If you are providing nursing care that is a listed as related service on an IEP, then the district is collecting federal funds for your time, but it is reimbursed only an average of 18% of th actual amount of time devoted to the services.
The recommended nurse to student ratio is 1:750 well students, 1:225 special education and 1:125 medically fragile (http://www.nasn.org/positions/2004pscaseload.htm
See 7-4 for school nurse ratio) . In some states it is less. Massachusetts has a nurse in every school, average 1:250, and mhas a maximum allowable 1:750.
Alabama Ala. Code 16-22-16. The ratio of pupils to school nurses is prescribed, starting at one per school system (1999-2000) to one school nurse per 7,000 pupils (2000-01) and reducing the ratio by 500 pupils per year down to 2,000 pupils (2010-11 and thereafter). The requirement is contingent on funding in the Education Trust Fund annual budget act.
Utah actually has one school nurse for every 6,330 students--the worst ratio in the country.
Below is Vermont's ratios.
SCHOOL QUALITY STANDARDS
Adopted by the Vermont Legislature and Vermont Department of Education
2126.96.36.199 Support Services
2188.8.131.52.3 Health Services
Health services, including health appraisal, counseling, communicable disease control, emergency and first aid care, shall be made available, in collaboration with parents and community health resources, to students in each school. These health services shall be delivered in accordance with the school district's written policies and procedures, and with requirements of state law relative to vision and hearing screening, immunization and child abuse reporting.
Each school shall engage the services of a person licensed as a school nurse and shall specify in writing his or her duties. There shall be no more than 500 students per school nurse. Schools with fewer than 500 students shall employ a nurse in at least an approximate proportion of the number of students to 500. The school shall strive to meet staffing ratios for Comprehensive School Health Services set forth in Vermont School Nurses' Association's "Guidelines for Establishing Safe School Nurse to Student Population Ratios." There shall be adequate equipment and space for delivery of confidential health services.
Guidelines For Establishing Safe School Nurse to Student Population Ratios
These guidelines apply to student populations in one building. Students with special needs often require a great deal of the school nurse's time to assess, plan, implement and evaluate their care. Student population numbers listed below need to reflect this by accommodating for the intensity level of the special needs students in a given population. Students who fit into an "at risk" category need to be counted as 3 students. Students who are moderately physically or emotionally challenged should be counted as 10 students (KSNO, 1994). Students with severe/complicated medical, physical, or mental challenges should be counted as 20.
"At risk" students may be characterized by any one or more of the following indicators:
1. A high rate of absenteeism from school - ten days or more;
2. Failure to achieve grade level standards;
3. Failure in two or more subjects or courses of study;
4. Behind in credits to graduate;
5. Retention at grade level one or more times;
6. Below grade level for students of the same age;
7. Pregnancy or parenthood or both;
8. Repeated commission of disciplinary infraction;
9. Member of a house hold that is at or below the poverty level using criteria for free and reduced lunch program;
10. Limited English proficiency;
11. Identified victim of physical, sexual, or emotional abuse and/or neglect;
12. Health or substance abuse problems;
13. Attempted suicide;
14. Identified as medically fragile or has special health needs;
15. Identified with an I.E.P. for Special Education, as 504, as gifted or with speech problems.
Additional factors to consider when establishing safe school nurse to student population ratios are:
1. The number of buildings the nurse covers - The travel time and the fact that the nurse is not always present to carry out such things as first aid and medication administration limits the coverage that she/he can provide. Ratios need to be lowered in these situations. For example, the minimum school health services ratio of 1/750 needs to be lowered to 1/500 students in a maximum of five buildings, each of which is accessible within 30minutes (Vermont Standard of Practices: School Health Services, 1995).
2. The staffing patterns - the use of unlicensed and licensed personnel such as secretaries and licensed practical nurses to cover the health office in the nurse's absence or to augment health services. The delegation of nursing tasks to these persons requires training and monitoring by the school nurse. Adequate time must be available for these functions.
3. The amount of time and responsibility the nurse takes for health education. Coordination, planning and lesson preparation can require large amounts of time away from other school nursing tasks. The more the nurse is involved with health education the lower the ratios must be to allow for proper follow through in the area of health services.
Adopted 1/14/98 by: The School Nurse Advisory Board to the Vermont Department of Education and the Vermont State School Nurse's Association Adopted 12/16/98 by: Vermont's Legislative Committee on Administrative Rules as part of the School Quality Standards
Quote from bergren
You state that you boss only cares about special education. If the reimbursement is like most other states, they could be paying your salary out fo the special education direct and indirect services you provide to the children. You should try to find out how muych revenue you are bringing in. Also, try to get the PTA and or some local businesses to donate some of the supplies you need. You are serving triple the nubmer of studnets the national association and CDC recommends.
"I am now having to check one school with over 300 kids every week for headlice. Last week I also had to check another school with 200+ by myself in one day." School wide headchecks are not recommended by the NASN, AAP, and the Harvard School of Public Health.
I cannot conceive of how you can do your job without a phone. How would they contact you in the event of an emergency? How do parents call? How can you call providers and how do they call you back?
Alabama Association of School Nurses
3060 Mobile Highway
Montgomery, AL 36108
Carol Austin, RN, BSN
State Department of Education, Health Services Specialist
Martha Holloway, RN, BSN, MHSA
QUOTE=seabreezern]I am the only one who does my job. There are people who help out with the medications. They each had to go to a class for this and all of the other nurses I talked with who held their classes did so with no problem. I had to do a self study because these people had other classes to attend to. There are no aids that assist me. Ocassionally I will have someone who can put a band-aid on but that is it. I am now having to check one school with over 300 kids every week for headlice. Last week I also had to check another school with 2oo + by myself in one day. I had to buy my own laptop, there is no phone this year because I dont use my own, and I have lost my office for the last 3 years. I was sharing a classroom with a teacher earlier this year. I fought to get an office and then my boss who was put over my position gives me excessive amounts of grief. That is a story in itself. I already spent money on a care plan book for myself and so I only have 150.00 or left for medical supplies. This also includes any paper or other supplies I might need. I am so worn out and tired of feeling like a failure. I have no support. My boss isnt a nurse and has made it clear that special ed is her main priority. She has been nasty more than once and has called me Pussycat in a ***** meaning way as well. With state coming in I am nervous enough and knowing that I have all of these care plans and other things left to do is not helping. I think it is time for me to move one...One person cant do an efficient job dealing with that many kids or schools. Last year I had 7 schools, but because of finances the 7th school closed down.....Anyway don't mean to be negative but I am at my wits end. Thanks again I will try your idea with the Journal of School Nursing. I am in Conecuh County which is a rural area in lower Alabama. Have a good day. Look forward to hearing back from you.