MSNO Legislative Tool Kit

• Share with them the data about your daily student encounters and health conditions
  
• Introduce them to your students who rely on nursing services in order to access their education (per parental consent)
  
• Let them count the epi pens, the inhalers, and the nebulizer sets, oxygen tanks, the AEDs, the glucometers, and the glucagon kits
  
• Advocate for funding for the fy 09 budget line item # 4590-0250 supporting School Health Services
  
• Advocate for the school nurse retirement bills, professional status, and pay equity
  
• Advocate for a school nurse in every school

• H 2647, An Act to Define Further Teacher for Retirement Purposes sponsored by Representative Elizabeth Malia and filed by the Massachusetts School Nurse Organization via the work and advocacy of Craven & Ober, Policy Strategists, LLC, the lobbying team hired by MSNO www.mass.gov/legis/bills/house/185/ht02pdf/ht02647.pdf.
  
  
• S 1524, An Act Relative to the Retirement Options of Certain Educational Personnel, sponsored by Senator Brian Joyce and advocated for by the Massachusetts Teachers Association www.mass.gov/legis/bills/senate/185/st01/st01524.htm

• S 1508, An Act Relative to a Retirement Buyback for School Nurses sponsored by Senator Robert Hedlund by request and petition of Joyce A. Toland, RN www.mass.gov/legis/bills/senate/185/st01/st01508.htm
  
  
• H 2614, An Act Relative to Creditable Service for School Nurses sponsored by Representative Thomas Kennedy on behalf of Fran Johnson, RN www.mass.gov/legis/bills/house/185/ht02pdf/ht02614.pdf
  
  

• Monitor State’s fiscal budget line item 4590-0250 and advocate for continued funding for Essential School Health Services www.mass.gov/legis/08budget/senate/section2.htm
  
  
• H 430, An Act Ensuring Adequate Nursing Services At Public Schools sponsored by Representative Jennifer Flanagan www.mass.gov/legis/bills/house/185/ht02pdf/ht02614.pdf
  
  
• S 349, An Act To Ensure Adequate School Nursing Services sponsored by Senator Richard Moore www.mass.gov/legis/bills/senate/185/st00/st00349.htm
  
  
• S 100, An Act Relative to Establishing a Special Commission to Study Essential Health Services in Massachusetts Public Schools sponsored by Senator Richard Moore www.mass.gov/legis/bills/senate/185/st00/st00100.htm
  
  
• S 101, An Act Relative to Funding for School Health Programs sponsored by Senator Richard Moore www.mass.gov/legis/bills/senate/185/st00/st00101.htm

• H 4199, (formerly H 2168) An Act to Promote Proper School Nutrition sponsored by Representative Peter Koutoujian and advocated for by the Massachusetts Public Health Association www.mass.gov/legis/bills/house/185/ht02pdf/ht02168.pdf

• Oppose H 1139, An Act Authorizing Self Monitoring and Self Treatment for Students With Diabetes sponsored by Representative Louis L. Kafka www.mass.gov/legis/bills/house/185/ht01pdf/ht01139.pdf
  
  
• Monitor impact in Massachusetts from the newly settled class action lawsuit between the American Diabetes Association and the California Department of Education www.diabetes.org/uedocuments/pr-cde-settlement-080807.pdf
  
  

• Monitor recognition of school nurses’ eligibility for professional teacher Status per passing of Chapter 267 of the Acts of 2006, An Act Granting School Nurses Eligibility for Professional Teacher Status www.mass.gov/legis/laws/seslaw06/sl060267.htm
  
  
• Monitor response from the Advisory Opinion on School Nurses and Eligibility for Professional Teacher Status by the Massachusetts Department of Education doe.mass.edu/lawsregs/advisory/061807nurses.html
  
  

• Improve the school nurse-to-student ratio and help ensure that all students’ health and safety needs are addressed while in the school setting
  
  
• Support the reauthorization of No Child Left Behind (NCLB), the full funding IDEA, and a position for a National School Nurse within the leadership of Department of Education.
  
  
• Ensure funding for school nursing services needed by students by supporting the improvement and reauthorization of SCHIP and Medicaid reimbursement to schools
  
  

• Plan to present oral testimony telling your story as school nurse with prior work experience as a nurse (please inform me of your plans to testify or with any questions via mls5154@aol.com)



• Plan to attend the hearing on September 27th and offer support for House Bill 2614 and Senate Bill 1508 by your presence with other school nurses.



• Submit written testimony via email/fax to the Joint Committee of Public Service* in support of House Bill 2614 and Senate Bill 1508 (and email a copy to me for MSNO via www.mass.gov/legis.
  
  

• What impact will the opportunity to buy-back years of creditable service have on you?



• Why should prior nursing experience be recognized as creditable service?



• What types/years of previous nursing experience do you bring to your role as a school nurse (intensive care, emergency room, cardiac, pulmonary, oncology, endocrine etc, mental health, pediatric medical/surgical acute care, community health, and primary pediatrics etc)



• Why do schools need nurses who bring with them a foundation of experience and a knowledge base and clinical skills to deal to autonomously respond to the vast magnitude of medical, physical, and psychosocial issues
  
  
• Request that the legislators consider the value of all nursing experience as creditable service and support that House Bill 2614 and Senate Bill 1508 be reported favorably out of committee.

• Replace sodas with healthier drinks, such as water, low- and non-fat milk, and juice

• Set healthy standards for fat and sugar in snacks

• Make fresh fruits and vegetables available in cafeterias

HB1139, An Act Authorizing Self Monitoring and Self Treatment for Students with Diabetes, is currently before the Joint Committee on Health Care Financing. (To learn more, please read MSNO's 3-07 Legislative Alert by clicking here.) Advocates for HB 1139, An Act Authorizing Self Monitoring and Self Treatment for Students with Diabetes have contacted superintendents in cities and towns to urge them to support this legislation.

HB 1139 would put children at risk and compromise nurses' scope of practice. The bill would allow families to determine how diabetes is managed in school without input from the school nurse, and allow non-medical employees in a school to make assessment decisions about sick children and to administer emergency medication (glucagon).

Action Please do it today!

Call or email your elected officials! Go to www.capwiz.com/massnurses to find out how to contact your legislators.

* Diabetes is a serious condition and complications require intervention from a licensed professional.

* Administering glucagon is a complicated procedure, as is assessing a student who is unconscious or seizing.

* Current regulations encourage collaboration between parents and the school. HB1139 would eliminate this collaboration.

Dear School Nurse Colleagues,

Representative Kafka (Stoughton) and Senator Moore have filed bills on behalf of the American Diabetes Association that would remove the care of students with diabetes away from the school nurse. It would also require teachers or staff to administer glucagon in an emergency. You can find the bill by going to this link:

www.mass.gov/legis/bills/house/185/ht01pdf/ht01139.pdf
or
www.mass.gov/legis/

(At the bottom of the page clink on: Current Legislation. Go to Text of House Bills. Search for HB 1139.)

This is a dangerous House Bill, that has been filed by a powerful group. We need to organize and stop this for the health and safety of our students. This cannot be ignored. You cannot expect anyone else to do this. Each school nurse must help. Each nurse needs to get a parent to call. This is critical. If this passes then the Epilepsy group will have a Bill to delegate Diastat, etc. This puts students and school departments at risk, and will gut school nursing in Massachusetts.

HB 1139 will be heard tomorrow by the Health Care Finance Committee; you are not limited to calling or writing tomorrow. But do it as soon as possible.

You can link to the committee members at:

www.mass.gov/legis/comm/j24.htm

Or if that doesn't work, the committee members are:
Moore of Worcester and Norfolk - Chair
Tolman of Second Suffolk and Middlesex
Jehlen of Second Middlesex
Fargo of Third Middlesex
Spilka
Candaras
Tarr
Walrath
Kulik
Hynes
Koczera
Khan
Linsky
Kane
Kocot
Speranzo
D'Amico
Puppolo
Hargraves
Gifford

The Department of Education's "Advisory Opinion on School Nurses and Eligibility for Professional Teacher Status" was posted on the DOE website earlier this week. Here is the link to the advisory: www.doe.mass.edu/lawsregs/advisory/061807nurses.html.

This is an important step for Massachusetts school nurses. It took a year for the DOE to act on this legislation, which passed in July 2006. However, now it is officially part of Massachusetts General Law that school nurses have professional status and are Professionals!!! This is another step forward.

This week Kathy Hassey, Ann Farrell and I testified to support HB 430 and SB 349, "An Act to Ensure Adequate School Nursing Services". Luckily many school nurse advocates joined us such as MTA, MFT, MNA, Representative Kahn and the Massachusetts Public Health Association. No other school nurses attended.

______________________________________________________________________

Please call and thank Rep. Markey at 202/226-2424, especially if you are in the MA 7th District. School nutrition is something many school nurses are focusing on.

WASHINGTON : Representative Edward J. Markey (D-MA), Chairman of the House Subcommittee on Telecommunications and the Internet, sent letters to The Coca-Cola Company, General Mills, Kraft Foods, McDonald's and PepsiCo. asking each to voluntarily implement the same restrictions on marketing to children recently announced by the Kellogg Company. Last week, Kellogg agreed to adopt nutrition standards for the foods it markets to children and to place limits on its use of licensed characters and product placements in marketing directed at children.

"While parents and families have an undeniable responsibility to steer their children toward healthy choices, the Institute of Medicine has linked the current unhealthy trend toward poor nutrition and childhood obesity in our country to the prevalence of television advertisements for fast food, junk food, sugared cereals, and other foods wholly lacking in nutritional value. If this trend continues, our children could be the first in generations to enjoy shorter life expectancies than their parents," said Rep. Markey. "These companies are some of the world's largest food and beverage marketers, and together they have the power to play a significant role in solving the childhood obesity problem through socially responsible advertising practices. I urge them to follow Kellogg's lead."

Rep. Markey asked each company to commit to at least the same standards as the Kellogg Company put in place and to outline additional steps that may be warranted to safeguard kids from junk food ads during children's television programming, which have been found to negatively influence children's dietary and nutritional choices. The five companies that received letters are some of the world's largest food and beverage marketers and account for much of children's food and beverage advertising expenditures in the United States.

On Friday, June 22nd, Rep. Markey chaired a hearing entitled "Images Kids See on the Screen," to explore the link between TV advertising and childhood obesity, and to ask whether regulatory or legislative solutions are needed to restrict food marketing on television to combat the serious public health issue of childhood obesity.

Also see www.businessword.com for a great opinion piece on why Congress should curb junk food marketing to kids. It makes it sound like Congress taking action on junk food marketing to kids is inevitable, which is good to have companies read in BusinessWeek!

LINKS to the letters:

http://markey.house.gov/docs/telecomm/Isdell.pdf
http://markey.house.gov/docs/telecomm/general%20mills.pdf
http://markey.house.gov/docs/telecomm/kraft%20foods.pdf
http://markey.house.gov/docs/telecomm/mcdonalds.pdf
http://markey.house.gov/docs/telecomm/pepsico%20letter.pd

You may want to contact Senator Timility and thank him for prioritizing School Safety as an Issue for the Committee on Public Safety. See his contact information below.

The Honorable James E.Timilty
Senate Chair, Joint Public Safety and Homeland Security Committee
State House, Room 518, Boston, MA 02133
Telephone: 617-722-1222
Email: James.Timilty@state.ma.us

While the health needs of Massachusetts’ students have grown increasingly complex, many thousands of students receive no, or inadequate, school health services. At the same time, Governor Romney has proposed elimination of the School Health Program in his FY’05 Budget. By discontinuing this successful program, school nurses will be laid off and thousands of children will no longer have access to needed nursing services which, in turn, will impact their ability to attend school.

To help address this problem, school nurses, parents, students and health care advocates converged on the Massachusetts State House on Wednesday, March 24, 2004 from 8:30 A.M. – 11:30 A.M. for a School Health Advocacy Day.

The event, hosted by the School Nurse Services Collaborative, featured a number of speakers including government officials, parents, school administrators and school nurse representatives. All hoped to educate legislators and demonstrate strong support for legislative efforts to reject the governor’s proposals and to reinstate the $12 million in funding that is needed to maintain the standard of care needed to service the growing population of students with mild to severe health needs. Among those speaking at the event was Anthony Delmonaco, a 10-year-old 4th grader from Pembroke, who helped galvanize support for this issue with letters he wrote that were published in both the Boston Globe and Patriot Ledger detailing his fears of losing access to his school nurse, who helps him cope with his asthma.   (CLICK HERE to read Anthony's full speech in support of his school nurse.)

In 1998, the Massachusetts Department of Public Health presented a plan to the House and Senate Ways and Means Committees for the expansion of school health services. In FY 2001 and 2002, the legislature responded by increasing funding for school health services. In 2003, the legislature rejected the governor’s first attempt to eliminate the successful Enhanced School Health program that funds school nurses in cities and towns with children lacking access to adequate health care.

School nurses provide a valuable social and health care safety net, particularly in tough economic times as school nurses are a primary source for poor or uninsured children to have access to health assessment. Also, in the wake of growing concerns over bioterrorism, school nurses provide a readily available resource for early detection and rapid response in local communities to a public health emergency.

As early as 1992, a special commission relative to the practice of school nursing recognized the unmet needs of Massachusetts students and concluded, “Children attending schools in the Commonwealth today are faced not only with the usual and common infectious disease, they face the threat of other major health problems not always well understood by teachers, parents and the community. Special needs children integrated into classrooms of every town have significant health and nursing needs, including such things as catheterization, suctioning and the administration of complex treatments. The administration of medication and the monitoring of their effects, couple with the needs of children from dysfunctional families, further complicates the picture of school health.”

According to Marcia Buckminster, Director of School Health Services for the Framingham Public Schools, the commission report accurately depicts the conditions in her schools, as well as schools throughout the state. “Within the last school year, our nurses have cared for acute, chronic and emergency health problems such as asthma, attention deficit disorder, migraine headaches, epilepsy, heart conditions, diabetes, life threatening allergies, arthritis and hemophilia. We have had students coming to school requiring colostomy care, intravenous medications, nasogastric feeding and other procedures.”

School nurses are also required by law to conduct annual postural, hearing and vision screening tests on all students and monitor compliance with school immunization regulations. They also provide health education to students, teaching healthy lifestyles, as well as management of illnesses.

Good morning.

I appreciate the opportunity to speak with you today and lend my voice and that of my colleagues in educational administration to the support of essential and quality nursing services in our schools. We should be proud that our commitment to educational opportunity has opened the school door wider than ever before. Today’s schools have very different demographics than those of the past. Our schools are more accessible to medically challenged students and families than ever before. Twenty-five percent of our students come to school today with some form of medical impairment. This number increases in our urban areas. Almost twenty-one percent of children in the United States, between the ages of nine and seventeen, have a diagnosed mental or addictive disorder. (Department of Health and Human Services, 1999) In Massachusetts, twelve percent of our school age children live in poverty and do not have appropriate access to primary care and many lack insurance.

The advances in medical technology have enabled more children with significant health care needs to attend school. Medical procedures that at one time could only be provided in hospital settings are now being performed in school settings by our school nurses such as catheterizations, tracheostomy care, colostomy care, intravenous infusions, feeding tubes, and insulin pump care to name just a few.

The students who attend our schools today have chronic health conditions that range from the minor to the severe. Today’s school nurse must be prepared to treat allergies, asthma, substance abuse, injuries from domestic violence, sexually transmitted diseases, pregnancies, emotional distress, and conditions resulting from congenital defects. The list is endless.

Added to that are the responsibilities of screenings for the early detection of hearing, vision, and postural defects, and special needs. The school nurse responds to the incidence of communicable diseases such as sexually transmitted diseases, chicken pox, hepatitis, and meningitis. Nurses not only work to prevent the spread of disease, but also to allay community fears. Each day hundreds of medications are administered. And it should be understood that requests for treatment are not made by appointment. The flow of service requests defies even the best schedules and organization.

Why do we do all of these procedures in our schools? Is it to increase jobs and expenditures in our schools? Of course not. We do it because it is an essential component of our commitment to serve all children and youth. We do it to provide equal access to education and provide the support necessary to achieve a positive outcome.

We have set some very challenging academic goals for our schools, Massachusetts Comprehensive Assessment System (MCAS); No Child Left Behind (NCLB), with high standards of academic excellence and proficiency for all. Educators want to meet those challenges. We are not afraid of accountability, but we want the tools necessary to attain those very challenging goals. Consider the following. NCLB requires that we maintain a 95% attendance rate in our schools. The school nurse helps us to provide the necessary accommodations to keep students in school, in class, and in the least restrictive environment. Absenteeism would soar without the support of school nurses. Can we expect our teachers to cover more rigorous material and at the same time attend to the medical and emotional needs of our most challenged students?

We need to provide the right supports to our classroom teacher. When a student is distressed and distracted for physical and/or emotional reasons, it won’t be extra tutoring that gets him or her back on track. More often it will be a school nurse.

If we are truly concerned with achievement of high standards for all, we will recognize and support the work of our school nurses. Study after study supports the fact that good school health programs are essential to increased academic performance. Desmund O’Byrne in a 2001 study for the World Health Organization wrote, "Good health supports successful learning. Successful learning supports health. Education and health are inseparable."

An U.S. Department of Health report, 1992 stated "Health is a silent partner to education. The health and wellbeing of children are directly related to their academic performance." (Novello, DeGraw, and Kleinman)

The 1989 Carnegie Council on Adolescent Development reported "Students who are hungry, sick, troubled or depressed cannot function well in the classroom no matter how good the school."

There are those who, despite the research evidence from a wide range of sources, believe that schools should not or cannot take on health issues. This position is absurd when we realize that 95% of our children are in school and that there is such a profound link between health and learning.

We should not underestimate the importance of school nurses. They are critical to our ability to address the health and education needs of our students and their families. Nurses are one of our greatest resources for closing the achievement gap between the advantaged and disadvantaged.

To be effective, education must address the "whole child."

In a joint statement on school health former Secretary of Education Richard Reilly and former Secretary of Health and Human Services Donna Shalala said, " America’s children face many compelling education and health development challenges that affect their lives and futures. To help children meet these challenges, education and health must be linked in partnership… school health programs support the education process… integrate services for disadvantaged and disabled children, and improve children’s health prospects."

In the long run, our ability to keep students in school, healthy, and focused will do more for academic achievement than the drill of academic tutoring. I’ll take a school nurse over a tutor any day of the week.

With effective healthcare we can help students learn more, we can reduce discipline problems in our schools and cities, we can produce more productive citizens for our future. Investment in Essential School Health Services should be a "no brainer."

The school nurse plays an important role as a health educator. Most serious illness and early mortality are the results of high health risk behaviors established in childhood. Six of these behaviors can be altered to prevent disease or death, poor eating habits, physical inactivity, tobacco use, drugs and alcohol abuse, accidental or intentional behaviors causing injury, and unprotected sexual activity. Education can help prevent children from engaging in these behaviors. (L. J. Kolbe, 1990, Health Education Epidemiological Surveillance System to monitor youth risk behaviors that most affect health)

C. Everett Koop, former U.S. Surgeon General stated "Health care is vital to all of us some of the time… but public health is vital to all of us all the time." The school is a very important public health setting. We all recognize that the "biggest budget buster" is the cost of Medicaid. We will never get those costs under control by cutting back on front-end health services in our schools. We must promote healthy lifestyles from an early age if we expect to curtail cost for medical services.

The full funding of the Essential School Health Services program in our schools needs to be increased not eliminated. It is a critical component of a successful school.

The fight for sufficient and quality health services and education in our schools is more than a fight for academic excellence. It is our commitment to the whole child, our commitment to a healthy future, and our commitment to a productive economy and to a healthy society.

I would like to thank the legislators who support essential school health services, the Massachusetts School Nurse Organization, Massachusetts Nurses’ Association, and those organizations that have joined this advocacy.

It is vital to use data like that below whenever you can show your "Educational" impact on children. When you are speaking with your Administrators or with your Legislators, please feel free to use these numbers from the 04-05 School Year ESHS Report (05-06 Report due out soon...will send when available). These numbers represent the aggregate data from the 102 Essential School Health Services School Districts. It shows the total number of Health office visits (just under 6 million not including screenings, Staff and Faculty visits..keeping them in school, Referrals to PCP's including NEW linkages to PCP's, Emergency Referrals, and Medications Administered). This might be of interest to your Administrators, encouraging them to apply for the new ESHS grant due out next year!

The "Essential School Health Services" School Nurse Data Report 2004-2005 (102 MA School Districts have the ESHS grant covering ~ 550,000 students, representing half the 1.1 million students in Massachusetts)

School Nurse Student Encounters: 5,930,181* (Just under 6 million)
* 88.5% of students were returned to class after assessment and/or treatment by the School Nurse

Staff/Personnel Encounters (Assessment and/or treatment): 147,624

School Nurse Referrals to Primary Care Providers : 160,980*
*12,253 referrals to new Primary Care Providers (linking students with PCP)

Emergency Referrals: 10,855
17% 911/ambulance services
83.9% Parents transported to emergency services or Primary Care Provider

Medications Doses Administered per month: (Daily and as needed) 93,709 (930,709 annually)

Student Injuries: 40,022
10.1% Intentional (assaults) or (self-inflicted injuries, overdose, suicide attempts)
69.5% Unintentional
20.4% Unknown

Stay Up-To-Date! The latest GPO/WEP news is posted on NEA's Legislative Action Center at www.nea.org/lac/socsec/index.html. Click on latest news.

Representative Brady to Reintroduce Partial WEP Fix:
Rep. Kevin Brady (R-TX) is expected to reintroduce this week his Public Servant Retirement Protection Act, which would provide a partial fix of the Windfall Elimination Provision. Like last year, the bill would change the formula for calculating Social Security benefits for individuals who have income both from covered and non-covered employment.

NEA supported the Brady bill last year as a first step toward full repeal. NEA's goal remains complete elimination of both the GPO and WEP. We will forward more information about the Brady bill following its introduction.

Support for Full Repeal Continues to Grow:
Support for full repeal of the Government Pension Offset and Windfall Elimination Provision continues to grow. The House version of the Social Security Fairness Act (H.R. 147) now boasts 238 bipartisan cosponsors. The Senate version of this legislation (S.619) now has 12 cosponsors. All members of the Massachusetts congressional delegation are cosponsors of these bills.

Action Needed:
Join the tens of thousands of NEA members who have signed NEA's Social Security petition calling for protection of retirement security by opposing Social Security privatization, opposing mandatory coverage for public employees, and support full repeal of the GPO/WEP.

To send a message to Congress and to sign the petition, go to the NEA Web site at www.nea.org/lac/socsec/offsets.html .

The Governor's House 1 budget for 2005 "discontinued" the state funded school health programs. The state senate and house budgets are in the process of being discussed and will be released in the next few months. Now is the time to contact state senators and representatives. Ask that they include funding for school health programs, specifically school nurses, in the '05 budget as they have in past years. A brief personal letter to your elected officials at the State House is a very effective way to communicate the important role school nurses play in the health care of Massachusetts school children.

The following phrases are some examples of talking or writing points that you may wish to use in your own personalized letter. These talking points were written by Mimi Stamer, the school nurse at the Blocks pre-school program in Framingham. Tailor them to fit your situation and share them with colleagues, parents and advocates. Use them also when talking to the press, school personnel and elected officials such as school committee members.

In the year 2005, we will be celebrating 100 years of school nursing in Massachusetts. We have a long history and a reputation country-wide of being one of the finest. Let's all do our part to preserve school health programs for Massachusetts school children

Besides heavy backpacks, children carry on their young shoulders, the weight of all the issues impacting their families during these difficult socioeconomic times. School health care responds to their ongoing needs for preventative health care, and management of complex, life threatening medical issues or chronic health conditions. School nurses help keep children healthy, safe, fed, clothed, and sheltered...our "bandaids" extend far, but their effects are often invisible to others.

Students come to school to learn and they visit the health room for bandaids and ice packs. Often behind sad, tired eyes or under thin ragged clothes, we uncover stories about the effects of being cold, hungry, scared, or sick. We know that recurrent headaches and stomach aches, and daily trips to the health room, may reflect a cry for help, a need for attention, a need for a safe spot- from such stresses as academic pressures or the trauma of violence. We see hurt spirits and wounded bodies whose minds struggle to stay awake, to pay attention, and to learn in school, and we know when "something" is not right. We look and listen for visible or sometimes hidden signs of emotional, physical, and sexual abuse. We convene school crisis teams and activate appropriate community agencies to help the child and the family. We always maintain the child’s safety and health as our focus and first priority.

School nurses are often the "life line" to families in crisis, in isolation, in stress. We listen to parents pour out their hearts as they describe their struggles with personal or their child’s physical or mental health issues, unemployment, homelessness, violence, and poverty. Parents share in confidence their struggles, fears, guilt, and needs. We are open, caring, and respectful. We provide parents of all socioeconomic, educational, and cultural backgrounds, ongoing health education, assessment of their child’s symptoms, and referrals for medical or mental health evaluation. We assist them to navigate the complexities of medical, legal, and educational systems. We provide clothing and food from donations, and advocate for adequate shelter and housing. We reach out and hold vulnerable young hearts and adult hands offering hope and strength. They turn to school nurses, because we are here in schools, accessible and willing … to help.

School nurses deliver the essence of health care. We care for the total person, the mind, body and heart. Our knowledge base focuses on the child’s physical, developmental, psychological, emotional, and social well-being. We apply a process of problem identifying, assessing and intervening. We don’t turn our backs or close our eyes. We know that no child lives as an island, so we advocate constantly for the child and family- their rights for education, health care, privacy, respect, and safety. We climb up "hills" and we go out on "limbs", and we often are the voice when they cannot speak, so we speak on their behalf, with confidence and compassion.

School health is the front line for children’s health care. All children have a right to an education and school is where most children come. The school nurse sees and knows what medical care is working, if medications are being given at home, if the child’s symptoms are being appropriately responded to, if the family is following up with the recommended evaluation or treatments. We see children who have not had medical intervention, who have not had educational or developmental evaluation, and whose families need support to navigate expert but complex medical systems. We know "it takes a village to raise a child", and we coordinate the collaboration of a child’s village: home, school, and community. School nurses make numerous phone calls and meet with parents, medical providers, with community agencies, with state insurance, and the interdisciplinary educational team. School nurses know that no medical specialists, no prescriptions, and no educational plans alone, will produce a healthy child, able to access education. Our role is to advocate, educate, and intervene constantly, with the child and family. As school nurses, we have the important challenge and satisfying opportunity, to make a difference in the students’ lives.

The reality of these difficult economic times is that school nurses often provide the only health care for most students who lack health insurance. Federal and State budgetary cuts that have decreased parents’ opportunities for employment, affordable childcare services, job- training programs, and affordable housing, have further impaired the families’ access to health care. State legislative decisions for budget cuts affecting health care and the limitations with insurance coverage from MassHealth and the Children’s Medical Security Plan have resulted in an increased number of underserved families without health insurance.

School nurses examine students with numerous complaints ranging from common sore throats, earaches, headaches, and stomachaches to more unusual rashes, behavioral changes, and potentially contagious diseases. With every encounter we assess students, and we advise parents about health management or recommend further evaluation by a medical provider to diagnose and treat illnesses and injuries. As registered nurses we provide education about fluids, and rest, nutrition and warmth, and routine medical intervention to reduce a fever, or cleanse a wound. As nurse practitioners working in the schools, we expand our roles and expertise, and may provide further diagnostic assessment and treatment via a school based or nurse managed health clinic. But for the child with no school nurse, with no health insurance and no health provider, the emergency room becomes the only source of health care. We know that emergency rooms become filled with families, seeking non-urgent health care, and children must wait long hours instead of being home, resting, and recuperating.

Children in Massachusetts, as nationwide, need timely and effective access to health care that promotes normal growth and development, healthy lifestyles, and that prevents and manages childhood and adolescent illnesses, risky behaviors, and injuries. School Health services support numerous health initiatives and programs that promote preventive health care for uninsured and vulnerable student populations. Nurse practitioners provide primary health care through nurse managed health centers. School health programs address issues concerning early screening for cancer, heart disease and diabetes, child/adolescent mental health, healthy lifestyles, dental health, comprehensive vision screening, adolescent risky behaviors, teen pregnancy and parenting, and the impact of child/adolescent exposure to violence, abuse and neglect.

Registered nurses in the schools are first line health professionals 1) to assess for physical and psychological symptoms manifested from bioterrorism or by the ongoing threat of terrorism, 2) to implement mass screening and immunization programs, and 3) to provide first responder treatment and emergency medical care. School nurses identify and respond to the management of communicable diseases. We have readily available data that supports the Massachusetts Department of Public Health with tracking outbreaks of communicable diseases including varicella, tuberculosis, meningitis, influenza and the list is endless. School health services have implemented the development of Emergency Response Planning Programs in school systems. Cutting funding that support school health services, limits the resources of skilled emergency responders for the entire state, during a time of national health and saf