Challenges and Importance of School Nursing in Kentucky
Kentucky faces challenges in student health, with disparities in economic status and race affecting children's well-being. School nurses play a crucial role in promoting healthy behaviors and supporting positive outcomes in academic, physical, and mental health. Concerns like disabilities, poverty rates, chronic absenteeism, and access to medical care impact school success. Despite facing health indicator challenges, support for school nurses is vital for improving student health and academic success in Kentucky.
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A Nurse in Every KY School All Day, Every Day Eva Stone, DNP, APRN eva.stone@uky.edu Sheila A. Schuster, Ph.D. kyadvocacy@gmail.com KNA School Nurse Task Force
Kentuckys Kids Preschool- 12thgrade- 638,236 children 60.5% economically disadvantaged 25.5% children of color Disparities in 4thgrade reading levels by economic status and race
Kentuckys Kids Visits to the school nurse 2019/2020 2,338,816 Visits to the school nurse 2020/2021 851,252 Chronic Health Conditions 121,105 Number of districts reporting no school nurses: 29
Kentuckys Kids-Pandemic Preventive Health Exams Immunization Rates School Loss
Significance Researchers state that second only to home, school represents the most influential environment in a child s life School nurses promote and support healthy behaviors by being a part of every school community, resulting in positive outcomes: Leads to healthy outcomes Academic Physical Psychosocial Mental Health A child s ability to learn is directly related to health status Schools are a hidden system of health care
Concerns Disabilities Poverty rates Medical care Chronic absenteeism School success
The Future Kentucky is among the bottom 10 in the nation for multiple health indicators in children: Physical health Mental health Diabetes Asthma Obesity Oral health Substance use
Support for school nurses American Academy of Pediatrics says: School nurses improve the health, well-being and safety of students, coordinate healthcare needs, and can positively impact the social determinants of health (economics, health, education, social/community and environments). American School Superintendents Association endorses Coordinated School Health : Schools play a critical role in promoting health; improved health leads to increased academic success, and healthy students are better learners. The link between health and schools has become more important during Covid-19 !
The 21stCentury School Nurse Community/Public health Care Coordination Leadership Quality Improvement Assessment of physical & mental health
The Solution: A School Nurse in Every School All Day Every Day Research Has Shown Schools With Nurses Have: Improved attendance rates with lower absenteeism Higher high school graduation rates Higher standardized test scores Decreased use of local emergency department services Reduced transmission of infectious diseases Earlier diagnosis and treatment of problems physical, psychosocial, mental and academic Management of chronic childhood conditions e.g., asthma, diabetes, cystic fibrosis, seizures Assessment and referral of students with substance use Screening, individual assessment and referral of students with poor physical or mental health
School Nurse Mental Health Intervention: Management of teasing and bullying resulting in decreased child anxiety and concentration problems Decreased absenteeism or early dismissal with nurses vs school staff Promotion of health and wellness programs A safe place for students to share confidential information and concerns about themselves or others in the school community Further decreased absenteeism or early dismissal with FT nurses vs PT nurses
School Nurses Role in Covid -19 Contact Tracing Vaccine Clinics Education Testing Support for in-person learning Coordination of Care Outreach Work during non-traditional instruction
Funding Support Reversal of the Medicaid Free Care Rule Community Partnerships ESSA Plan: Title I, II, and IV funds Part A can be utilized to fund a nurse in the school ESSER- during pandemic
Funding A School Nurse in Every KY School, All Day, Every Day
Funding A School Nurse All Day, Every Day THE NEED: Given Kentucky s poor health rankings, historic lack of access to health care services and the current COVID pandemic with its physical and mental health impacts, the urgency has never been greater to focus on the health of Kentucky s children and youth. And the school setting both in terms of location and access offers the greatest opportunity for regular physical and mental health contact with Kentucky s students. THE CONTEXT: Hiring of school nurses is at the discretion of each school district and has been done inconsistently over the years. The greatest obstacle is the lack of funding, but there has also been a lack of consistent data-collection, making it impossible to fully evaluate the range of outcomes from having a nurse in the school building.
Funding A School Nurse All Day, Every Day PROPOSED COST OF A FULL-TIME SCHOOL NURSE IN KENTUCKY: We surveyed school nurse salaries in our contiguous states, as well as other southern states. From that information, we chose an hourly school nurse salary rate of $27/hour, which places Kentucky in the middle of the 12 states that were surveyed. A typical school year is 43 weeks, with a work week of 37.5 hours/week, making the school year 1,612.5 working hours. At $27/hour, the base salary is $43,537. We added in 30% of the salary for benefits, which would be $13,061. The total salary for the school year for each full-time nurse would be: $56,598.
Funding A School Nurse All Day, Every Day OUR PROPOSAL: With $9M in funding each year of the upcoming biennial budget, every public high school, middle school and elementary (K 5thgrade) school in Kentucky would have a school nurse in their building all day, every day. School districts that do not have a full-time nurse in each of their high schools, middle schools or elementary schools would be given funding for salary and benefits to hire a full- time nurse or to supplement their part-time nurse to a full- time position.
Funding A School Nurse All Day, Every Day OUTCOMES: The literature suggests that having a nurse full-time in the school building will yield a positive influence on student attendance, identification and management of chronic health conditions, early detection and intervention with mental health issues, improved coordination of health and mental health services within the school and with community providers, assistance with testing for communicable diseases, and improved availability of health education. The legislative work done after the Marshall County High School shooting in developing trauma-informed schools will be enhanced and reinforced by having a full-time nurse in the building who can be one of those trusted adults to whom students confide. Research on the outcomes of placing a nurse in every Kentucky school would be conducted by the UK College of Nursing and would continue over the next several years, as funding allows.
Funding A School Nurse All Day, Every Day FUNDING OPPORTUNITIES FOR SUSTAINABILITY: In 2018, Governor Bevin s administration sought and was granted permission from CMS to reverse the Medicaid Free Care Rule so that Medicaid-eligible services delivered in the school setting could be covered if made available to all Medicaid-eligible students, not just those who have an Individualized Educational Program (IEP), as had formerly been the case. While it has taken some time to prepare the schools to use this funding mechanism, it is now in place and covered services provided by the school nurse can be billed to Medicaid. This provides a mechanism for school nurses to earn part of their salary by delivering health services.
