Sunday, December 11, 2016

The School Nurse Program at Collier County Public Schools

As promised in my last post, I am returning my focus to Collier County Public Schools and our state and local government, now that the 2016 elections are behind us. I look forward to sharing what I learn with you in the weeks and months ahead.

This first post-election piece was inspired by Ann Campbell, chairman of the League of Women Voters of Collier County’s Social Policy Committee, who was formerly a nurse.

Last season, Campbell and her Committee were concerned about the downsizing of the Collier County Public Schools (CCPS) nursing staff that accompanied the renewal of the District’s contract with Naples Community Hospital for the school nurse program. The renewal had been approved unanimously by the School Board at its March 10, 2015, meeting following public comments, a presentation by Eileen Vargo, Coordinator of Health Services for CCPS, and Board discussion.

From the Executive Summary that accompanied the Board Agenda Item:

The School Health Services Act, Florida Statute 381.0056, requires health services be provided in accordance with a local School Health Services Plan, developed jointly by the County Health Department and the District School Board. Pursuant to statute, the Plan must include, at a minimum, provisions for: health appraisals; nurse assessments; nutrition assessments; health records reviews; vision screenings, hearing screenings, scoliosis and growth and development screenings; referral and follow-up of suspected or confirmed health problems; meeting emergency health needs; referral of students to appropriate health treatment; consultations with parents or guardians regarding the need for health care; maintenance of records; health counseling; required medication administration and medical procedures; prevention of communicable diseases; preventive dental services; and health needs of students with disabilities.

The approved three-year contract with NCH began at an annual cost of $2.6 million. There are provisions for annual increases based on the Bureau of Labor Statistics Medical Consumer Price Index (MCPI) not to exceed 5% per year and any new costs to support district expansion and the addition of new schools. This state requirement is an unfunded mandate.

The CCPS Health Services web page is here.

I attended a meeting last month arranged by Campbell for her Committee with Eileen Vargo, CCPS Director of Health Services, and Christene Parker, RN, Naples Community Hospital, Director of the CCPS School Nurse Program, to find out what impact the changes had over the school year. With her permission, below is Campbell's summary of the meeting.

Background: Twenty years ago, in 1996, The League of Women Voters of Collier County supported the establishment of the current school nurse program under the auspices of Naples Community Hospital (NCH). Prior to that time, K – 6 students received screening (vision, hearing, spine) via the Health Department. Students’ medications were retained by and administered by school secretaries. NCH administration became concerned about the number of, often preventable, visits of school children to the Emergency Room. They stepped up to introduce a pilot school nurse program in the schools. It made a difference. 
Over the years, the NCH program has expanded to include nurses in every school at least part time and athletic trainers in all high schools. The program has had a positive impact in Collier County Schools even though it didn’t meet the nationally recommended ratio of one nurse to every 750 students. 
In May 2016, the American Academy of Pediatrics announced a policy recommendation that there should be at least one full time nurse in every school to deal with the increasing complexity of health problems among the students. 
School health nurses are often the only health care professional that students meet. The nurses intervene to reduce unneeded emergency room visits; identify critical problems requiring prompt attention by medical providers; help to reduce absenteeism; and provide support to school administration, teachers and staff. They promote a safe, healthy environment and facilitate parent involvement in the health of their children. 
There are no national guidelines for school nursing. Some states have requirements such as one nurse with advanced training in each district. No mandate exists for certified school nurses (now a recognized specialty). Florida neither mandates nor funds school nurses. It is left to county school districts to provide this important service.
Today in Collier County, there are 47,000 students being served in 50 schools. Eileen Vargo reported that CCPS Health Services and the NCH-sponsored School Nurse program work together with the Florida Department of Public Health in Collier County, Florida’s Vision Quest (providing testing and eyeglasses), The University of Florida College of Dentistry, and others to deliver high quality school health services to Collier’s students. Health needs run the gamut from seizure disorders, mental health crises, infections, minor injuries, to tube feedings and respirators. There are 2,400 children with life-threatening allergies, 100 with insulin dependent diabetes. Many of the students require individual health care plans. As the medical acuity of individual students increases, leadership must continuously evaluate how to place nursing staff to meet the needs of the children in a cost-effective manner. 
The “Lead” RN, in a “truly professional nursing role,” assesses the health needs of the children and is responsible for the training of Assistants in first aid, supportive care and more. Nurses (RNs and LPNs) are paired with Assistants in the schools according to the acuity of the students’ needs. 
Thirty schools have nursing coverage five days a week, up from 21 to 23 last year. That led to an adjustment in the other schools with five schools covered four days a week, ten covered three days, two covered two days and two with coverage one day a week. A typical day for a school nurse might involve 60 student visits or more. 
We asked Eileen Vargo about the challenges she sees at this time. Among them are: 1. Staff vacancies — there is a need to recruit and retain qualified and experienced staff; 2. The growing number of students with chronic health conditions, requiring medications or procedures at school — and the impact on staffing needs; and 3. Providing nursing services to medically fragile students in our ESE (exceptional student) special classes while also providing care for all students.
Christene Parker, who came on board to head the NCH program just before school started this year, brings a wealth of experience from her work in school nursing in New Jersey. She sees the purpose of the school nurse program as focusing on the health and wellness of all the students, thereby putting into place appropriate strategies to maintain student health and support attendance. She speaks enthusiastically about encouraging professional development for her staff to enhance nursing skills and foster critical thinking and decision-making. Christene reminds us that school nursing is an area of practice that is unlike nursing in a hospital or clinic; the school nurse works independently, with a great deal of autonomy in a community setting.


We learned a great deal during our visit with Eileen and Christene and we thank them sincerely for allowing us to get a picture of the great work that they are doing. We think one of the other challenges for children in Collier County might be matching their insurance (or lack of it) with local pediatricians in a timely manner when they are referred for care by the school nurse. Of course, we would like to see more funding for the program so the increasing needs of the children can be safely met. We hope to follow this issue and support the School Nursing Program in any way that we can.
According to the Centers for Disease Control and Prevention, "Scientific reviews have documented that school health programs can have positive effects on educational outcomes, as well as health-risk behaviors and health outcomes." It's important for voters to be aware of the many challenges faced by Florida school districts that go beyond teachers, tests and textbooks. Attending to the health needs of its students is just one of them. Many thanks to Ms. Campbell for arranging this meeting and allowing me to share her summary.
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