employee data. The DSSR system did not collect information on school nurses or the school physician.

The new EPIMS will collect demographic data and work assignment information on individual public school educators, including school nurses, for the first time in our state's history. This information will enable Massachusetts to comply with the No Child Left Behind Act by accurately reporting on highly qualified teachers and other staff. Many school systems have started to gather the data for the EPIMS reporting, which will be sent to the MA DOE over a secure portal. The EPIMS data also will be used to perform greatly needed analysis on the qualifications of teachers, nurses, and other professional staff employed by school districts.

The EPIMS system will collect data in 26 different entry fields from your full name, date of birth, employment status, certification, your degrees, the degree institutions, etc. For a full listing of data fields you need to find the Department in your school system that is implementing EPIMS as it varies in each district, or you can check the DOE website: http://www.doe.mass.edu/infoservices/data/epims.

School nurses are included in the EPIMS Data Base. Specifically items:

Degree/Subject (data field SR 20):

Job Classification Code (data field WA 07):

Teacher Assignment (data field WA 08):

Grade (data field WA 09):

Nurse Leader – 00 (does not apply)

Highly Qualified Status (data field WA 14):

The MDOE recognizes that all nurses are licensed by the MDOE and BORN and are highly qualified. However, for this report they must use the Federal definitions, which do not apply to school nurses.

It is important for school nurses and MSNO to recognize the need for complete and accurate reporting in EPIMS because the MDOE and MDPH currently do not know who the school nurses are in Massachusetts, where they are or are not, and how nurses stand as far as certification is concerned. This will give the MDOE the information that we need to insure the health and safety of our students. We hope that it will help all school nurses and therefore all school children.

The MDOE Director of Information Services and Technology, John Shontell, has been very helpful and has promptly addressed our concerns regarding school nurses, nurse leaders, and the EPIMS system. He also sends monthly emails to all school districts with updates. If you have any questions about the program please discuss them with your district EPIMS coordinator.

This is the DOE link to the EPIMS: www.doe.mass.edu/infoservices/data/epims .

School Nurses Now Eligible for PTS
by Sarah Nathan
From: MTA Today, V.35, No.1/ August-September 2007, p. 2

Public School Nurses have gained the same protection from unfair dismissal that has long been in place for Massachusetts teachers.

A law that is now in force - following an MTA challenge to an interpretation by the state Department of Education that would have pushed back its effective date - allows School Nurse to earn "professional teacher status" after completing three consecutive years of service in the same school system.

School Nurses who were employed for three consecutive years prior to Oct. 22, 2006, have already earned PTS. Nurses who were working prior to that date are able to accrue that time and use it to reach the three-year mark.

"This is an important show of respect for School Nurses across the Commonwealth," said MTA President Anne Wass. "This new law fills a void that was overlooked for years. Nurses provide an invaluable service to students, teachers and school staff and have earned the job security provided by this law."

Late last year, the MTA challenged a draft advisory from the DOE stating that School Nurses could not begin to amass service time until after the law was enacted. More recently, the DOE posted an advisory acknowledging that nurses who met the criteria for PTS prior to Oct. 22, 2006 - the date of enactment - now possess this important job protection.

"Its time has come," Judy DeFalco, who is entering her 25th year as a School Nurse at Shrewsbury High School, said of the law. "There is no money attached to it, but there is a feeling of pride that we belong side by side with the teachers in caring for the children of our districts."

DeFalco, who supervises the nursing staff in the Shrewsbury Public Schools, was the original sponsor of the bill seeking job security for the nurses. In 2003, after learning that nurses did not have the same job security as teachers, she reached out to her hometown legislator, Rep. Karyn Polito (R - Shrewsbury), who filed the bill on her behalf. Rep. Christine Canavan (D - Brockton) filed a similar bill, which subsequently passed. The MTA, along with the Massachusetts School Nurse Organization, actively lobbied for the bill's passage.

With the law on the books, School Nurses who attain PTS are protected by the substantive and procedural due-process rights outlined in the Education Reform Act of 1993.

School Nurses with questions about this new law should contact their local union president or MTA field representative.

MA. Health Care Reform Poses Problems for Some
Catherine Spader, RN
Nursing Spectrum: NurseWeek Today. Downloaded September 10, 2007
September 4, 2007

Healthcare Reform Poses Challenges for Some Mass. Residents
Catherine Spader, RN
Monday September 10, 2007

The state of Massachusetts is witnessing an unprecedented increase in insured residents since the passage of its groundbreaking healthcare reform law. In 2006, 372,000 of Massachusetts' 6.2 million residents did not have health insurance. As the first state in the country to require adults to carry health insurance, the ranks of newly insured residents have swelled by an estimated 168,000 in the last year.

Adding to this success are the more than 1,100 businesses, including high-profile organizations such as the Boston Red Sox, Dunkin' Donuts, and Gap, that have signed up with the state for a program that allows part-time and contract workers to purchase health insurance on a money-saving, pretax basis.

Despite the July 1 deadline to carry health insurance, nurses and other healthcare providers may continue to see many uninsured residents, as well as newly insured residents, who face healthcare access challenges. "We are extremely pleased with the progress we have made so far, but there is still a long way to go," says Dick Powers, spokesperson for Health Connector, which assists residents with the purchase of affordable healthcare coverage at its website, www.MAhealthconnector.org.

State offices are swamped with applications for the newly expanded MassHealth (Medicaid) program and the Commmonwealth Care plans that provide fully or partially subsidized insurance under MassHealth. On Aug. 11, the Boston Globe reported as many as 50% of applicants to these programs have had to resubmit paperwork, and many are receiving confusing and contradictory information about their qualifications for the programs.

The Massachusetts Health Connector views school nurses as key players who can guide more families into insurance enrollment. The organization has provided every school nurse in the state with information about affordable insurance plans in time for the back-to-school season. Information specialists also are working to improve the efficiency of the Health Connector website, which provides insurance information, plan options, and the opportunity to enroll online for coverage, according to Bob Nevins, Health Connector chief information officer.

Coverage and access issues

Although the new healthcare reform law is a big step toward universal healthcare coverage in the state, some residents will continue to fall through cracks in the system and remain uninsured. The penalty for failure to carry insurance by the end of the year -- loss of personal exemptions on 2008 state tax returns -- can be waived for some segments of the population such as individuals with no or very low incomes and those who can demonstrate financial hardship. In addition, illegal immigrants do not qualify for subsidized insurance plans.

Healthcare industry experts also are concerned about access challenges newly insured patients may face. Getting an appointment as a new patient at a primary care practice in Massachusetts may be tough, as many practices already are brimming with patients. Results of a Massachusetts Medical Society's physician workforce study released July 24, found the state continues to experience a physician shortage in primary care that is worsening access to care. The study cites a variety of concerns, including increasing difficulty of scheduling appointments in a timely manner and fewer internists who accept new patients.

Impact on nursing

Increased demand for primary care services by a newly insured population could mean a greater need for nurse practitioners and highlight the preventive and health maintenance services provided by RNs, according to Marita Prater, RN, MS, president of the Massachusetts Organization of Nurse Executives.

"The state's new healthcare reform should play into nurses' strengths," Prater says. However, the state's nursing leaders say it is too soon to see the new law's effects on healthcare facilities. An informal survey of the Massachusetts Organization of Nurse Executives board members conducted by Prater revealed that board members have yet to feel any impact from healthcare reform. "Hospital budget gurus may be saying that there is a decline in free care as we get people signed on with insurance, but it's still too early to tell what that does to the bottom-line fiscal budget," Prater says. On a positive note, she speculates healthcare reform could translate to better compliance with follow-up care, referrals, and medications. Reform also could translate to decreased lengths of hospital stays because of available funding for appropriate levels of home care, rehabilitation, or long-term care. In addition, some patients who receive care at federally subsidized free clinics potentially could qualify for insurance and have other options for care.

Despite some of the uncertainties and the growing pains of implementing healthcare reform, industry experts are banking healthcare reform will increase awareness of the importance of maintaining health, leading to better use of preventive and primary-care services and less acute and episodic care. "This law forces a different mindset about healthcare," says Prater. Catherine Spader, RN, is a freelance writer for Nursing Spectrum. To comment on this story, e-mail jboivin@gannetthg.com.

What nurses need to know about healthcare reform in Massachusetts

Q: Where can I direct people for information about how to purchase insurance?

It's easy to demystify the state's new insurance program for patients, family, and friends by referring them to the user-friendly Commonwealth Health Insurance Connector Authority's website at www.MAhealthconnector.org. People with additional questions or those who prefer to enroll in a plan by telephone can do so by calling (877) MA-ENROLL weekdays from 8 AM to 6 PM.

The site provides detailed information on all the available insurance plans, including covered benefits, premiums, co-pays, deductibles, and out-of-pocket maximums. It also provides information to employees in employer-sponsored health plans, employers who are shopping for plans for themselves and their employees, and brokers who are exploring options for their employer clients.

Residents can scrutinize each plan individually as well as view side-by-side comparisons before making their selections and can enroll in plans through the website.

Q: What types of plans are offered?

The Health Connector administers two separate programs; Commonwealth Care and Commonwealth Choice. Commonwealth Care offers subsidized insurance to people whose annual incomes are up to 300% of the Federal Poverty Level.

The new Commonwealth Choice provides commercial health products to uninsured individuals and small businesses. The program offers health insurance plans from six participating carriers: Blue Cross Blue Shield of Massachusetts, Fallon Community Health Plan, Harvard Pilgrim Health Care, Health New England, Neighborhood Health Plan, and Tufts Health Plan. These products will receive the Connector seal of approval certifying the product is of high value and good quality.

There are six major health insurance plans available through the state's Health Connector. Plans are grouped into gold, silver, and bronze categories, based on price and benefits. There is also a special plan for independent young adults ages 19-26.

Q: How do residents qualify for these plans?

Qualification for the subsidized Commonwealth Care program or the unsubsidized Commonwealth Choice program is determined by income. Additional information such as family size, residence, age, and occupation immediately alerts users to what types of plans they can purchase and how much they cost.

Employers of any size who do not contribute to their employees' health plans and wish to allow those workers, particularly part-time and contract employees, to purchase health insurance on a pretax basis can purchase insurance through the Health Connector after establishing Section 125 plans. Employers with 11 or more employees were required to offer Section 125 plans by July 1.

Q: What benefits do residents need?

Until Jan. 1, 2009, any health insurance plan offered by an employer or legally sold in Massachusetts meets the individual mandate. On Jan. 1, 2009, the standards go up. To meet the rules by 2009, residents will need a plan that:

Q: Who is exempt from purchasing insurance?

Residents who are exempt include those who have Medicare Part A or B, MassHealth (Medicaid), or access to the health services offered by the U.S. Veterans Administration.

In addition, the penalty for failure to carry insurance by the end of 2007 can be waived in some segments of the population. These include individuals with an annual income of $15,315 or below, married couples without dependents with an annual income of $20,350 or below, and families with an annual income of $25,755 or below.

This also includes those who can demonstrate financial hardship, such as :

Q: What is the penalty for not purchasing insurance, and who will enforce it?

Adults who do not have insurance by the end of 2007 and are not exempt from the requirement will lose their personal exemption when filing their state tax return in 2008. The penalties on adults who do not carry health insurance in 2008 will grow significantly. Uninsured adults will be fined half of the monthly premium cost of the most affordable plan available to them, as certified by the Health Connector. Penalties will be enforced by the Massachusetts Department of Revenue when it collects state income taxes.

Question of the Month: Delegation
Massachusetts Board of Registration in Nursing
July 2007

Question of the Month
Q: As a school nurse I'm often asked if I can delegate the use of a vagal nerve stimulator to the general school staff to use when a student begins to have a seizure. Can I make this delegation?

A: No. The Board has determined that the delegation of the vagal nerve stimulator is not an activity that fits with the regulatory criteria on supervision and delegation as stated in the Boards regulations at 244 CMR 3.05 (www.mass.gov/dph/boards/rn > Statutes, Rules and Regulations > Rules and Regulations-244 CMR > 3.00).

In general the criterion dictates that only those activities which do not require nursing assessment and judgment during implementation may be delegated. In determining their response to this question, the Board considered not just the task of swiping the magnet but also the overall safety concerns of the child having a seizure. It is the Board's position that a seizure is one of those events that require a professional assessment and follow-ups as necessary, the two main determinants for deciding if an activity can be delegated by a nurse to an unlicensed person. As with all technologies, the Board remains committed to reevaluating its positions in order to remain current with the accepted standards of practice.

The entire July 2007 MABORN Board News may be read at http://www.mass.gov/Eeohhs2/docs/dph/quality/boards/nursing_news_july07.pdf.

R. Gino Chisaro, RN, MSN
Deputy Executive Director
Massachusetts Board of Registration in Nursing
Email: Rgino.chisaro@state.ma.us

NASN News
Patty Wright, MSNO NASN Director
October 2006

NASN is interested in compiling a Registry of Certified Diabetes Educators (CDE's) who specialize in pediatrics and have an interest in or practice in the school setting. This would be used as a resource list of consultants to NASN. Please send contact information to me at wright@msno.org . I will then forward the information to NASN.

Were you aware that NASN has established the NASN Endowment Fund? The purpose of this fund is to:

Support research about school nursing and the health of school-aged children
Fund grants that improve school nursing practice and school-affiliated delivery of healthcare
Provide scholarships for school nurses seeking graduate degrees and/or certification in advanced nursing practice

Update: Massachusetts School Nurse Research Network (MASNRN) News
To Learn More About This Network, click here. or visit www.masnrn.org
Kathy O'Neill, MSNO MASNRN Representative
October 2006

MASNRN is starting its third year of operation and is growing in numbers and grants. The Asthma grant, completed in the Spring of 2006, is currently being written for publication. The Teasing and Bullying Grant, completed at the end of the school year, June 2006, is now in the process of data entry. The two immunization grants, "Promoting Flu Immunization in Children and Chronic Conditions" and " Promoting Flu Immunizations in Children with Chronic Conditions Using Technology" are in the recruitment process. The principal investigators, Mary Jane O'Brien and Judy Aubin are looking for approximately 30 school nurses to participate in this research. If interested, please email Kathy O'Neill at oneill@msno.org.

MASNRN is always looking for new members, especially from western Massachusetts and the Cape. Feel free to contact Kathy O'Neill anytime regarding membership requirements. Many of the school nurses who were involved in the Teasing and Bullying grant are also participating in the Immunization grant as well. They said that they feel like a part of nursing's future as they participate in evidence-based practice research.

Massachusetts School Nursing Research Network

Massachusetts School Nurse Research Network
www.masnrn.org

The Massachusetts School Nurse Research Network (MASNRN) has been awarded its first grant. It is the Research Grant from the National Association of School Nurses, which was awarded to Marie DeSisto, RN, MSN as the Principal Investigator at the NASN Awards Celebration during the Conference in Washington, DC. The research project has recruited 5 towns to participate in the project including Springfield, Braintree, Waltham, and Newton. The research proposal is currently undergoing review by the IRB Committee. The MASNRN project will involve improving care for students with Asthma.

MASNRN Mission Statement

MASNRN is a practice based research network comprised of a representative, collaborative group of professional school nurses, nurse academicians, and other interested parties for whom school health is a priority. Its members believe that students need and deserve high quality nursing and health care to help attain their full academic potential. This requires that school nursing embrace evidence-based practice. MASNRN conducts research and uses translational research to improve the student health outcomes and the efficacy and efficiency of School Nursing care.

MASNRN Description

MASNRN is a practice-based research network. It began as a collaborative effort of three distinct entities: a professional organization—the Massachusetts School Nurses Organization (MSNO), a state agency—the Massachusetts Department of Public Health’s School Health Unit (MA-DPH-SHU), and a university school of nursing—the Boston College William F. Connell School of Nursing (BCSON). MASNRN began in 2004 and is governed by a Board of 10 representatives appointed from each of the three consortium agencies. An Advisory Board of community members provides input regarding identifying priority research areas, expanding the nexus of primary care activities across disciplines and practice sites, and determining effective strategies for research dissemination. MASNRN members are drawn from the 1,100 nurses of the 103 ESHS districts described above. It is uniquely positioned to develop and implement a school nursing research agenda using a research network approach to investigate problems common across schools.

School Nurses

MASNRN is recruiting school nurses to join the MASNRN Network. School nurses who are interested in research and improving school nursing practice are welcome! We estimate that belonging to the Network will not involve more than 1-2 hours per week. Nurses do not have to be involved in every project. You have the option of participating in a study, or opting out due to commitments, interest etc. There is flexibility.

In order to join the network you must complete a biosketch (similar to a Curriculum Vitae) and complete an online program on Human Subjects Research that was developed by the National Institute for Health. The Human Subjects Research program takes approximately 3 hours and you do not have to complete it in one sitting. Upon completion of the program you will take a quiz, and you will get a certificate of completion (you can use this for PDP’s). For information about joining the MASNRN Network please email Gail Lopez at maschoolresearch@yahoo.com.

Free or Affordable Health Care Programs in Massachusetts
(Courtesy of Health Care for All)

MassHealth (Massachusetts Medicaid)
In Massachusetts, Medicaid is called MassHealth. MassHealth covers more services than other state health programs and is usually the best program to choose if you or your family is eligible. MassHealth, however, has strict income and eligibility rules.

MassHealth Standard: Covers most health services for children, parents of children under 19, pregnant women, and low-income adults with disabilities.
MassHealth CommonHealth: Covers most services for adults and children with disabilities. There is no income limit but a premium and/or one time deductible may be charged.
MassHealth Prenatal: Covers routine prenatal office visits and tests (not childbirth) for pregnant women.
MassHealth Family Assistance: Covers part of your family's health insurance premiums if you can get qualified health insurance from your employer, or allows you to enroll your children in a health plan through MassHealth if you cannot get private health insurance. Has higher income limits than MassHealth Standard or MassHealth CommonHealth.
MassHealth Limited: Covers emergency services and childbirth for low-income residents. No social security number required. Pregnant women, children under 19, parents of children under 19 and disabled adults may be eligible.

Nationwide Poison Help Number

For your information: There is now a new toll-free nationwide poison help number in service. Emergency treatment advice for poisonings, as well as poison prevention information, will be available by calling this number nationwide.

Pioneer Valley Food Allergy Support Group

For your information:
We are a peer-led group of Pioneer Valley parents, raising children with food allergies.

Meetings
The last Wednesday of every month.
6:30 to 7:30 P.M.

Randall's Farm
631 Center Street
Ludlow, Massachusetts.

Join us for education, advocacy, coping strategies, recipe swarps, etc.
For more information, please email Nicole at NicoleMS@comcast.net.

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