horrible immunization compliance rate

  1. 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?
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    About jnemartin, BSN, RN

    Joined: May '12; Posts: 43; Likes: 58

    31 Comments

  3. by   KeeperOfTheIceRN
    Does your administration approve of excluding until they return the required docs? I know that's the ONLY way many of my parents will respond. Something about telling them their kid can't come until its done lights a fire under their rears. I would start there and see if your administration will allow you to exclude for that reason. Potentially being audited and then subsequently fined due to poor compliance could persuade them to be on board with that idea.
  4. by   AdobeRN
    What is the district policy? What is your State law regarding immunizations and school? I am in Texas - my district is pretty strict about following the law regarding immunizations - kids are excluded from school if they do not have all the required immunizations or Affidavit on file.

    to keep it from happening next school year - kids are sent home and/or not allowed to start the first day of school. Hopefully you have admin support on this - it makes this part of our job so much harder if the principal turns around and over rules you.
  5. by   jnemartin
    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.
  6. by   EnoughWithTheIce
    Quote from jnemartin
    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.
    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!!
  7. by   jnemartin
    ok true. Apart from giving my admin weekly updates on the status of the health files, I have sent all referrals by email, so I have a record of my communications with parents, and documented when I called and LM re the missing documents, too. So I have a good paper trail.

    I have gotten the strangest replies from parents - like they have sent old vax records after I explicitly ask for Tdap and MCV, or they just email me back with an updated contact email but then never reply when I email to their the new contact - it's so weird!
  8. by   jnemartin
    update: I just told my principal very bluntly that I am worried that if our immunization compliance rate is reported at 65-75% I am worried our school will be investigated by the dept of health. She said that she will send a strongly worded email out to parents warning that if they don't send in the reports, the dept of health may come and require their students be removed from school. so not *exactly* what i was hoping for (of course I'd prefer the dept of health not be poking around looking for issues), but better than ignoring the issue
  9. by   jnemartin
    This school is not regulated by a district, but I plan to look into writing a policy if our parent company/school doesn't have one (I doubt it).

    Next year our plan is to require the immunization reports along with tuition payment/registration, as well as streamlined messaging from the nurse at our feeder 5th grade.
  10. by   jnemartin
    Quote from AdobeRN
    What is the district policy? What is your State law regarding immunizations and school? I am in Texas - my district is pretty strict about following the law regarding immunizations - kids are excluded from school if they do not have all the required immunizations or Affidavit on file.

    to keep it from happening next school year - kids are sent home and/or not allowed to start the first day of school. Hopefully you have admin support on this - it makes this part of our job so much harder if the principal turns around and over rules you.
    This school is not regulated by a district, but I plan to look into writing a policy if our parent company/school doesn't have one (I doubt it).

    Next year our plan is to require the immunization reports along with tuition payment/registration, as well as streamlined messaging from the nurse at our feeder 5th grade.
  11. by   NutmeggeRN
    I would think a private school can make whatever rules they choose, within the law. So it makes sense that they mirror the state laws.

    Explain in graphic detail, what can happen with the measles or varicella outbreak, pictures etc.
    Ask how would the school respond, if there was a child who died to due to exposure to a vaccine porevatable disease?
    Why not have a plan in place in case they enroll an immunocompromised child? They, have a duty to protect that child.

    I guess they just don't understand the consequences...
  12. by   Flare
    i was in this position a number of years ago where i inhereted a mess when i took over a school and found that most of the seventh graders weren't immunized as they should have been as sixth graders. I stayed in close communication with my principal about the situation, sent out urgent letters giving the parents a "reasonable" amount of time before exclusion anf I even spoke to my auditor ( the nurse from the public health authority).
  13. by   OldDude
    Sounds like you've put forth due diligence in everything you have the authority to act on. Good job. Try not to fret over it. You inherited a mess. You're moving forward and that's all you can do.
  14. by   scuba nurse
    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.

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