FAQs

Frequently Asked Questions: Organizations and Agencies

Chances are if you have a question, someone else has the very same question!  Organizations develop Frequently Asked Questions (FAQs) documents to address those issues and concerns that arise from the field.  If you have a question about regulations, school nursing practice or requirements, start with one of these FAQs.

The New Jersey Department of Education posts frequently asked questions on its website.  The FAQs address a range of health-related topics.

This FAQ provides information on mandated health and physical education programs and implementation of the New Jersey Comprehensive Health and Physical Education Standards. http://www.state.nj.us/education/genfo/faq/faq_chpe.htm

This FAQ specifically addresses issues related to family life and sexuality education.http://www.state.nj.us/education/genfo/faq/faq_hfle.htm

This FAQ addresses general information such as access to preschool or kindergarten, bullying, school dress codes and other issues of a general nature. http://www.state.nj.us/education/genfo/faq/faq.htm

This FAQ was developed by the New Jersey Department of Health and Senior Services to address immunization requirements. http://www.state.nj.us/education/students/safety/health/cdpr/vaccine.pdf

The National Association of School Nurses publishes a FAQ that specifically addresses the benefits of NASN membership. http://www.nasn.org/Default.aspx?tabid=69

The Centers for Disease Control and Prevention (CDC) provides information on coordinated school health programs in this FAQ. http://www.cdc.gov/healthyyouth/cshp/faq.htm

Frequently Asked Questions: New Jersey State School Nurses Association

1. Why should I join NJSSNA?
NJSSNA is a professional organization that represents the specialty area of school nurses.   School nurses often work independently.  Joining NJSSNA helps a school nurse network with other school nurses.  It also provides tools to advocate for good health for students, staff, families and the community at large.

2.  Why did NJSSNA affiliate with NASN?  What are the benefits of dual membership?
NJSSNA affiliated with NASN in order to enhance services for New Jersey’s school nurses.  Members of NASN/NJSSNA are eligible for discounted or free continuing education programs and vision coupons for students.  The dual membership expands networking and advocacy and allows nurses to participate in discussion groups dedicated to school nursing practice.

3.  I am a member of my county association.  Does that mean I am a member of NJSNA (or NJSSNA) too?
Even though the county associations are affiliated with NJSSNA, they each have a separate membership fee.  It is strongly recommended that you belong to both the state and county affiliates.

4.  I am not a member of NJEA.  Can I still be a member of NJSSNA?
Yes.  NJEA membership is not required for membership in NJSSNA.

5.  I am a school nurse in a private school.  Why should I join NASN or NJSSNA?
As a NASN member, you can take advantage of a special interest group for private school nurses.  Membership in NJSSNA will allow you to take advantage of discounted rates for professional development.

6.  How does NJSSNA represent me and my interests as a certified school nurse?
The association serves as an advocate for best practice and provides resources and professional development focused on the role of the school nurse and the impact of health on student achievement.  The association monitors legislation that may impact student health and provides comments to sponsors.  It also serves on committees to address school policies, responds to inquiries about school nursing practice, and educates the public about school health.

7.  What professional development opportunities are available to me as a member?
The NJSSNA sponsors an annual conference focused on school nursing practice and issues.  It also provides topical workshops (e.g., diabetes, asthma), offers sessions at the annual NJEA Convention, and provides other professional development upon request.  In the future, the association will sponsor a speaker’s bureau and plans to design web-based modules to help school nurses complete mandatory continuing education requirements.

8.  When and where are meetings held?
Monthly meetings are usually at the NJEA Building in Trenton.   A dinner meeting is held in May of each year to honor retirees.  To find out the meetings schedule, go to www.NJSSNA.org and look under “meeting schedule.”

9.  How can I serve on a committee?
You can contact any executive board member and request to serve.  You are welcome to come to any monthly meeting to meet the board and see what we are all about.  You can also email your request to njssnaexdir@gmail.com or call the NJSSNA office at 609-233-2466.

10. If I have a question about NJSSNA, who should I contact? How can the Association be reached?
Contact information for every board member is on the website.  You can also contact the association via email at njssnaexdir@gmail.com or via phone at 609-233-2466.

 

Certification and Employment

1. How can I become a certified school nurse (CSN)?
Detailed information on certification can be found by clicking on  ”Certification” under Resources on the NJSSNA website.

2. What’s the difference between a registered nurse (RN) and a certified school nurse?
A certified school nurse is specially trained to address both the health and educational needs of students in grades P-12.  The specialty nursing has been described as part public health, part pediatrics, and part emergency nursing.  New Jersey school nurses must complete a bachelor’s degree and take specific courses in dealing with students with special needs, substance abuse, school law and policy, and community health.  They also complete a field experience working with a certified school nurse.  Certified school nurses-instructional also take courses in teaching health and must complete a classroom-based instructional experience.  Certified school nurses non-instructional complete all the requirements except the health teaching requirement.

3. What is the difference between national school nurse certification and New Jersey certification?
Certification issued by the New Jersey Department of Education is required for employment as a school nurse in a New Jersey public school.  The National Board for Certification of School Nurses, Inc. (NBCSN) is an independently incorporated organization established for the purpose of developing and implementing the voluntary certification process of school nurses.  The NBCSN is an independent organization; however, NBCSN works in collaboration with the National Association of School Nurses, and communication between the two organizations is a priority. For more information, please go to: http://www.nbcsn.com/index.htm

4. Where can I find information on fees for certification?
The New Jersey Department of Education establishes the process and fees for certification.  Go to http://www.state.nj.us/education/educators/license/overview/ for more information.

5. What do school nurses do?  What is a typical day for a school nurse?
School nurses provide a wide range of services to students and school personnel.  In addition to mandated screenings of vision, hearing, and height/weight, school nurses administer medications, monitor students with chronic health conditions such as asthma or diabetes, administer first aid, train school staff on a variety of health issues, and serve on school and district committees to address student behavior and achievement.  Nurses communicate with healthcare providers, develop individualized healthcare plans, create emergency treatment plans, and collaborate with parents to provide care and support student attendance.  School nurses conduct screening programs for preschool and kindergarten admission and administer pre-participation physicals for middle and high school athletes.  They counsel pregnant students, assist students and their families to secure appropriate healthcare, and provide formal and informal health teaching.  In addition, school nurses support school personnel with health problems and organize programs focused on managing hypertension, losing weight, and stress management.

6. How can I find a job as a certified school nurse?
School nurses are hired by local boards of education.  Some districts advertise in local newspapers.  Others post open positions at NJ Hire: http://www.njhire.com/DefaultNJ.cfm?CFID=825231560&CFTOKEN=5FF3EB1A8C7646ED819EFC959469BF7D.  One of the best ways to secure a job is to serve as a school nurse substitute.

7. What is the salary of a school nurse?
Certified school nurses are considered teaching staff members.  Salaries are locally negotiated and school nurses must be employed on the same salary guide as teachers and counselors.

8. Will I have a secretary or health aide to assist with office procedures?
This is a local decision based on the size of the school, the ages of the students, and the acuity level of students in the building.

9. I would like to ”try out” school nursing before investing in courses.  How can I become a substitute school nurse?
Serving as a school nurse substitute is a good way to learn about school policies and procedures.  To obtain a school nurse substitute certificate, you must hold a valid New Jersey registered nurse license. Contact your county office of education (http://www.state.nj.us/education/counties/) for information on obtaining a school nurse substitute certificate.

10. What will I be paid as a school nurse substitute?
Substitute school nurse wages are locally negotiated and vary based on size of school, acuity levels, and the number of days you are needed.

11. What are the continuing education requirements for school nurses?
Certified school nurses are required to complete 30 hours of continuing education every two years in order to renew their registered nurse license.  Since they are considered teaching staff members, they are also required to complete 100 clock hours of professional development every five years.  The New Jersey Board of Nursing permits school nurses to use an array of professional activities to meet these requirements.

12. I am a licensed practical nurse.  Can I become a certified school nurse in New Jersey?
No.  Only registered nurses with a bachelor’s degree and specific coursework are eligible to become certified school nurses in New Jersey.

13. I hear some schools hire “supplemental RNs” to work with the school nurse.  What does this mean?
Supplemental nurses are registered nurses that work under the supervision of certified school nurses.  The duties of the supplemental nurse are outlined in N.J.A. C. 6A:16-2.3 available at http://www.state.nj.us/education/students/safety/regs/.

14. What kind of hours will I be expected to work?

Working hours are set at the local level and are based on the age of the students, the grades in the school, the number of schools covered by the nurse, the size of the school, and the number of nurses employed by the district.  Some districts may also employ school nurses during the summer for specialized programs.

15. Will I be eligible for a pension?
Certified school nurses are teaching staff members under the law and are eligible for the same pension and benefits negotiated by the local collective bargaining unit.

16. Will I be eligible for tenure?
As a teaching staff member, certified school nurses are eligible for tenure after three years and one day of successful employment with a school district.

17. Will I be required to teach health education?
Only those nurses holding the school nurse instructional certificate are eligible to teach health education.  Most often, school nurses are not required to teach a regular instructional load at the middle and high school level but may be asked to teach certain content as time and caseload allow.  Some nurses teach on a regular basis at the elementary level.  These assignments are often dictated by the size of the school and the acuity levels of the students.

18. Are charter schools required to hire a certified school nurse?
Yes, charter schools must hire a certified school nurse and comply with all school health services mandates as outlined in N.J.A.C. 6A:16.   These rules apply to the provision of programs and services for all students in kindergarten through grade 12 by New Jersey public school districts, charter schools, jointure commissions, educational services commissions and approved private schools for the disabled acting under contract to provide educational services on behalf of New Jersey public school districts.

19. Are private schools required to hire a certified school nurse?

There are two kinds of private schools.  Approved private schools for the disabled must hire a certified school nurse and comply with all regulations outlined in N.J.A.C. 6A:16 (see above).  Private and parochial schools are not required to hire a certified school nurse but may participate in the Nonpublic School Nursing Services Program as described in N.J.A.C. 6A:16-2.5.

Medications

1. Why are school nurses not permitted to administer over-the-counter medications such as aspirin or Tylenol without a doctor’s order?
In accordance with New Jersey law, only licensed physicians or advanced practice nurses (APNs) are permitted to make a medical diagnosis or prescribe medications.  Certified school nurses are registered nurses (RNs) and thus must have a physician’s order to administer any over-the counter medication or prescription medication.  In some districts, school physicians may authorize standing orders and protocols that permit school nurses to administer certain medications.  School nurses should refer to their district policies and protocols.

2. Are teachers or other school personnel permitted to administer medications to students?
No, teachers and other school personnel are not appropriately licensed to administer medications.  However, New Jersey law permits specially trained school personnel to administer certain emergency medications as described in question 3 (below).

3. Under what conditions can the school nurse delegate to other school personnel the administration of certain emergency medications?
N.J.S.A.18A:40-12.6 permits delegation for the emergency administration of epinephrine and N.J.S.A. 18A:40-12.12-12.14 permits the delegation of Glucagon. For more information, go to: http://www.state.nj.us/education/edsupport/diabetes/ and http://www.state.nj.us/education/students/safety/health/services/epi.pdf.

4. Are students permitted to carry their own inhalers while at school and at school-sponsored activities such as sporting events?
Yes, N.J.S.A 18A:40-12.3 permits the self-administration of medication by a pupil for asthma or other potentially life-threatening illnesses or a life-threatening allergic reaction.  School nurses must ensure that the student’s asthma treatment plan (action plan) is current and reflects the student’s needs.

5. Are students permitted to carry and administer insulin?
Yes, N.J.S.A 18A:40-12.15 permits students to manage their diabetes during the school day and at school-sponsored events.   School nurses are required to complete an Individualized healthcare Plan (IHP) for students with diabetes.  For more information, go to: http://www.state.nj.us/education/edsupport/diabetes/.

6. Where can I find guidance on managing the diabetic student in school?
Guidance developed by the New Jersey Department of Education can be accessed at:  http://www.state.nj.us/education/edsupport/diabetes/.

7. Where can I find guidance on managing students with potential life-threatening allergies?
The Guidelines for the Management of Life-Threatening Food Allergies in School was released by the NJDOE in September 2008 and is available at: http://www.state.nj.us/education/students/safety/health/services/allergies.pdf.

8. Where can I find guidance on managing students with asthma?
The New Jersey Pediatric/Adult Asthma Coalition of NJ (http://www.pacnj.org) provides materials and Asthma Treatment Plans. Information is also available from National School Boards Association at: http://www.nsba.org/Mainmenu/SchoolHealth/asthma-page.aspx and the Centers for Disease Control and Prevention (CDC) at: http://www.cdc.gov/asthma/.

Procedures

1. Where can I find a job description for a school nurse and a non-certified nurse?
The certified school nurse description is located in N.J.A.C. 6A:16-2.3(b) and (c).

The non-certified nurse description is located in N.J.A.C.6A:16-2.3(d).   You can access these regulations at:  http://www.state.nj.us/education/code/current/title6a/chap16.pdfhttp://www.state.nj.us/education/code/current/title6a/chap16.pdf.

The district board of education must have an approved job description that outlines the requirements of the certified school nurse and any supplemental nurse positions.

2. Where can I get a copy of the current New Jersey School Health Guidelines?
The Guidelines are no longer available. The most recent New Jersey School Health Services Guidelines was released in October 2001 and is now outdated. In response to new requirements, the NJDOE released a series of topic-specific guidance documents and post additional guidance on the NJDOE in FAQs.  You can access these materials at: http://www.state.nj.us/education/students/safety/health/.

3. Where can I get a copy of screening standards for hearing and vision?
Current screening requirements include height, weight, blood pressure, visual acuity, auditory acuity, and scoliosis.  N.J.A.C. 6A:16-2.2 (k) details when these screening procedures must occur.  The NJDOE does not establish how to conduct these screenings and when to refer students for follow-up care.  Those protocols must be established by the school physician in consultation with the certified school nurse.  Reference materials are available from NASN at http://www.nasn.org.

4. What is the role of the school physician?
School physicians must hold a current license as a doctor of medicine or osteopathy issued by the New Jersey Board of Medical Examiners. The role of the school physician is described in N.J.A.C. 6A:16-2.3(a).  School physicians authorize standing orders, review physical exams, and advise the school nurse on protocols and procedures.

5. Where can I find the health forms I am required to use?
The State of New Jersey Health History and Appraisal (A-45) can be accessed at: http://www.state.nj.us/education/students/safety/health/records/hha.pdf.

County offices of education may also have “paper” copies of the A-45 available.

The Annual Athletic Pre-Participation Physical examination form, part A&B (English) and part A (Spanish) can be accessed at:  http://www.state.nj.us/education/students/safety/health/records/athleticphysicalsform.pdf.  Questions about these forms should be directed to the NJDOE.

The Asthma Treatment (Action) Plan can be accessed at:

http://www.pacnj.org/plan.html

http://www.state.nj.us/education/students/safety/health/services/

You can also access other forms and updates on the NJDOE website at: http://www.state.nj.us/education/students/safety/health/records/.

6. When will New Jersey have an electronic health record system?
A universal electronic health record is still under development.  Until it is approved, New Jersey continues to require the A-45, State of New Jersey Health History and Appraisal form, which is the only form approved by the Commissioner and required by the Department of Health and Senior Services.

7. I just got a call from the Health Department saying it will monitor my immunization records.  What does this mean and what do I need to do to prepare?
Your local or county health department auditor will examine your student health records to determine the school’s compliance with NJ state immunization mandates.  All records must be made available (A-45 forms) to the inspector during the scheduled visit.

8. I have been asked to accompany students on a field trip. Since I am the only school nurse, what happens if there is an emergency at my school while I am away?
School districts should have policies and procedures for nursing coverage at schools when the nurse is absent (including field trips). The school could hire a substitute school nurse or arrange for a school nurse from another school in the district to cover multiple buildings.  In addition, school districts should develop policies that address parental notification when a school nurse is unavailable and how routine and emergency services will be provided on those occasions.  The certified school nurse should be part of the planning process since the nurse is aware of the medical needs in the building.

9. My school wants me to accompany students on an overnight field trip out-of-state.  I am not licensed to practice in that state.  Can I provide services to my students on the trip?
School nurses asked to accompany students on out-of-state trips should check with the Board of Nursing in that state to determine if he/she may provide specific nursing services to students from his/her school while on the trip.

10. When I am absent, my school does not get a sub nurse.  The principal calls the parents of students with medications and treatments and tells them they either have to come in and administer the med or treatment themselves or keep their child home for the day.  Is this legal?
Considering the number of students exhibiting medical problems and requiring medications and treatments during the school day, the district should make every attempt to recruit and secure a cadre of substitute nurses for such occasions.  When that is impossible, according to the New Jersey Department of Education “Frequently Asked Questions on Student Services ” at http://www.state.nj.us/education/genfo/faq/faq_ss.htm, “students who have been classified as eligible for special education or who have a 504 plan that includes medications cannot be denied access to educational opportunities based on their need for medication during the school day. It is recommended that children who require accommodations because they are on medication should have a 504 plan. The school must make every effort to provide reasonable accommodations for these students.”  When developing a student’s Individualized Healthcare Plan and Emergency Plan, special circumstances should be discussed with the parents and the child’s healthcare provider. The plan for providing medications and treatments in the absence of a school nurse should be included in the district’s policy/procedures as well.

11. I am a new nurse in this building.  The previous nurse gave every teacher a list of all students with medical problems.  I believe this is a breach of confidentiality.  What is the best way to inform teachers of student health issues?
You are correct in not distributing student lists of medical problems.   This is no longer acceptable practice.  First, you need the individual student’s parent/ guardian permission, in writing, to share any medical information. You should verbally inform individual teachers about the medical concerns of students in their classes. Follow-up by distributing emergency health plans for individual students to those staff members expected to come in contact with the students during the normal school day.  Just being informed about a medical concern is not enough.  The emergency plan helps to educate appropriate school personnel about signs and symptoms to determine if an emergency exists.  It also details actions to take in an emergency.  In addition, a 504 plan may be needed if the student requires accommodations for his/ her health issue.

12. Where can I find the latest information on state TB and immunization requirements?
State TB information can be located at http://www.state.nj.us/health/tb/tech.shtml and state immunization requirements can be located at http://www.state.nj.us/health/forms/imm.pdf.

You can also access information on communicable diseases, including TB and immunizations at: http://www.state.nj.us/education/students/safety/health/cdpr/.

13. My school physician wrote standing orders.  Must they be renewed every year?
Yes, school physician’s standing orders need to be renewed annually by the Board of Education and are effective for one school year.

14. My school has a large number of students absent today.  Should we close the school?
During high incidence of infectious diseases (such as influenza) schools should monitor not only the number of students absent but “why” they are absent.  This may require school personnel to make follow-up calls to homes/parents to determine if absent students manifest the same symptoms.  For guidance on whether to close a school due to absenteeism, consult your local or county health department.

15. My principal wants me to transport sick children home in my personal vehicle.  Is this permitted?
There are many reasons why this is not appropriate practice.  First, your auto insurance probably does not cover the use of your personal vehicle to transport students and you are not appropriately licensed to drive a district-owned vehicle to transport students since New Jersey statute and regulations require that drivers hold a valid Commercial Driver’s License with appropriate endorsement(s) for the class and type of vehicle operated, issued by the New Jersey Motor Vehicle Commission. In addition, if you are driving a vehicle, you cannot attend to the needs of a sick child.  Depending on the age and size of the child, your personal vehicle may not be equipped with appropriate vehicle safety seats.   Additionally, should no one be at home, who will care for the sick child?  When a child requires transport to a hospital for emergency care, 911/EMS should be activated.  Finally, who cares for the students remaining at the school while the school nurse is transporting ill students?  School policies should require all parents and guardians to name multiple individuals who can assume responsibility for transportation and care when their child becomes ill at school.  If those individuals are not available or accessible, then the child should remain at the school until the parent/guardian or appropriate designee arrives to pick-up the child.

16. Where can I find sample individualized healthcare plans?
Sample individualized care plans can be found in texts or by searching the Internet for evidence-based, reputable sources. For example, the American Diabetes Association provides a sample management plan at http://www.diabetes.org/living-with-diabetes/parents-and-kids/diabetes-care-at-school/written-care-plans/.  Similarly, the NJDOE provides a sample on its website at http://www.nj.gov/education/edsupport/diabetes/.  The Epilepsy Foundation has planning materials available at:   http://www.epilepsyfoundation.org/programs/schoolnurse/schoolnurse.cfm.  Be mindful that the use of preprinted templates may not fit the individualized needs of a specific student.  Additionally, preprinted templates may not take into account New Jersey laws and regulations including the New Jersey Nurse Practice Act, particularly if mention is made to delegate a nursing task.

17. Are New Jersey schools required to have AEDs?
At the present time, New Jersey schools are not required to have an AED on campus.  School districts that do provide AEDs on campus must abide by NJ laws on use of the AED.  CPR/AED training programs must be approved by the Department of Health and Senior Services.  The district must notify emergency response personnel of its presence and location.

18. I have a child in my school with special needs that has 1:1 nursing care delivered by a LPN who works for an agency contracted by the district. What is my role in the supervision of the LPN?  What is my role in providing care for the student?
When the district contracts with an outside agency to provide specific services for an individualized student, it is the responsibility of the agency that employs the LPN to ensure that he/she has the requisite license, training, and capacity to provide the care as outlined in the child’s IEP.  In most cases, the school district contracts with the agency not the individual; thus the agency is responsible for ensuring that the LPN is supervised and able to provide safe and effective care for the student. The LPN provides only those specialized services outlined in the IEP.  The certified school nurse is responsible for state and district requirements such as mandated screenings, immunization compliance, and emergency care outside the scope of the specified services in the IEP. The certified school nurse is also responsible for maintaining mandated school health records and has an important role in developing the IHP/IEHP for developing an IHP/IEHP in collaboration with the child’s parents/guardians, healthcare providers, the LPN providing direct care, and other service providers such as physical therapists.  The IHP should clearly state who is responsible for providing 1:1 care for the student when the LPN is not available.

Since the LPN is not a school district employee, any supervisory responsibilities assigned to the certified school nurse must be negotiated and included as part of the school nurse’s job description with clear delineation of any delegatory responsibilities.

19. Can a school require a parent to accompany their child on a field trip?
Students who have been classified as eligible for special education or who have a 504 plan which includes medications (or other nursing tasks) cannot be denied access to educational opportunities, including field trips.  A school district cannot require a parent to accompany his/her child on a field trip.  If a parent is asked to attend and he/she is unable to do so, the school district might:

  • Send a school nurse on the trip;
  • Hire a school nurse substitute to go on the trip;
  • Confer with the parent and the child’s healthcare provider to alter the time, dosage, route or kind of medication on the day of the trip and obtain a written order for the change; or
  • Confer with the parent the healthcare provider to eliminate the medication on the day of the trip and obtain a written order from the healthcare provider for the change.

At no time should a student be denied access to a field trip because the options cited above cannot be fulfilled.

20. Some of our coaches do not work in the school district.  Are they still permitted to serve as delegates for epi-pens or Glucagon?
A school nurse may only delegate auto-injecting epinephrine or Glucagon to a district employee who volunteers to serve as a delegate and who is appropriately trained.   Coaches under contract to the district, regardless of where they teach during the school day, are considered board-approved district employees and can serve as delegates.  Volunteer coaches, parents, student trainers, and athletic officials (umpires, referees) cannot be trained as delegates.

21. How should I dispose of used epi-pens?
Most responding MIC/EMS units will take used auto-injecting epinephrine and place it in the sharps box in the “rig.”  If that is not feasible, all school nurse offices should have a “sharps” box for disposal of any needle/lancet mechanism.

22. My school is new and does not have a nebulizer.  I understand that funds were available to purchase them for each school.  How can we get a nebulizer for our school?
N.J.S.A. 18A: 40-12.7 requires each public and nonpublic school to have and maintain at least one nebulizer in the office of the school nurse.  When this law was passed, there was a one-time start-up appropriation to assist in the purchase of nebulizers.  The initial funds have been expended and additional funds have not been appropriated.  If your school needs assistance to purchase the nebulizer, contact your local state legislator or reach out to the Pediatric Asthma Coalition of New Jersey at http://www.pacnj.org/.

23. My principal wants me to calculate BMI for each student and send a letter home to parents.  Are we required to record BMIs for all students?
While some school nurses have opted to calculate BMI and share that information with parents, it is not required.  School nurses are required to measure height and weight and record it on the A-45 Health History and Appraisal Card.  In some schools, BMI may be calculated as part of fitness testing in physical education classes while other schools may use Fitnessgram, which uses other measures of body composition.  Currently, school nurses are only required to assess and record heights and weights.

24. A local doctor/chiropractor wants to provide free screenings for students and staff.  Should we take advantage of this?
District policies should address providing school personnel, students and their families with free professional services such as medical screenings.  Such offers raise concerns about access to students and confidential information, consent for the exam and the resulting paperwork involved, and follow-up care for those found in need.  There is always an ethical concern about possible self-referrals.   In addition, the local district already employs school nurses and a school physician to provide specific services to students and staff.  Administrators should determine if the proposed services duplicate those already available to the school community.  Finally, current medical practice advocates for individuals to receive care at their medical home to ensure continuity and confidentiality.

25. My principal says I cannot leave the building for lunch.  Sometimes, I just need to take a walk!  He says the school nurse must be present in the building at all times when the school is in session?  Is this true?
No, there is no law or regulation that states that a school nurse must be present in the building at all times when school is in session or at all school-sponsored events.   If you are covered by the local negotiated teacher’s contract and the contract says you are entitled to non-student contact lunch time, you should be permitted to leave the building and enjoy an uninterrupted lunch period.   That being said, it is important to build the capacity of school personnel to respond appropriately during events that may occur while you are out of the building.   Being available by cell phone or walkie-talkie can also help when triage needs arise.  Your school administrator needs to recognize that a health-promoting school considers the needs of all and that you need a few minutes of respite during the school day in order to function optimally and maintain your own health.

26. My principal will not approve my attendance at any professional development during the school day.  Teachers attend conferences all the time—I have continuing education requirements to fulfill for my RN license and for my certification.  How can I be expected to complete my professional development plan (PDP) if he won’t approve me going to workshops?
First, you must discuss your professional responsibilities regarding required PDH/CEUs with your administrator. He/she may not even know that the NJDOE 100 hour requirement applies to you and may not understand that you have additional requirements for your RN license.  Planning ahead is important.  When you develop your PDP, make sure that you have some concrete ideas on how and where you can fulfill the requirements (such as attending the NJSSNA annual conference which is held on a Saturday) or participating in evening workshops through your county school nurse association.  If you are a member of the New Jersey State School Nurses Association, you also hold membership in the National Association of School Nurses.  There are numerous opportunities to garner free CEUs through their website at www.nasn.org.  Additionally, there are other opportunities to get PDH’s after school hours, such as those conducted by the NJ-EMS for Children, your county school nurses association, home study booklets, and from internet sites such as www.medscape.com .

However, if your request for attendance at professional development during the school day is denied because substitute nurses are not available, your administrator may be hesitant to approve your absence from school.  Attempt to build an emergency coverage system within your district if there is more than one school nurse.  Build the capacity at your school for staff to respond to emergent and urgent presentations by calling 911 or parents to render needed care on the in frequent instances that you will be out of the building.  If you feel you have been unfairly denied the same treatment afforded other district staff, you should speak of your concerns with your union representative.

27. My principal will not allow me to attend school and district inservice days on educational topics.  He thinks I should stay at school and “work on records.”  How can I be expected to understand education if I am excluded from these sessions?
Certified school nurses in New Jersey are considered teaching staff members and are required to take specific courses that require them to understand both health and education.  While all professional development designed for teachers may not be helpful for school nurses, schools work best when they are a “professional learning community” where all school personnel work together to improve the learning environment for students.  As a member of the PLC, school nurses may bring a different and unique perspective to the work of the school, the reasons why students have difficulty learning, and the ways to help students achieve.  Denying school nurses and other educational services personnel a role on the educational team is naive and short-sighted.  Creating a PLC that is collegial and collaborative and represents the work of the entire school is critical to addressing the needs of the whole child.  School nurses can be part of a wellness committee, a PLC dedicated to health-related issues and involving the health and physical education teachers, school food services, personnel, counselors, and others concerned about student and staff wellness.

While it may be tempting to work on records or clean the office rather than attending a session on math or reading instruction, you may be surprised how much you may learn about classroom practices and how children learn.  While your PDP is most likely tied specifically to your school nursing practice explain to your supervisor that you want to take advantage of team building when the opportunity arises.  If you are assigned to teach formalized health classes, consider attending programs that address not only the health curriculum, but also general instructional methodologies to keep current in the classroom.   Having a dialogue with your principal about the various roles of the school nurse might also help. Assure him/her that your records are up to date and that you wish to attend some of the educational in-service days.   You are the link between the health and academic success for many of your students.  Being   aware of educational initiatives and how they impact on students can better help you understand students’ academic curriculum, opportunities, and stressors.

Also,  in 2007, representatives from the NJSSNA met with representatives of the Board of Nursing to discuss how school nurses can meet the dual requirements set forth by the Board of Nursing and the NJDOE. As a result, the NJSSNA received a letter from George Herbert, Executive Director of the Board defining continuing education as the  “successful completion of  a continuing education course or program related to nursing which is taken in order to comply with the requirements of a State or Federal agency; one hour for each 60 minutes of attendance.”  That language was added to the BON regulations and can be found here: http://www.njconsumeraffairs.gov/laws/nursingregs.pdf.   Professional development requirements set forth by the NJDOE fulfill the “state agency” requirement found in the rules.

28. What are the confidentiality rules for students with HIV/AIDS?  Substance abuse?
Confidentiality of certain health information – such as HIV status and substance abuse counseling and treatment – is regulated by separate statute, which accords a greater restriction to access of information and demands that such information be kept separate from student health records.” “N.J.S.A. 26:5C-5 & N.J.S.A. 6A:16-1.5(c) establish rules of confidentiality and disclosure of records with HIV identifying information.   School staff with knowledge of or access to information that identifies a student as having HIV infection or AIDS must be shared only with prior written informed consent of the student age 12 or greater, or of the student’s parent/guardian and only for the purpose of determining an appropriate educational program for the student.” (NJ DOE, 2001).

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