Category Archives: Healthcare

School Health Care Realignment of Services


Stan Jester
Board Of Education
District 1

On Thursday Oct 1, ten(10) school nurses across the district were given two days notice they were being transferred to other schools.
I asked Superintendent Stephen Green to help us understand the guidance the district used to make these recent school nurse reassignment decisions.
Elementary Schools affected are: Bouie, Fairington, Kittredge, Vanderlyn, Oakcliff, Huntley Hills, Columbia, Oakview, Briarlake, and Hawthorne.  Reaction by the communities and many nurses:

DeKalb County Seal Logo

Parents angered over reassigned school nurses
 Parents, students upset DeKalb school nurses being moved
Nancy Jester Why are DeKalb school nurses being ripped from their communities?
Nancy Jester Former DeKalb administrator demands special service and approximately 6000 children in 10 schools pay the price
School Council Letters To BOE

Board Discussions About Nurses

March 2, 2015 note from Michael Thumond (Superintendent)
Based on feedback from the last Board of Education meeting, a revised proposal was developed that includes possible timeline for implementation, comparison of neighboring district service models and three options for consideration by the board. Please find the proposal attached at  Student Health Services In Schools Revised Proposal.pdf
Laws, Rules And Policy



Dr. Stephen Green sent this out Friday Oct 9:

Subject: School Health Care Realignment of Services
By: Superintendent Stephen Green

I have approved the realignment of health care services for students based on the need to have a registered nurse in place for students who have specific health care needs, i.e., diabetes, seizures, etc. This is with the understanding that there may be exceptions but any exceptions will be treated as such and will be addressed on a case-by-case basis. While we understand and appreciate the relational impact of this decision, priority has been given to our students and their health care needs.
School Health Care Realignment of Services
Some diabetic students in the DeKalb County School District were not being served in accordance with district practices. The practice as implemented in 2004 was to ensure that every student with diabetes was supported by a licensed nurse during the entire instructional day. In addition, the District ceased hiring additional School Clinic Assistants in 2004 and only hired licensed nurses to support the growing health care medical needs of students.
As directed by the BOE and Superintendent in FY2014 and FY2015 the administration assessed the current level of services for all students throughout the District. In our assessment we found that there were diabetic students in elementary schools without a licensed nurse. In these settings, nurses from neighboring schools had to be pulled for approximately 2 or more hours per day for support including insulin injections; leaving their respective locations unsupported. In addition to our audit, the Board of Education approved the addition of 5 nurses to support the middle and high schools for FY2016.
A plan was developed utilizing 2014-2015 as well as current 2015-2016 school enrollment data; along with a comparative analysis of practices in place in neighboring districts. Additionally, we reviewed state regulations regarding nurses and determined that the most viable solution was to continue with our current practice of ensuring that every student with diabetes was supported by a licensed nurse during the entire instructional day. This was predicated on the concerns of the District regarding insulin injection, incorrect dosages, corrective equations, interpretation of medical orders, school nurse best practices and the continuity of care.
The plan was shared with the Superintendent and permission was given to move forward. From our assessment, there were 5 elementary schools with students with a diabetic diagnosis or insulin dependent that were not being served during the entire instructional day by a licensed nurse. As such, the following plan was initiated;

  • On September 3, 2015 all school health personnel attended a meeting
  • During this meeting a 3 tier plan was discussed
  • The plan included reassignments based upon the needs of all students in the District;
  • Hiring of nurses to support the middle and high schools;
  • Providing opportunities for unlicensed personnel to earn Certified Nursing Assistant (CNA) credentialing by August 2017; and
  • The District went further to develop a collaboration with DeKalb High School of Technology South to develop the training for current non-licensed staff.

The selection method was based upon the proximity of staff within the Region, essentially wanting to keep staff as close to the current location as possible.
While the District understands that no person truly desires to be reassigned or leave their current location, we must do what do what is in the best interest of students. We are saddened that some have elected to end their service abruptly due to this reassignment; however, pursuant to BOE policy employees work assignments are at the discretion of the Superintendent according to the best interest of the District.
Moving forward we have already posted the 5 nurses positions added to the FY2016 budget for MS and HS and expect to interview candidates by the end of the week. Additionally, we will work with schools where the staff elected to resign abruptly to get the positions advertised for replacement and District licensed personnel will be in place to support the schools.

 


Certified Nursing Assistant
A certified nursing assistant, or CNA, helps patients or clients with healthcare needs under the supervision of a Registered Nurse (RN) or a Licensed Practical Nurse (LPN). Also known as a Nursing Assistant (NA) a Patient Care Assistant (PCA) or a State Tested Nurse Aid (STNA), the individual who carries this title needs strong work ethic and ability, but issues of liability and legality prevent CNAs from performing certain procedures.
Role of the CNA
Your regular responsibilities as a nursing assistant will vary based on where you work or live. Nursing assistants can work in a wide variety of settings; nursing homes, hospitals, adult day care centers, personal homes and assisted living facilities all require nursing assistants to act as a helpful liaison between the RN or LPN and the patient. In many cases, the nursing assistant serves as the RN’s or LPN’s eyes and ears, and relays information between many patients and one or two RNs.
Medical Assistant
medical assistant is an allied health professional that supports the work of physicians and other health professionals, usually in a clinic setting Medical assistants perform routine clinical and administrative duties under the direct supervision of a physician or other health care professional. Medical assistants perform many administrative duties, including answering telephones, greeting patients, updating and filing patients’ medical records, filling out insurance forms, handling correspondence, scheduling appointments, arranging for hospital admission and laboratory services, and handling billing and book keeping. Duties vary according to laws of the jurisdiction and may include taking medical histories and recording vital signs, explaining treatment procedures to patients, preparing patients for examination, and assisting during diagnostic examinations. Medical assistants collect and prepare laboratory specimens or perform basic laboratory tests on the premises, dispose of contaminated supplies, and sterilize medical instruments. They instruct patients about medications and special diets, prepare and administer medications as directed, authorize drug refills as directed, telephone prescriptions to a pharmacy, draw blood, prepare patients for X-rays, take electrocardiograms, remove sutures, and change dressings. They also facilitate communication between the patient and other health care professionals.
Registered Nurse
A registered nurse (RN) is a nurse who has graduated from a nursing program and met the requirements outlined by a country or state licensing body in order to obtain a nursing license. An RN’s scope of practice is determined by local legislation governing nurses, and usually regulated by a professional body or council.

Nurses and Healthcare Workers

School nurses provide health care for chronic acute illness, give medication and are first responders for in-school injuries.  Student Health Services provided this staffing report on DeKalb Schools’ Nurses And Healthcare Workers (2/2/2015) for its elementary schools.
Currently, DeKalb Schools only funds healthcare employees in elementary schools.  The board (with Marshall Orson leading the charge) and superintendent are looking into staffing the middle and high schools with nurses and healthcare workers.  Across the metro Atlanta area, the following models are currently used to provide healthcare services:
Atlanta Public Schools (47,000 students)- 2 lead nurses, 19 district consulting nurses, and licensed nurses serving all schools. These nurses share schools and respond based on need.
Cobb County Schools (111,000 students)- 1 lead nurse, 5 district consulting nurses and licensed nurses in local schools.
Clayton County Schools (50,000 students)- 6 supervising nurses with CNA’s (Certified Nursing Assistants) and CMA’s (Certified Medical Assistants) serving local schools. Supervising nurses oversee the services of the CNA’s and CMA’s in the schools.
DeKalb County Schools (100,000 students)- 1 lead nurse, 3 consulting nurses and licensed nurses and clinic assistants supporting the elementary schools. Consulting nurses may assist in the middle school and high school setting, if needed.
Fulton County Schools (94,000 students)- 1 medical doctor, 1 lead nurse, 14 district cluster nurses and unlicensed clinic assistants in the local schools. Cluster nurses support the unlicensed persons in the schools.
Henry County Schools (40,000 students)- 1 lead nurse, licensed nurses and clinic assistants serving the all schools. Personnel assigned to multiple sites. Assignments are made by cluster.
Gwinnett County Schools (161,000 students)- 1 lead nurse, 10 cluster nurses, and registered nurses and clinic assistants in local schools.
Through analysis, the following trends were found:

  • A few districts only hire licensed nurses. (APS, Cobb).
  • Many districts utilize a cluster assignment format and assign personnel to multiple sites. (Gwinnett, Fulton, APS, Henry, Clayton)
  • Many districts employ a lead nurse and supervising nurses to support the personnel in the local schools. (APS, Gwinnett, Henry, Cobb, Clayton, DeKalb and Fulton)

OPTIONS
Based on this analysis and considering the increased health needs of students in the district, the following three options are being presented to the DeKalb Board of Education for consideration:
Option 1: Hire 24 licensed nurses to support middle and high schools and keep current structure (55 licensed nurses and 21 unlicensed persons in the elementary schools) to support elementary schools in the district. Persons would work in feeder pattern. This would be an expansion of the current model in DeKalb and is similar to the model in Gwinnett County Schools.
Option 2: Hire 24 CNA’s (Certified Nursing Assistants) to work in the middle and high schools and reassign current licensed nurses (55) to work in clusters/regions to support the unlicensed persons and CNA’s throughout the district. This model is similar to the service delivery in Clayton County Schools.
Option 3: Reassign currently employed 55 licensed nurses that work in the elementary schools to support all schools throughout the district. The nurses would be assigned by clusters/ regions and would be assigned to schools based on acuity of need. This model is similar to the service delivery in Atlanta Public Schools and would save the district money, as new hires would not be needed.
Timeline
2014-15 Placement of Health Personnel (approximately $400,000)
March, 2015 – The Student Support Department will work with Human Resources to post positions on PATS. Advertisements will be placed in local trade publication and at local schools with students graduating with appropriate credential.
April, 2015 – Interviewing and Hiring process will be coordinated with Human Resources.
2015-16 Placement of Health Personnel (approximately $880,000)
June/July, 2015- The Student Support Department will work with Human Resources to post positions on PATS. Advertisements will be placed in local trade publication and at local schools with students graduating with appropriate credential.
July/August, 2015- Interviewing and Hiring process will be coordinated with Human Resources
Additional Considerations
To help retain nurses that serve our students, consideration should be given to reclassifying the workday for nurses from 6 hours to 8 hours. This increase in salary would help to make hiring competitive with other markets that might pull from qualified candidates. Additionally, the classification should be the same among regular education nurses and special education nurses. Currently, there is a major difference in the salaries and regular education nurses leave to work for the special education program because of salary.
To provide support to all schools, consideration should be given to increasing the number of district consulting nurses from 3 to 6 to better support the persons serving the local schools.