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The Iowa School Nurse is a registered nurse with a license from the Board of Nursing to practice nursing as directed by the Iowa registered nursing laws (Iowa Code 152 and 655 Iowa Administrative Code).
Each Iowa Public School District has a school nurse - Iowa Code section 256.11(9B) to provide school nurse and school health services. The school nurse endorsement, at a minimum, is a registered nurse with a license from the Board of Nursing. The school nurse is employed, shared, or contracted by the district and the amount of time is not specified. The district works toward the goal of one school nurse for every 750 enrolled students. Available and not required is a School Nurse Statement of Professional Recognition (SPR) from the Board of Educational Examiners. The school nurse with a SPR (RN license from the Board of Nursing and baccalaureate degree) meets the definition of "teacher" and is eligible, details determined locally, for teacher special funds, evaluation, and professional development.
“School nursing is a specialized practice of professional nursing that advances the well-being, academic success, and life-long achievement and health of students. To that end, school nurses facilitate positive student responses to normal development; promote health and safety, including a healthy environment; intervene with actual and potential health problems; provide case management services; and actively collaborate with others to build student and family capacity for adaptation, self-management, self-advocacy, and learning (NASN, 2010c).
Tenets of School Nursing Practice
- Nursing Practice is individualized.
- Nurses coordinate care by establishing partnerships.
- Caring is central to the practice of the school nurse.
- Registered nurses use the nursing process to plan and provide individualized care to their patients.
- A strong link exists between the professional work environment and the registered nurses ability to provide quality patient care and achieve optimal patient outcomes.
Standards of School Nursing Practice
Standards of Practice for School Nursing
Standard 1. Assessment
Standard 2. Diagnosis
Standard 3. Outcomes Identification
Standard 4. Planning
Standard 5. Implementation
Standard 5A. Coordination of Care
Standard 5B. Health Teaching and Health Promotion
Standard 5C. Consultation
Standard 5D. Prescriptive Authority and Treatment
Standard 6. Evaluation
Standards of Professional Performance for School Nursing
Standard 7. Ethics
Standard 8. Education
Standard 9. Evidence-Based Practice and Research
Standard 10. Quality of Practice
Standard 11. Communication
Standard 12. Leadership
Standard 13. Collaboration
Standard 14. Professional Practice Evaluation
Standard 15. Resource Utilization
Standard 16. Environmental Health
Standard 17. Program Management"
American Nurses Association and National Association of School Nurses. (2011). School Nursing: Scope and Standards of Practice 2nd Edition. Silver Springs, MD: nursesbooks.org and nasn.org.
Kindergarten and Pre-School
Starting Kindergarten - Brochure guide for parents to prepare children for kindergarten.
Immunizations - Required to enter school. Local Public Health audits in fall. Law, certificates, program information, required to submit certificate to begin school.
Dental Screening - Required. May attend school without the screening. I-Smile/Public Health personnel audit in spring. Rules, forms, and information.
Lead Test– Required. The school requests a yes or no test administered response from parent and the student may attend school without the test. The school submits a list of all kindergarten students on the spreadsheet provided by Iowa Department of Public Health, Bureau of Lead Poisoning Prevention within 60 days of the start of the school calendar. The department notifies the school of the children not meeting the requirement and assists to assure these children are tested. Available are religious and very low risk (approved by the bureau) exceptions.
Vision Card - School required to give a vision card to the parent/guardian of each registering preschooler and kindergartener. No requirement for exam to attend school. Order cards from Iowa Optometric Association.
Plus local district requirements.
Tdap (Tetanus, Diphtheria, acellular Pertussis) - Beginning for the 2013-14 school year, children entering 7th grade and above if born on or after September 15, 2000, shall receive a one-time dose of tetanus, diphtheria, acellular pertussis (Tdap) vaccine.
Dental Screening - Required. May Attend school without the screening. I-Smile/Public Health personnel audit in spring. Rules, forms, and information.
Plus local district requirements.
Abuse of Students and Children Manual - The manual is in two parts, the first part mandatory reporting of suspected child abuse to DHS and the second part abuse of students by school employees, Chapter 102 Level One Investigator with reporting and investigating alleged abuse of students by school employees.
Allergies- The Food Allergy & Anaphylaxis Management Act, a part of the food safety act (FAAMA), passed by the U.S. Congress and signed into law, January 2011, requires the U.S. Secretary of Health and Human Services to develop and make available to schools a voluntary policy to manage the risk of food allergy and anaphylaxis in schools and provide for school-based food allergy management incentive grants to support implementation of food allergy management guidelines in public schools. The Food Allergy and Anaphylaxis Network’s (FAAN) School Food Allergy Program and the National School Boards Association, Safe at School and Ready to Learn: A Comprehensive Policy Guide for Protecting Students with Life-Threatening Food Allergies are recommended for use in Iowa schools.
Allergies - Allergy resources and recommendations include a school team identifies student needs and may provide an individualized health plan, emergency plan, allergy action plan, and 504 plan as appropriate to provide the student with an allergy safe and healthy school environment. The Peanut Allergy Institute recommendation, ‘Concern over peanuts in public places has led to some schools calling for peanut bans. However, bans, which can never be fully enforced, may lead to a false sense of security and put the child at greater risk. There is no evidence supporting the effectiveness of this practice. A more effective solution is to educate students, schools, and foodservice professionals and set up a food allergy management plan. When it comes to school peanut bans, FAAN does not advocate them. They recommend parents, doctors and school officials work together to develop a plan that best fits their situation’.
Americans with Disabilities Act Amendments Act (ADAAA) 2008 and the Iowa School Nurse - ADAAA - The ADAAA, effective January 1, 2009, impacts school nursing. The document and presentation provide information regarding the ADAAA law and its applications to school nursing. View the presentation at http://iowa.adobeconnect.com/p55778553/
Bed Bugs -Bed Bugs- While an annoyance, bed bugs have not been found to carry disease; however have been found to cause panic. With the increased number of reported cases of bed bugs in our communities, it is recommended schools make available to the community information on bed bugs and the school plan.
Bloodborne Pathogens: OSHA-Occupational Exposure -Bloodborne Pathogens- The United States Department of Labor, Occupational Safety and Health Act (OSHA), Occupational Exposure to Bloodborne Pathogens Regulations and Standards, adopted by the Iowa Division of Labor, Occupational Safety and Health Bureau purpose is to end and reduce employee exposure to blood and other potentially infectious materials. The laws require Iowa schools and education agencies, as employers, to develop an occupational exposure to bloodborne pathogens program. Connect Pro Meeting: OSHA-Iowa School Occupational Exposure to BBP, one-hour viewing (link)
Clinical Laboratory Improvement Amendments (CLIA-Federal law U.S.C. 42 §263a, 42CFR Part 493) - Requires a certificate of waiver for schools to examine materials from the human body to provide information for diagnosis, prevention, or treatment of any disease, impairment, or assessment of health (for example, blood glucose, urine testing, throat swab). The law applies to a school nurse or other qualified school personnel, following health care provider orders and manufacturer's instructions, administering these tests at school and in school activities. The Iowa Department of Education has a CLIA Certificate of Waiver to meet the requirement for each Iowa school under the jurisdiction of the Iowa Department of Education to carry out these tests. Additional CLIA information and good laboratory practices.
Concussions and other Brain Injuries - Protection of Students Key provisions of the new Iowa 'Brain Injury' law, effective fall 2011, include:
- Annually, every student (grades 7-12) and their parent/guardian must receive, sign, and return a concussion and brain injury information sheet signatures before student may participate in interscholastic sports, cheerleading, and dance in any way (practice or competition).
- Students must be immediately removed from participation (practice or competition) in an extracurricular interscholastic sport, cheerleading, dance if coach or official observes signs, symptoms, or behaviors consistent with concussion or brain injury.
- The student, to return to participation (practice or competition), provides the school with a signed evaluation/clearance to return by a licensed health care provider trained in the evaluation and management of concussions and other brain injuries.
The Iowa High School Athletic Association (IHSAA) and Iowa Girls High School Athletic Union (IGHSAU) developed guides and forms located on their websites including signature sheet, "Heads Up: Concussion in High School Sports." Use this form beginning fall 2011 for interscholastic sports, cheerleading, and dance. Students cannot practice or compete until this form is signed and returned to school. The parents/guardians keep the concussion and brain injury information sheet for reference and return the sheet signature portion to school. The acknowledgement of receipt statement may be included as part of the general forms parents and students sign.
The IHSAA and IGHSAU Concussion Management Protocol complies with the legislation. The 'Return to Participation Protocol Following a Concussion' is required to be on file at school signed by a "licensed health care provider" (a physician, physician assistant, chiropractor, advanced registered nurse practitioner, nurse, physical therapist, or athletic trainer licensed by a board) for the student to return to practice or competition.
The IHSAA and IGHSAU websites link to a free, 20-minute concussion course. Mick Koester MD hosts the recommended course for school administrators, coaches, and sports officials. Contact: Alan Beste, Assistant Executive Director, IHSAA, PO Box 10, Boone, IA 50036-0010, 515-432-2011.
Data- Number of Public LEA School Nurses and AEA Special Education Nurses in selected years.
Delegation -Delegation and the Iowa School Nurse - Iowa school nurse delegation, decision making, and documentation.
Emergency-School Health Planning -Emergency-School Health Planing - The emergency school health plan in each school building provides for a safe and healthy learning environment for students and school personnel considering the total and individual population needs.
Evaluation for School Nurses Example - Evaluation for the School Nurse Example - Provides a side by side listing of the Teaching Standards and Criteria, Nursing Standards, School Nursing Standards, and School Nurse Competencies for School Nurses evaluated on the teacher evaluation.
Exclusion from school due to Illness - Exclusion from School Due to Illness - Basic criteria/planning for student illness temporary exclusion from school.
Family Educational Rights and Privacy Act (FERPA) - The School Nurse practices FERPA to protect the privacy of student health information. The following presentation and transcript reviews FERPA definitions, consent exceptions, relationship to other laws, notifications, education program, and resources:
Iowa Students with Special Health Needs - Information on Students with Special Health Needs including laws, school nurse and school health services assessment and planning, and service implementation in school and school activities.
Connect pro meeting: Iowa Students with Special Health Needs, 56 minutes at (link)
Iowa Emergency Guidelines for Schools 2012 Iowa Emergency Guidelines for Schools 2012
Iowa School Safety Guide 2012 Iowa School Safety Guide 2012
Guidelines for the Management of Chronic Conditions in Iowa Schools Guidelines for the Management of Chronic Conditions in Iowa Schools
Detailing the student's needs for school nurse and school health services and example IHP form.
Individualized Education Program (IEP) - Statewide AEA Special Education Procedures Manual and AEA Special Education Documentation Guide
Influenza The Iowa Department of Public Health (IDPH) information for schools and community colleges to assist in influenza prevention and planning.
Laws -Iowa School Health Legal Reference Summaries -The Law summaries are not a substitute for the actual laws. For further clarification, refer to the legal references full text.
Licensed Practical Nurse in Iowa Schools - Iowa School Health Services and the Licensed Practical Nurse in the School - Lists the laws on LPN Practice in Iowa Schools.
Mailing List is a communication tool for Iowa School Nurses. The mailing list is the Department of Education link with school nurses allowing the Department and Nurses to communicate via email messages. Iowa School Nurses can use the mailing list to request information, advice, share news and initiatives, and receive news. School nurses joining the mailing list add their email address to the online school nurse mailing list and can send messages to all members at any time. When messages are posted, the message automatically goes to everyone on the list. Joining the mailing list is free.
Medicaid Presumptive Eligibility - Medicaid Qualified Entity (QE) for presumptive eligibility. The school nurse, in a Medicaid approved provider school, can become a QE to make the presumptive determination about a child's Medicaid eligibility based on the family's income self declaration statement for the child to receive immediate medical care. More in Informational letter 978 (http://www.ime.state.ia.us/docs/978_PresumptiveEligibilityforChildren.pdf).
Medication Administration Course - This basic online Iowa medication administration course is available to school personnel without a health license to whom authorized health practitioners have delegated the administration of medication at school and in school activities. The course is designed to partially meet the laws for Iowa school personnel to administer school medications at safely and effectively. To access the course select mandatory courses, register/login your username and password, and select course catalog. Short units are available including medication administration of rectal diazepam, glucagon, insulin pumps, insulin injection, gastrostomy, and nebulizer. The special units offer education on tasks beyond the basic core course. Contact your AEA or Heartland Professional Development, 1-800-255-0405, Ext. 14701 for information.
Medications Management in Iowa Schools Resources to support the health and safety of students and staff. Contents include laws, policies, procedures for medication administration, roles, responsibilities, education for qualified designated personnel, example forms, glossary, resources, and references.
The toolkit can be found by clicking the link below. The toolkit contains resources to build a skills observation kit, skills checklist, special checklists, example forms for assistive personnel documentation, training-supervision-monitoring record, course evaluation, and emergency plan.
Accessing Iowa Mental Health Services - Serving Children and Youth in their Homes, Schools, and Communities. Laura Larkin, LMSW, Program Planner, Division of Mental Health and Disability Services, Iowa Department of Human Services. January 2011, webinar contents: Identification of knowledge or service gaps; Review of national and state data on children’s mental health needs; Overview of outpatient, wraparound, system of care, remedial, and children’s mental health waiver programs; and Service funding.
Iowa Outpatient Mental Health Services - Designated County Community Mental Health Centers and Waiver Mental Health Providers.
NEWS: School Nurse and School Health Services - Iowa Department of Education newsletter.
- April 2012 - News: School Nurse and School Health Services Topics: School Nurse Day, Sun Safe Iowa, CHANGE Dental Screening, CHANGE Staff Physical Examination, Iowa School Nurse Data, Iowa Minor Consent Laws, Iowa School Emergency Planning, Iowa Child Death Review Team, Iowa Example School Nurse Evaluation, School Leader Update Information, Calendar, and Resources
- January 2012 - News: School Nurse and School Health Services Topics: Iowa School Nurse Web Page, FERPA Webinar, Iowa Licensed Practical Nurse in School, Iowa School Nurse Data, Student Cumulative Record Retention, Obesity in Special Needs Children, Herpes Gladiatorum, Calendar, and Resources.
- August 2011 - News: School Nurse and School Health Services Topics: Iowa Department of Education Website Address, Concussion-Brain Injury Legislation, School Nursing Scope and Standards of Practice, Fight the Flu Now, Flood-Related Disease Precautions, Homeless, Specialized Instructional Student Support Services, Unintended Consequences, Confidentiality, Improving School Nutrition Standards, Lead Reporting Requirements, Iowa Immunization Requirements, Calendar, and Resources.
School Health Council
Guide to Community-School Health Councils: Promoting Healthy Students, Schools, and Communities - This presentation describes an effective structure and process for partnerships between the community and school to promote and support the improvement of student health and how to use the community-school health council to meet the health needs of all the differing school populations.
School Health Records
School Screenings -School Screenings- The Federal Protection of Pupil Rights Amendment (PPRA) and State requirements and interpretation govern the provision of school screenings.
Status Epilepticus and Midazolam - Status Epilepticus and Midazolam- Provides status epilepticus information including definition, etiology, morbidity, mortality, prevention, and treatment. Presented by Dr. Charuta Joshi, Clinical Associate Professor, Division of Pediatric Neurology, UIHC, May 5, 2009.
Advisory Committee - Promoting Healthy Youth, Schools and Communities: A Guide to Community-School Health Advisory Councils - Guidance for schools planning to form a Community-School Health Advisory Council to promote coordinated school health.
Center for Disabilities and Development - University of Iowa Hospitals and Clinics resource for healthcare services, training, research, and information for people with disabilities. Consulting services and a Disability Resource Library are available for both professionals and families.
hawk-i - Information on the Iowa health insurance for uninsured children.
Health Education - Information and guides for health education.
Iowa School Nurse Organization - Professional Organization supporting school nurses in the delivery of health services to improve student's health and academic success.
Medline Plus - Information on prescription and over the counter medications and links to other health topics.
School Health - School Health programs promote health and healthy behaviors in the lives of students, staff, families, and the community.
School Health Links and References - Resources for school health programs.
Special Dietary Needs - US Department of Agriculture. (2001). Accommodating Children with Special Dietary Needs in the School Nutrition Programs: Guidance for School Food Services Staff. USDA, Washington, DC.