horrible immunization compliance rate

[jnemartin]

my immunization reporting is due for 6th graders on Nov 15th (not sure if states differ on this). My compliance rate is about 65%.

It's my first year as a school nurse at a very small school. both the feeder school's nurse and the nurse who used to hold my position quit at the end of last year, so there was apparently no messaging on vax schedules to parents whose kids were leaving the 5th grade school and entering 6th grade at my school. I was hired just as school started (and I've never been a school RN before), so it took me a couple weeks to get my bearings, and first referrals went out the first week in September. Second referral went out October, followed up with at least one phone call. Most parents have received 2 email referrals and 2 phone calls regarding the missing documentation. I'm about to make another round of phone calls tomorrow...

At the beginning of my outreach efforts only 11% of students had their documentation in, so obviously I've made some headway, but it's crunch time and I'm not quite sure what to do with this large group of parents who are simply not responding.

The point is, I'm really nervous to report these low numbers because I'm worried I may trigger an investigation from the State and they will think "What the heck is going on over at that school!?" Next year, I will put some things in place to prevent this from happening again, but at this point... what should I do? has something like this happened to anyone else?

[scuba nurse, BSN, MSN, RN]

Do you have any info on what physician the student uses? (we have a form that is filled out each year at the beginning of school that asks this information). I have called many docs offices and asked for the reports to be faxed over. Many are in fact compliant, but never send in the paperwork. I find it easier sometimes than getting parents to bring anything in. In our state, immunizations for schools are not considered a HIPAA violation, and therefore can be faxed.

[MrNurse(x2), ADN]

I have kept my administration in the loop throughout all of this - but I'm not sure they truly get how bad it is (although I literally told them we have 11% compliance and so on...). I actually send weekly progress reports and have included this topic in almost all of them.

I believe the law in my state is that children are not allowed to attend without the required documentation... however, my school is TINY and private, and many of the state laws here do not apply to charter/private schools. So i am not entirely sure if the law applies here or not, but I can 100% tell you my administrators will not enforce that even if it does, due to the culture of the school being very close-knit.

If you are in Maryland (we are due the 15th), it pertains to private as well as public. This is the worst year I have had with compliance, I have 11 students, approximately 50%, non compliant. Thankfully our health department is doing a clinic tonight. I have only heard from 1 family that let me know they are planning, the rest crickets. We exclude Monday morning. My numbers are small enough that it will only take ten minutes to finalize on Tuesday. Your administrators must be pretty green to not see this as serious.

[AdobeRN]

At the end of the day, if the admin chooses not to follow state law then the consequences are on them and not you. Just document. document, document!!

Hopefully, it will not take a measles or varicella outbreak to help see the light!!

Exactly....I think our district admin finally realized this when there started to be Measle/Mump outbreaks around Texas a few years ago. The DID NOT want to be on the news - LOL.

[ruby_jane, BSN, RN]

I believe the law in my state is that children are not allowed to attend without the required documentation... however, my school is TINY and private, and many of the state laws here do not apply to charter/private schools. So i am not entirely sure if the law applies here or not, but I can 100% tell you my administrators will not enforce that even if it does, due to the culture of the school being very close-knit.

AHHH. Ok, then. Print a copy of the state law, hand it to them. Put it in writing that they're violating state law and your recommendation is that Monday (or whatever day you choose) all students not in compliance will be dismissed until they get into compliance.

And then you've done your diligence. You can't care more about this then the administrator does. If the admin is not doing his/her job and you've documented, you have that evidence. Good luck!

[Cattz, ADN]

Does your state have an Immunization Registry?

[Kooky Korky, BSN, RN]

I have kept my administration in the loop throughout all of this - but I'm not sure they truly get how bad it is (although I literally told them we have 11% compliance and so on...). I actually send weekly progress reports and have included this topic in almost all of them.

I believe the law in my state is that children are not allowed to attend without the required documentation... however, my school is TINY and private, and many of the state laws here do not apply to charter/private schools. So i am not entirely sure if the law applies here or not, but I can 100% tell you my administrators will not enforce that even if it does, due to the culture of the school being very close-knit.

I wonder who you can ask, anonymously, or where you can turn, anonymously, to find out what the law is in your state. Local Health Department?

Also, if your Admin won't back you up, I wonder about the wisdom of pursuing this. You can only do what you can do. Keep excellent records of your efforts. Keep track of every email, every letter, every call. If you design a leaflet that tells of the possible complications of vaccine-preventable diseases, keep a copy of it and a list of those you sent it to. If you teach a class for teachers and students on vaccines and how they can prevent sicknesses and their complications, make a video of it and show it to parents on Parent-Teacher Night.

Perhaps you can somehow get the unvaccinated kids to be "jealous" of the vax'ed kids. Like they're feeling excluded from the club or something like that. Or is there a PTA/PTO that might get involved? Or parents you know personally and are friends with who can sort of put the word out?

Maybe you can scare the teachers and staff into becoming more proactive about helping you with this situation.

A long time ago, I had to give a class about dental care to children. I had my big huge set of "teeth" and a big oversized toothbrush. I had a short movie. Then the kids got to each take a turn at brushing the teeth. It was fun, it was hands-on, they got to move around some, and it used their sight, vision, touch. And there was even a little rhyme (which is likely not correct now, but was back then). "Brush your teeth the way they grow, down from the top, up from below".

Maybe you could let the kids practice shooting an orange with a fake needle and yelling "Ouch!" because it does, after all, hurt some.

Or whatever creative way you can think of to get them on the bandwagon. Or show some movie about how wonderful it is not to have to fear those mean old viruses that want to hurt kids.

Hey, hey, get your vax today.

Rest up some, then go out and play.

Or some equally silly but catchy rhyme might help.

Good luck.

[KatiejonD, RN]

What I would do at this point is:

1) draft a letter co-signed with your Principal. Add that immunizations are required to be up to date by November 13th, or that student's will be excluded from school until compliant (per school board policy XYZ and State of whatever law XYZ). Remind parents that they may drop them off themselves, send them in with their child, or request to have their PCP's office fax it over.

2) once the 13th comes, you must follow-through. And the principal must have your back. This is serious and children die every year from communicable diseases d/t not being vaccinated, or under-vaccinated populations.

3) I recommend following-up with all communications with your Principal regarding this with an email THAT YOU SAVE. It might just be that the previous RN's quit because they were not getting backed-up by administration. (This is why I left my school RN job - they would not follow state laws, despite my efforts and the writing on the wall was that I would be held accountable for it. The state DID take note, and I had all the saved emails to show that my Principal was refusing to allow me to follow the law).

4) In May of 2019 send out letters to all parents reminding them what is due BEFORE the school year starts, and include links to the school board policy AND the state's law.

Let's hope that your administrators ARE supportive of you, but make sure you have proof that you are advising them clearly about following policy and laws. Because if it comes down to them not following-through... that needs to be something they are held accountable for, not you. Best of luck!

[jnemartin, BSN, RN]

RE the online immunization records:

Yes. I have accessed it, but didn't turn up any additional vax info. the issue is that the families weren't totally aware that they needed to get certain vax over the summer.

[jnemartin, BSN, RN]

AHHH. Ok, then. Print a copy of the state law, hand it to them. Put it in writing that they're violating state law and your recommendation is that Monday (or whatever day you choose) all students not in compliance will be dismissed until they get into compliance.

And then you've done your diligence. You can't care more about this then the administrator does. If the admin is not doing his/her job and you've documented, you have that evidence. Good luck!

this is a good idea. my principal did back me up by sending a strongly worded email (your child may be removed by the dept of health after Nov 15), but I don't think we were strong enough from the onset. of my 52 students, 11 of them have appointments scheduled for AFTER the reporting date. so annoying.

[jnemartin, BSN, RN]

thank you guys for the supportive comments. I do realize I inherited a mess, but I had such high hopes on rectifying the messy records and lackadaisical approach to nursing and the Health Office. My admin is listening, but not really understanding the issue. I think at this point, after 4 email referrals and 1-2 phone calls per family, the best I can do is report what I have. I opened by report document and there is a section for "comments," and I plan to use that space to let the auditors know how many students have upcoming appointments and also the reason for a drop in compliance stems from no messaging over the summer. Hopefully they get the idea that I worked really hard to get the rate up from where it was (even though it's still quite bad).

[RedKat]

Sorry you've been put in this situation! You've gotten some good advice from other members here. I also work at a private school. I think it's a somewhat uncommon situation - but I am actually an employee of the public school district in which my private school just happens to be located; everyone else at the private school is an employee of that school. Because I work for the public school district, we follow all their health-related protocols at the private school. This includes rules regarding exclusion for incomplete immunization records. At the start of the current school year, another private school (located in a different public school district) merged with my private school, so we went from previously having grades 6-12 to now having P3-12. Many of the new students from the other school came to me with incomplete IMM's for the grade they were now entering. We're supposed to exclude after 2 weeks, but I'll be honest, I hadn't even gotten a chance to look through all those records in the first 2 weeks. I was scrambling to do it, but my priority was trying to straighten out orders for emergency meds and ensuring that I knew who had what allergies, asthma, and other medical issues. Oh, and I'm only at my school for 2 1/2 hours a day. Needless to say, when the state contacted the school in early October to give us less than 48 hours notice that our immunizations were being audited (and they didn't tell me which grade(s) would be audited), I went into full-blown panic. I was incredibly lucky that when they came for the audit, they selected two grades of students that were with me last year, so their records were 100% complete and accurate. They told me that in my state, if students are incomplete and haven't been excluded, the school faces fines of something like $2000 per student. Not trying to scare you - but I'd suggest that you make sure you get clarification on what laws and penalties (if any) apply to your school, and make sure your administration is aware. Best of luck to you - next year will be better for both of us!

[Amethya]

I'm having a better year this year, I think. Last for few years, I had issues with immunizations. We were so badly out of compliance in my 1st year, and my 2nd year I actually did what I could and got all my kids in compliance. This year I only had 83 kids out of compliant. Found all the immunization records and now I'm only 22 kids out of compliance.

What I learned is that we did as much as we can, I told them what's the deal, they have until Nov 29 to turn in the papers, if they don't their kid doesn't go back to our school. Simple.

If your admin is still giving issues, talk to your head nurse and get them to help you explain that this is MANDATED BY THE GOVERNMENT AND STATE! If not compliant, the school can be in serious trouble.