Should Philly school nurses be able to send home unvaccinated students? District says no.

[NRSKarenRN, BSN, RN]

Should Philly school nurses be able to send home unvaccinated students? District says no.

....But for the last several years, the Philadelphia School District has prohibited school nurses from excluding unvaccinated students, a move that worries Devine and others given the recent local outbreak of mumps and other infectious diseases cropping up across the country.

Across the district, 12,405 pupils lack either all of the state-mandated vaccinations or have an exemption from them because of medical, religious, or philosophical reasons. That’s roughly 10 percent of the district’s student population.

“It’s very dangerous that you’ve got kids who are not immunized, and you have medically fragile kids,” said Devine. “It’s unprecedented.”...

...Karyn Lynch, chief of student support services for the district, said the shift in exclusion decisions was needed to standardize procedures “so that across the city, everyone is following the same process. To inequitably implement across the district would be inappropriate."...

But on the ground, nurses bristle at their lack of authority over student health, and say in the past they were following orders of the state Health Department to exclude, when appropriate, students who lack the required immunizations.

Jerry Jordan, president of the Philadelphia Federation of Teachers, which represents school nurses, said the district’s recent shift was “a real concern.”

“This speaks to the question of professionalism, the way people are treated,” said Jordan. “Nurses did not exclude children without the approval of the principal. They’re the medical experts in our school buildings, and we should listen to their advice.”

[beachynurse, ASN, BSN]

We have a policy that unvaccinated students do get sent home, with the exception of military families, they have 30 days to either produce a record, or begin getting shots, or homeless families who have the same. I set up a plan with them, and follow up with each immunization. If they miss an immunization I send a letter home with an exclusion date, which is signed by both myself and an administrator. I will make a reminder call 1 week prior to the due date of the immunization, but if the due date comes and no immunization, the student WILL be excluded from school until they get the immunization. Some parents will try and send the student anyway, so I call the student down to the clinic, call the parent and telll them to come pick up the student. I tell the parent if they give me a hard time about it, that the student will sit in the clinic all day until the immunization is given. That usually does the trick.

[UrbanHealthRN, BSN, RN]

Interesting article! It gave me a lot of food for thought about my own job.

Many states have laws about vaccine requirements for school. I'm assuming PA is this way, but I could be wrong. If we're going to put these requirements into place, though, how can anyone expect to enforce the rule if there isn't some sort of consequence attached to it? A large part of my current job is Head Start classrooms, and while Head Start at the federal level gives me all sorts of health requirements to follow, there is almost no way to enforce the requirements with families. If I kept excluding kids because they didn't get a lead test or anemia screen or whatever done, we wouldn't have anyone enrolled in Head Start anymore, because it seems like there's always something missing that I have to track down with these kiddos. The only consequence I've seen so far is Head Start taking away funding dollars because a program couldn't get enough kids completely caught up. Because that's what happens when you care more about the kids than the parent does. Right.

Anyways, my other question is, if there's actually an outbreak of a vaccine-preventable disease, can non-vaccinated kids be excluded at that point? I'm hoping yes, and that this article was just speaking to how schools try to enforce vaccination requirements for school entry, but it makes me nervous. First a school nurse can't do anything about a non-vaccinated kid when they're healthy, then what'll they do when there's illness....

[beachynurse, ASN, BSN]

2 minutes ago, UrbanHealthRN said:

Interesting article! It gave me a lot of food for thought about my own job.

Many states have laws about vaccine requirements for school. I'm assuming PA is this way, but I could be wrong. If we're going to put these requirements into place, though, how can anyone expect to enforce the rule if there isn't some sort of consequence attached to it? A large part of my current job is Head Start classrooms, and while Head Start at the federal level gives me all sorts of health requirements to follow, there is almost no way to enforce the requirements with families. If I kept excluding kids because they didn't get a lead test or anemia screen or whatever done, we wouldn't have anyone enrolled in Head Start anymore, because it seems like there's always something missing that I have to track down with these kiddos. The only consequence I've seen so far is Head Start taking away funding dollars because a program couldn't get enough kids completely caught up. Because that's what happens when you care more about the kids than the parent does. Right.

Anyways, my other question is, if there's actually an outbreak of a vaccine-preventable disease, can non-vaccinated kids be excluded at that point? I'm hoping yes, and that this article was just speaking to how schools try to enforce vaccination requirements for school entry, but it makes me nervous. First a school nurse can't do anything about a non-vaccinated kid when they're healthy, then what'll they do when there's illness....

Our guidelines state, and parents have to sign that they are aware that their child will be excluded if they are unvaccinated and an outbreak of any disease occurs.

We are not allowed to exclude unvaccinated students, as long as they produce a letter that states a "religious exemption" . Of course, none of our familes actually have a religious belief that prevents vaccines, it is a philosophical one but they lie and write letters claiming religious exemption and there is nothing we can do. We CAN however exclude unvaccinated students if there is an outbreak of a vaccine preventable illness. With measles on the rise it is only a matter of time...

[beachynurse, ASN, BSN]

1 minute ago, MHDNURSE said:

We are not allowed to exclude unvaccinated students, as long as they produce a letter that states a "religious exemption" . Of course, none of our familes actually have a religious belief that prevents vaccines, it is a philosophical one but they lie and write letters claiming religious exemption and there is nothing we can do. We CAN however exclude unvaccinated students if there is an outbreak of a vaccine preventable illness. With measles on the rise it is only a matter of time...

We do have a religious exemption too, which is a joke. All the parents have to do is sign and notarize. I think it should also be signed or have something from their place of worship stating that they have a belief in no immunizations, but, who am I? Parents use that form for everything..

[UrbanHealthRN, BSN, RN]

We have a religious exemption option for our kids, too, but not all parents whose kids need vaccines sign it, and I don't offer it freely to families as an option. I'd prefer they ask me about the exemption on their own, or communicate to me first what their vaccine preferences are.

For the kids who don't have an exemption, and who don't have all their vaccines, I will exclude from time to time until they get caught up. State law says we need those vaccines done, and my agency policy allows for exemption if reasonable attempts to get them done aren't successful. Many times, our kids who need vaccines are also behind on other health care, so it becomes a big package deal of health care for the kiddo.

[Feral.Cat.Herder, RN]

On 4/25/2019 at 9:25 AM, beachynurse said:

We do have a religious exemption too, which is a joke. All the parents have to do is sign and notarize. I think it should also be signed or have something from their place of worship stating that they have a belief in no immunizations, but, who am I? Parents use that form for everything..

We have religious exemption too, but it doesn't even need to be notarized. They can write it on a napkin and they'll be exempt ?

[beachynurse, ASN, BSN]

On 4/26/2019 at 1:29 PM, Feral.Cat.Herder said:

We have religious exemption too, but it doesn't even need to be notarized. They can write it on a napkin and they'll be exempt ?

That really sucks. I have contacted my legistaors about changing the form on a couple of occasions. Of course I got a rediculous form letter back to pacify me. I'm going to keep trying.

[CanIcallmymom, BSN, RN]

Wow. Glad we don't have that policy here. The state would rip us to shreds in an audit, I'm sure! In our district, we exclude on the first day.

[Feral.Cat.Herder, RN]

3 hours ago, CanIcallmymom said:

Wow. Glad we don't have that policy here. The state would rip us to shreds in an audit, I'm sure! In our district, we exclude on the first day.

and that's how is should be!

[kidzcare]

3 hours ago, CanIcallmymom said:

Wow. Glad we don't have that policy here. The state would rip us to shreds in an audit, I'm sure! In our district, we exclude on the first day.

Us too! I like it but I wish we would exclude second day or third. This past august I had to call a sixth grade student out of an assembly to sit in the health office and wait to get a hold of the parents for 45 minutes while he sat there and looked scared and confused. His very first day of junior high and he was being punished and embarrassed for something his parents didn't do.

I say, let them stay the first day and call and make sure the student understands that they cannot be in school the next day without the paperwork.