Office of Desegregation Monitoring United States District Court Eastern District of Arkansas Ann S. Brown, Federal Monitor 201 East Markham, Suite 510 Heritage West Building Little Rock, Arkansas 72201 (501)376-6200 Fax (SOI) 371-0100 Date: November 16, 1994 From: Melissa Guldin 1, Ass Isociate Monitor To: Gwen Efrid, Little Rock School District Health Services Coordinator Subject: LRSD Nursing Staff Our office recently received some information from the Little Rock School District regarding possible budget cutting strategies. The list of budget reduction possibilities included the substitution of Licensed Practical Nurses (LPNs) for the Registered Nurses (RNs) currently working in the schools. I understand that there are important differences in training, experience, and qualifications between LPNs and RNs. Since the issue of RN versus LPN is sure to be debated in the months ahead, I would like some information on the current status of the LRSD nursing staff. This data should help me be better informed regarding the districts nursing program. Please send me a list of all LRSD schools that currently receive nursing services, the number of days (or hours) per week that each site is served by a nurse, whether that nurse is an RN or LPN, and each nurses race and gender. If you have any additional information that you think would be helpful or informative, I would welcome receiving that also. I would like to become more familiar with the scope of the nursing program, before the district makes budgetary decisions. When the monitors visited the incentive schools, we were impressed with the wellness clinics serving the students, staff, and patrons of the incentive schools. The clinics myriad of health services and eligibility for Medicaid reimbursement help ensure that area residents and LRSD staff have increased access to quality health care. In addition to the staffing information requested, would you please send me a list of all the schools with wellness clinics that have been approved for medicaid reimbursement. Thank you for your help in providing this information. Please call me if you have any questions or concerns.To: From: Subject: Little Rock School District November 28, 1994 Melissa Guldin, Associate Monitor 0 RECr 5.- a V > DEC 61994 Office of Desegregation Monitori. Office of Desegregation Monitoring Gwen Efird, Little Rock School District Health Service Coordinator LRSD Nursing Staff In response to your recent request for information on the nursing program in the Little Rock School District I am inclosing some material. School. 1 . All schools are served by an RN except Metropolitan High We have an LPN assigned there primarily because all of the students attend a home base school and their health care is the primary responsibility of the nurse in the home school. As you can see, enrollment in all cases. the coverage is not determined by the student Incentive schools have full time coverage. Most of the Magnet schools and all of the After those factors are considered, student enrollment. the remaining nurses are assigned on the basis of We do not have enough African American nurses but continue to try to recruit them. American. Last year we hired four nurses: two were African LPNs this year. Because the Administration had requested that we hire we pursued that route but were unable to get qualified LPNs who would work for the salary offered. We were then told that we couldn't hire anyone. That freeze was just lifted two weeks ago and last week we hired one full time nurse and two part time nurses to cover the five schools substitutes during this semester. which have only had All three nurses are African American. Much to my disappointment, the fulltime nurse called me Friday, and stated she had an offer of a job with better salary and would not be working for us. I am also inclosing a document that was written almost four years ago when the issue first came up. illustrations, and will be glad to do We could easily add many other so if it would be of assistance to you
but the issues will remain the same. If it would be helpful to have an updated statement on the curriculum offered by the nursing schools. provide it. without the 1994 material. In the interest of time. I will be more than willing to I am sending this to you The Position Statement on pg. 3 succinctly states our thoughts. The remainder of position. the paper provides justification for that Because the paper is long, I have highlighted the areas that may be most helpful. 810 West Markham Street Little Rock, Arkansas 72201 (501)824-2000We share your appreciation for what is going on in the Incentive Schools. The nurses involvement in these schools with expanded Health Services, EPSDT Screening and the Health Education Component has been my dream for school nursing. We need this kind of a program in all of our schools, and it can only be provided by an RN staff. All of our nurses are billing for Medicaid Reimbursement on hearing and vision Last year, we earned $12,500. through this exams. program. Only the nurses who are trained to provide EPSDT and whose health rooms have been certified, can bill for the physical examinations. Part of the money earned has been spent on equipping more health rooms for EPSDT. EPSDT trained. Currently, eighteen of our nurses are Only RNs can provide this service. We have Wellness Clinics at McClellan, Central and Forest Heights. McClellan is staffed by our full time nurse who has dug hard into the community to obtain additional resources. The Health Dept, is providing two afternoons a month of family planning and Arkansas Childrens Hospital is sending their residents over on a weekly basis. The clinic at Central is a five day a week comprehensive clinic that provides for adolescent health needs
with a big emphasis on mental health concerns. Reimbursement from that program goes to the Health Department because they fully fund the five full time people plus additional services that they bring in. their services at Central, students daily. our full time nurse In addition to sees 40 to 50 Forest Heights has a part time Wellness clinic which is also funded by the Health Department. They also fund 40% of our nurses salary. Initially, program came about with special funding from Johnson and Johnson but that grant is no longer available. this Additional schools which are equipped for EPSDT screening and have been bv the Health Department include: Romine certified by Interdistrict, Elem., Cloverdale Elem, King Interdistrict and Washington Magnet. The Cloverdale and Pulaski Pulaski Heights Heights schools are involved because of a New Futures Initiative. If you need for me to provide any additional information or if it would be helpful for me to come by and visit with you, I will be --- ii--_ ' J consider this a very serious issue and feel very strongly that the children in our district need the most willing to do so. services provide. of the best qualified health care staff that we can c.c. Jo Evelyn ElstonLRSD School Checklist Senior High Schools (5) Grades 10-12 RN Davs 01 Central John Hickman 1500 Park, 72202 324-2300 08 J.A. Fair Al Niven 5201 David O. Dodd, 72210 228-3100 02 Hall Dr. Victor Anderson 6700 H', 72205 671 -6200________ 12 McClellan Jodie Carter 9417 Geyer Springs, 72209 570-4100 05 Parkview Junious Babbs 2501 Barrow, 72204 228-3000 5 3 31 5 3 White Black White White White LPN Davs Vocational-Technical Center (1) Grades 10-12___________________________________ 04 Metropolitan Dr. Doyle Dillahunty 7701 Scott Hamilton, 72209 565-8465 Junior High Schools (8) Grades 7-9 15 07 09 13 16 03 10 11 Cloverdale Gayle Bradford 6300 Hinkson Rd., 72209 570-4085 Dunbar Nancy Volsen 1100 Wright Ave., 72206 324-2440__________ Forest Heights Richard Maple 5901 Evergreen, 72205 671 -6390 Henderson Everett Hawks 401 Barrow Rd., 72205 228-3050_______ Mabelvale Clell Watts 10811 Mabelvale W., 72103 455-7400 Mann Magnet Marian Lacey 1000 E. Roosevelt Rd., 72206 324-2450 Pulaski Heights Ralph Hoffman 401 N. Pine, 72205 671-6250______ Southwest Charity Smith 3301 S. Bryant, 72204 570-4070 3 3 T i 3 5 3 3 Black White Black White White White White White ^2 day Bla
k 1 day Elementary Schools [361 Grades K-6______________________________ 19 Badgett Mary Golston 6900 Pecan Rd., 72206 324-2475 17 22 Bale Levanna Wilson 6501 W. 32nd, 72204-570-4050 Baseline William Finn 3623 Baseline Rd., 72209 570-4150 06 Booker Magnet Dr. Cheryl Simmons 2016 Barber, 72206 324-2482 18 Brady Mary Menking 7915 W. Markham, 72205 228-3065 21 28 31 32 23 24 25 Carver Magnet Mary Guinn 2100 E. 6th Street, 72202 324-2460 Chicot Otis Preslar11100 Chicot Rd., 72103-570-4062___________ Cloverdale Sadie Mitchell 6500 Hinkson Rd., 72209 570-4055 Dodd Mary Jane Cheatham 6423 Stagecoach Rd., 72204 455-7430 Fair Park Barbara Means 616 N. Harrison, 72205 671 -6260_______ Forest Park Virginia Ashley 1600 N. Tyler, 72207 671 -6267_______ Franklin Franklin Davis 1701 S. Harrison, 72204 671-6380 48 Fulbright Mac Huffman 300 Pleasant Valley Dr., 228-3080 26 Garland Robert Brown 3615 W, 25th, 72204 671 -6275 37 Geyer Springs Eleanor Cox 5240 Mabelvale Pike, 72209 570-4160 27 49 30 46 20 33 34 50 38 Gibbs Magnet Donna Davis 1115 W. 16th, 72202 324-2490 Jefferson Francis Cawthon 2600 N. McKinley, 72207 671-6281_______ Mabelvale Julie Davenport 9401 Mabelvale Cut-off, 72103 455-7420 McDermott Michael Oliver 1200 Reservoir Rd., 72207 228-3072______ Meadowcliff Jerry Worm 25 Sheraton Dr., 72209 570-4165__________ Mitchell Donita Hudspeth 2410 Battery, 72206 324-2415____________ Otter Creek Carolyn Teeter 16000 Otter Creek Pkwy., 72209 455-7440 Pulaski Heights Kay Loss 319 N. Pine, 72205 671 -6290 39 RIghlsell Bobble Goodwin 911 W. 19th, 72206 324-2430 36 40 Rockefeller Anne Mangan 700 E. 17th, 72206 324-2385 Romine Lionel Ward 3400 Romine Rd., 72204 228-3086 41 Stephens Lonnie Dean 3700 W. 1 Sth, 72204 671 -6350 47 Terry Ladell Looper 10800 Mara Lynn Dr., 72211 228-3093 51 Wakefield Lloyd Black 75 Westminister Dr., 72209 570-4190 42 Washington Karen Buchanan 115 West 27th, 72206 324-2470 52 29 43 44 45 Watson Dr. Diana Glaze 7000 Valley Dr., 72209 570-4195_______ Western Hills Margie Puckett 4901 Western Hills, 72204 570-4175 Williams Magnet Dr. Ed Jackson 7301 Evergreen, 72207 671 -6363 Wilson Gwen Zeigler 4015 Stannus Rd., 72204 570-4180________ Woodruff Pat Higginbotham 3010 W. 7th, 72205 671 -6270 Trl-Dlstrlcl Alternative Learning Center Othello Faison 800 Apperson, 72202 324-2370 1 2_ IL 5 1-L 5 4 2 J_ Ik 2 5_ 3 5 T IT 5 3 2 ? 5 4^ 5 5 3r 2 2. 5. 2 IT 2^ 2 1 Black White Black Black White White Black Black White White White White White White Black White Black Biack White White Black White White White White White White Black White White White White Black White Each Junior High School nurse is taking a month for the ALC. She goes on the 2nd & 4th Wed. afternoon. FORM # 425 The Coordinator goes on the 1st & 3rd Wednesday.RECEIVED DEC 6 1994 Office of Desegregation Monitoring POSITION PAPER REGISTERED NURSES FOR SCHOOL NURSING IN THE LITTLE ROCK SCHOOL DISTQRICT Presented by: Gwendolyn L. Efird, R.N., C.S.N., M.S.Ns. * January 31, 1991laole of Contents Introduction 1 Positive Statement 3 Rationale for This Position 4 Comparison of Nurses Education Program Little Rock School Nurses' Responses Illustration of School Nurse Practice 8 12 14 Summary and Recommendation 17 References 19IJ.TRCDUCT 1G:
Since the onset of modern nursing in the mid eighteen hundreds, frequently been called on to clarify its status as a profession. the medical profession nursing has "ei ther nor vhe community at large has found it easy to recoc- nize nursing as an independent profession whose practice whose efforts are committed to the prom.otion, is theory based, and health. maintenance and restoration of Because of economics and the availability of less qualified individ- uals, physicians and hospitals have been tempted to employ people with less preparation than recommended by the nursing profession. It is interesting to note that school nursing has experienced a similar sequence of events. Early in this century, it became apparent to school districts in London, New York and Boston that placing public health nurses in the school setting could have a favorable impact on student attendance and performance. The prevalen.e of communicable disease was so extensive that plans were developed to assess children at the beginning of the day to determine if they had any contagious illnesses. With the early success of this effort, it was recognized that nurses could make positive contributions to other health needs of students. children were cared for and then in the 1920's. Screening .programs were developed, sick nurses became involved in classroom instruction. Contacts with families such as home visits proved very beneficial as the school nurse attempted to improve the health status of students. (Rice, Miller & Rini, 1988). As school districts in many states began to employ school tion again arose concerning qualifications for the nurses. nurses, the ques- Why not hire less qualified people to do the job? The nurse's role was seen as the "good Mom, someone who could soothe a hurt, put on a band aid, take a' temperature and tl make a phone cal 1. These obvious responsibilities continue to be important in the school setting, but too often the casual observer is unaware of the indepth work that is performed by a competent professional registered nurse. The persistent question asked in our local school district is. can an RN do that an LPN cannot do?" It is as if the only issue to be "What addressed is the action itself. will the data obtained be interpreted? What about the reason for the action? How What essential information, though not obvious, yet present, is important to the assessment and diagnosis of the problem? How can this child's health needs best be met? What is going onin other arenas of this cm id's life? Because nence complex health issues that can adversel' the Little Sock School child's life? fessional Di strict should ! students in our sc^ y affect the learn-- registered nurses to continue to employ well ':ools expe- g process, provide school health qu-Uified proservices. ..f a V 2 POSITION STATEMENT The position of this paper is that Registered Nurses are prepared not only to provide the action in school nursing stand the reasons behind the action, desired results and but are well prepared to underto accomplish the goal of optimum health for each student- alternate approaches Practical Nurses, because of a more limited academi Licensed prepared for some of the action. c preparation, are only tion for nurses i Therefore, the minimum level of preparan the school setting should be that of a Registered Nurse. - 3Because nurses who tance of professional RA I ICRALE FOR THIS POSIT practiced in the school standards and setting recognized the impor- of School Nurses (NASN) criteria for school was established. preparation, the National Association This organization has developed a nursing practice including a definition and description It has also established the minimum level of needed for nurses who will practice in the school setti the NASN statement of definition, description of functi of functions. ti ng. preparation The following is for work. on and preparation Definition: The school nurse strengthens and facilitates the educa- tion.1 process by modifying or remo.ing health-related barriersto learning in individual wellness for students and students and by promoting an optimal level of staff. appropriate assessment, planning. The nurse assumes and/or referral activities
intervention, evaluati responsibility 'for on, management. serves as the direct link between physi- Clans families, and community agencies to assure access and continuity Of health care for students
provides relevant instruction, counseling, guidance to students, parents, staff, and others concerning health- related issues
upholds professional provides relevant instruction. parents, staff, and others Act, and other state school nursing practi trative guidelines. Description of FunctiI and local standards, the state Nurse Practice statues and regulations applicable to ce
and adheres to district policies and adminis- ons Based on Standards of Schoo1 1. Nursing Practice: 2. 3. 4. 5. Applies appropriate theory practice. Establishes and as basis for decision-making in nursing maintains a comprehensive School Health Collects information about the health the student in a systematic and continuous manner. Uses data collected about the health student to determine program. and developmental status of a nursing diagnosis. and developmental status of the Develops a nursing care plan with delineating school specific goals and interventions nursing actions unique to students' needs. 46. Intervenes as guided by the nursing care plan to implement nursing actions that promote, maintain, or restore health, prevent illness, and effect rehabilitation. 7. Assesses student responses to nursing actions in order to revise the data base, nursing diagnosis, and nursing care plan and to determine progress made toward goal achievement. 8. Collaborates with other professionals in planning to assure quality of health care provided to students. 9. 10. 11. Assist student, families, and school personnel to achieve optimal levels of wellness through health education. Assumes responsibility for continuing education and professional development and contributes to the professional growth of others. Participates with others in assessing, planning, implementing, and evaluating school health and community services that include primary, secondary, and tertiary prevention. 12. Contributes to nursing and school health through innovations in theory and practice and participation in research. Preparation for Work: 1. A baccalaureate degree from an accredited institution of higher learning. 2. Valid state registered nurse license. 3. Current state and/or national school nurse certification. 4. Two years nursing experience in child health. (American School Health Association, 1987) In 1988, school nurses in Ohio addressed a similar questioTi to the one that we are addressing. The issue for Ohio was the recognition that school nurses needed a baccalaureate degree and certification in school nursing.. They recognized that "unless a child is alert, healthy, well-fed and fit, you cannot teach that child those subjects traditionally called basics (Rice, et al, 1988). The role of the school nurse was not only one of routine inspections and screenings, but the nurse had the expanded role for guidance, consultation and coordination of the school health program in her 5school. An ahequatL' school area of the health nurses' need to be health program ezpa.nes room. It involves the entire cli.- that may have prepared to identify and remedi one the geographical te of the school and is not the absence of a negative impact on the 1 ate these health concerns i11ness earning environment. a state of well being inclusive of phys and physical defects. Optimum health sociological and spiritual components. iological, Optimum health involves psychological, educational. It became important for nurses to re-think their role as one who orders and did not think or question the School nurses decisions "took practice nursing in an independent setti of thinking and judgement and suggestions of others. sound theoretical background. required in an ng. able to think and Ohio independent practice, To provide the kind reason through situations recognized that a well one must have a prepared nurse was , . - more precisely and resulting in better decisions being made for the accurately, student (Rice, et al, 1988). Today's children have a broader behavioral issues, all of which have t range of physical, social. emotional and process. We see an increase in acute and chroni he potential to impede the educational deficit disorders, child abuse and pregnancy, emotional disorders. neglect, drug abuse. c health problems, attention Law 94-142, students with depression and suicide. streamed into the regular school more serious handicapping conditions teen and pre-tee.n Because of Public setting. are now main- nurses be available, not only to do the It is essential that, well educated supervise the aids. procedures. secretaries and other nursing procedures, but to teach and LPN's are not qualified support people who perform these for this teaching role*. School nursing involves the health practice. prevention of illness which is also part of public This may be accomplished tion or early diagnosis and treatment. through practices of health nurses make is to teach and needs. Nurses will frequently encourage children to A major contribution that school promo- care for their own health condition, how to teach a child how to adapt.'to a specific health quences of the illness and how basis. Both the informati practice appropriate behaviors to minimize negative conseT to practice good health habits are best done by on taught and the method of on a regular a nurse with adequate academi conveying the message c preparation (Wold, 1981). Basic to this author's Phi'losophy of Nursi ing is the concept that "to nurse is 6to teach" (Ritter, 1951). If our own learning base is mininal, we are less able to convey health knowledge to our children. k 7CCMPARISO.'J OF NURSING EDUCAiION PROGRAMS When comparing the various nursing programs, the striking difference that confronts the observer is the length of time program. a student nurse spends in the A. The College of Nursing at the University of Arkansas Medi requires two full years of undergraduate cal Science Campus sciences and then two full courses in the liberal arts and years of nursing courses that teach Foundations of Professional Nursing. Concepts of Nursing Practice, Nursing Management, Pharmacology, Nutrition, Nursing Leadership, and Nursing Concepts and Practicums in Medicine, Surgery, Pediatrics, Obstetrics, Mental Health- Psychiatry and Community Health. On the successful completion of these eight semesters and passing of the state board examination for registered professional nurses, the nurse, now with a bachelors of (BSN), is prepared to: science in nursing 1. 2. Use.the nursing process to assist the client in attaining, maintaining and restoring maximum wellness potential. Utilize nursing knowledge, skills and attitudes in managing clients who lack the ability, will or knowledge to meet health related needs and accomplish developmental tasks. 3. Collaborate with health care professionals and consumers in identifying and meeting current and emerging health related needs of clients in a 4. variety of settings. Utilize the research process to: a) Evaluate and apply research findings to nursing practice b) Improve nursing practice and client health through the identification and referral of researchable clinical nursing problems. 5. Apply the knowledge and values synthesized from the humanities. physical and behavioral sciences in the practice of professional social, nuring. 6. Participate in the formulation of professional 7. patient care in nursing practice settings. Participate in seeking solutions to selected standards for quality moral, ethical, legal. 8. economic and social issues affecting nursing practice. Utilize leadership and management principals to foster professional 89. C. D. B. nursing practice and inprove care deliver delivery systom. Demonstrate ability to y within the health engage in critical thinki and independent judgement. (University of Arkansas for Medical Sciences, 1989). care ng, decision making The Baptist Hospital School of Nursing for Registered Nurses utilizes seven semesters which include 18 hours of liberal and 74 hours of courses similar to the (JAMS ing Theory, Practicums, Concepts arts and science courses program. These include Murs- ns,. . . Practice in Medicine, Surgery etrics. Pediatrics, Community Health and Mental completion of this graduate of the diploma program the nurse may take for those subjects offered Baptist School of Nursing. program. 1. 2. 3. 4. 5. Operationalize the Health-Psychiatry. On She will have earned state boards and is a through Henderson State Teachers academic credits Their stated objectives are as follows: the needs' of individuals. nursing process when College at the providing nursing care to groups and families. meet Promote maximum adaptation of individuals or crisis. Promote wellness through health resources. Demonstrate continuing personal experiencing .illness, stress care teaching and using available professional growth by participating in professional and educational Practice professional activities. nursing as a generalist in health care faciliti or other settings where nursing care is provided.. (Baptist Medical Systems, 1991). The University of Arkansas at Little Rock offers gram with results in an associate degree (AD) in nursing, required to take 31 hours in liberal arts and an intense two year proStudents are es nursing courses. On completion of thi sciences and 39 hours in nursing and is eligible to take the s program thenurse has an AD in professional nurses. state board examination for registered The School of Practical . . . . Nursing at Baptist Hospital requires 12 months of study which at best cduld be on a semester basis. Because the considered 3 semesters although they are not entire course is completed in 12 months 9there is very limited time for the physical and social theory and nursing practice. sciences, nursinq The stated objective for this program is: it is the responsibility of the School to prepare a graduate practical nurse who is qualified to use observational skills while providing nursing care to patients in situations that are relatively free of complexity and to assist the professional nurse and/or physician in caring for patients in complex situations, are expected to: Graduates 1. Participate as a member of the health care team by contributing to the Nursing Process within the established guidelines for LPN practice. 2. Demonstrate respect for the individual by providing nursing care based upon nondiscriminatory practices. 3. Demonstrate professional accountability by practicing within the , defined legal standards and LPN code of Ethics. 4. Demonstrate professional growth through self-directed participa- . 5. tion in educational and professional activities. Demonstrate stewardship in the utilization of resources and facilities. (Baptist Medical System School of Practical Nurses, 1991). The key words here are providing nursing skills to patients in situations that are free of complexity and to assist the professional nurse in caring for patients in complex situations. is It is to be recognized that school nursing ifrequently challenged by complex physical concerns, but one cannot deny that the student population of today is overloaded with complex psycho-social concerns that can be most effectively addressed by well prepared staff. including nurses who are educated to assess and remediate these concerns. The legal definition of practical nursing is set forth in the Nurse Practice Act of the State of Arkansas, Act. No. 432, Regular Session, 1971, amended. Statute 72-746f.: as The practice of practical nursing means the performance for compensa- tion in the care of the ill, injured or inform under the direction of registered professional nurse or a licensed physician or a licensed a dentist, and not requiring substantial specialized skill, judgement, and knowledge required in professional nursing. II I 101 I I i The employing nurse and/or supervising nurse shall not allow or encourage or authorize the Licensed Practical Nurse to exercise judgement and beyond the scope of practice of the Licensed Practical Nurse. skills When the question gets asked again, What can an RN do that an LPN cannot do?" one should respond with the question, Which nurse has a sufficient level of knowledge and theoretical base to understand what needs to be done. why it needs to be done and what are the expecXed outcomes? be capable of assimilating her theoretical knowledge and they may be applied to any situation at hand. II The nurse should concepts so that She should use the nursing process to assist in attaining, maintaining and restoring wellness (LIAMS, 1989). IIr LITTLE ROCK SCHOOL NURSES RESPONSES On January 16. 1991. after work hours. their concerns about the the school possibility of using LPN's in the Several insightful thoughts were presented and 1. Two of our Their position the school 2. 3. 4. 5. 6. nurses met to discuss are included here. nurses became RN's after practicing for was that LPN training is not sufficient school setting. some years as LPN's. nurse job. They felt that the knowledge program prepared them to students. meet the challenging health Uvita Scott explained it well when she RN requires you to change his ability to just foil reason for the desired a preparation for gained in the RN care needs of our said. II Becoming an your type of thinking." One must replace her/ ov/ orders and become one who thinks through the outcome of the nursing intervention. nurses must demonstrate initiative in the practice of The school nurse is the only medical Professional their profession. person at the school. independent,, ..ere .edica, or nrs,g must have a broad understanding of individual health health needs of the community. She needs as well as the Families increasing,, are depending on the schoo, "U e to determ,ne what needs to be done for their chi,d. Recognizing that man, of our famiiies have iimited resources and cannot access health care - Frequently parents seek nurse to be the primary needs to be done for their child. our families have limited resources and responsive school as frequently as they may wish, the no cost, well K T .. * * -prepared, nurse can be a candle in the dark for these families. Although many of our daily responsibi1iti es seem routine and even minor. ** I" conditions of enormous 1 L Foutine activities may end up in the complexities of abuse, trauma, depression. and other significant physical and mental health Because of their knowledge base and academi prepared to participate in health education cl uable assets to the cl involvement i More and sei zures concerns. c preparation, RN's are asses. They are valassroom teacher who frequently requests nurses' n the health education classes. more school personnel procedures for children are beiag called on to perform with handicapping conditions. nursing Nurses provide 12the leadership and direction for those procedures, trained to provide nursing leadership. LPh's are net 7. Several school nurses expressed enable black LPN's to become school concern about lov/ering standards to nurses. RN's have become excellent school They felt that our black nurses and that there is no need to lower the standards. Blacks are just as capable as whites and shouldn't indicate any possibility that they us is to do a better job of recruitment. are not. we The task before 8. It is to be noted that the current trend is to require a Baccaleaureate degree in nursing as minimum preparation for school nurse practice. When our job description was rewritten in 1987, it would have been prudent to put the-BSN requirement in, however, it was recognized that the Little Rock School District needed to hire more black nurses and the probability of raising the requirement to a BSN would have reduced our chances of hiring black nurses. There is a significant number of black nurses, who successfully completed an AD or Diploma program and we do not want to exclude them from eligibility. 13ILLUSTRATIONS OF SCHOOL HORSE PRACTICE To illustrate fully the various opportunities for nursing care that confront our nurses v/ould require a book in itself. The follov/ing stories will demon- strate the needs of some of our students that can be remediated by a well prepared nurse. 1. John had been in a drug rehabilitation program prior to his return to school. His school had established a good support program for kids like John and he was involved in a group let by a teacher and the school nurse. Because the nurse had a sensitivity for John's program, had established good communication and trust with him "and was perceptive of his needs, she was able to assist John in dealing with his problem. At various times , his behavior could have been interpreted as disruptive, but the nurse was able to see beyond the superficial actions and recognize John's appeal for assistance, sional nurse with RN preparation. This is the work of a profes- 2. In November, the school nurse screened the Community Based Instruction CCBI) students for scoliosis. Some deformity was observable in the chest area on a student named Mike. The curve noted on the examination did not measure to the degree that normally would require referral to a physician, but the student's back did not look normal so the nurse phoned the mother and suggested that an orthopaedic evaluation be arranged. The student was subsequently seen at Children's Hospital where the doctor noted minimal scoliosis. Syndrome, further evaluation was indicated. Because the*student had Downs It was recognized that the child had insufficient strength in the cervical spine and was very vulnerable to cervical injury. Surgery was recommended and provided. 3. Without this nursing service, Mike's unstable cervical spine may have gone undetected until he became seriously injured. On a weekly basis, one nurse meets with the pregnant girls to monitor their weight, blood pressure, energy levels, and to discuss any problems or concerns that they may have. This same nurse meets with a group of students after school to talk about teen issues and any pro- blems that the students may have. The functions of measuring vital signs and weight cap be done by an LPN, but the comprehensive understanding of the many issues that may impinge on these students' health is the responsibility of an RN. 144. One school nurse has a child with diabetes who is new to our school system this year. Because this child s diabetes v/as out of control, she nad not been able to play outdoors with the other children and also had very frequent absences. full time nurse, the Since being in our school, v/here v/e have a nurse has been working with her to get her regulated and into normal childhood activities. Her diabetes is better con- Her diabetes is better trolled and there has been a marked improvement in her self image and feeling of independence. The daily support and teaching from the school nurse has contributed to this student's health and well being. Again, we need people who not only do things, but understand the issues, the disease processes and can assist with any necessary adaptations so that 5. optimum health may be obtained. Pregnancy can complicate any teenager's life and thi situation for Mary. her to live with him and his new wife. Her mother had died and her father s was especially the was not allowing Severe asthma further compli-' Gated the pregnancy because of limitations on the medication she could take, uepression was becoming apparent, so her school nurse arranged to see her very frequently, observing for high risk symptoms. Depression Because parental support was not available, the school nurse assisted in getting . this student on the nutrition suppliment program for expecting mothers. Mary is still in school and scheduled to graduate in June. tant to provide comprehensive health we expect them to remain in school. It is impor- services for students like Mary if 6. High school student. Jim. was being misunderstood by his mother, his teachers and his friends. A persistent twitching and nervous feeling had been with him since junior high and no one tried to find out what was behind it. performance in school. It v/as affecting both how he felt about himself and his His school nurse assessed the symptoms and nized that a possible neurological disorder known recog- 7. may be present. as Tourettes syndrome With much persuasion from the nurse Jim's mother finally agreed to take him to Children's Hospital where the neurologist diagnosed his disorder and placed him on medication. sistent follow-up by the school adequate health care This type of pernurse is necessary if we are to provide The nurse's ability to utilize her knowledge base and assessment skills paved the way for Jim to get treatment. Roger is being well ijared for at his school. Because he has spina bifida 158. he needs to be catherized at school every day. sterile procedure that can be done by moth The proper technique This is a clc' n non- ers, aids, teachers or nurses. must be taught and Roger's school nurse had not only instructed the aide in this procedure. port and encouragement. Staff and students in this school more about spina bifida because this nurse much teaching. but is following up with supunderstand is involved and provides The last story that will be presented is important because it could have been a repeat of the well publicized story of a small bo, in Little Rock who lost his leg story unfolded. as a result of abuse and neglect. As the following It was apparent to several of us that if our school nurse had not pursued this situation to a point of satisfactory tion, another child complemay have been severely impaired. Joe had an infection on his foot which the nurse had been concerned about. referral, sending home the She had made a written form and following up with a phone call. -She was treating the infection at school with the protoco.l established by our school physician. parents were not cooperating
The foot was getting worse and the For several days, the no medical attention had been obtained. nurse continued to encourage the parents. response was to tell Joe that he was not to allow the Their toe any more. Joe came to give the nurse that nurse to see his conversation, the infection odor message and during this made to involve the Department of Human was very apparent. The decision was responded to the concern that day. Services (DHS) and they However, they made contact with the parents who apparently agreed to take Joe in for treatment, but did viot follow through. and further contact by the Two days later, treatment still had not been initiated evidence of follow-up by DHS was apparent. nurse with DHS proved stressful in that no a supervisor in DHS and A phone call was placed to Services took Joe to the hospital where response did occur. The Department of Human eral days. We need nurses who he became an inpatient for sevbeing of our students. will be advocates for 'the health and well 16SUMMARY It is fully recognized within the educational comnunity that adequate academic preparation is essential. Teachers, counselors, psychological examiners and administrators all meet certain criteria prior to employment. The days are gone when a person can be placed in a classroom and told to teach. Ho one would consider that one year of college could prepare a person for teaching. Our children's minds are too valuable to entrust to an underprepared teacher. Standards of education must be upheld and certainly our children have benefited from these standards. Therefore, we should not consider entrusting the health care of the same child to someone with only one year of preparation in nursing. sional registered nurse program is essential. The knowledge base gained in a profesWe talk of world class schools for our children. These children deserve world class nurses who are well prepared to meet their health care needs. RECOMMENDATIONS It has been clearly stated in this paper that the registered nurse level of nursing should be the minimum standard for school nursing, but there is another issue at hand that is important to address. The reason that the question of using licensed practical nurses has surfaced relates to the fact that out of a staff of twenty-nine nurses only five ai'e black. In a district with a majority of black students it is important that we provide good role models for all of our students. It has been the practice and will continue to be the practice, for the coordinator of health services to always recommend for hiring any qualified I i black RN who applies for a nursing position, facilitate hiring more blacks include: Additional,practices that may I 1. 2. active recruitment of graduating nurses from the RN programs
seeking assistance from leadership in the black community to be aware of our need for black RNs. 3. Encouraging our'minority recruiter to become more involved in helping us recruit black nurses
174. 5. having our school nurse program presented in nurse recruitment fairs
developing brochures on school nursing for distribution to schools 6. of nursing
making annual contact with the black nurses association
and 7. wording the advertisements, "Minority Recruitment." 18references American School Health Association (1987). Practice: II A Guide for Administrators" Evaluating School Nursing p.34. Baptist Medical System (1991). School of Nursing Catalog P. 2. Baptist Medical System (1991) . School of Practical Nursing Catelog P.5 Rice, G., Miller, L., 4 Rini. N. Nurses 2000 A
D. (1988) Why Board Hired P- 1. 11. 13, 19. 20. and Beyond Ohio Association of School Certified School Nurses Ritter, B. (1951) Classroom Instruct! Washington, D.C. on Capitol City School of Nursing University of Arkansas sation). at Little Rock College of Nursing (per phone conver- University of Arkansas for Medical Sciences (1989) Catelog p. 13. College of Nursing White, D.H., (1985) A Study of Current School pournal of School Hea1 th 5 (2) p. 52. Nurse Practice Activities
Wold, S. (1981). C. V. Mosby Company. School Nursing: A Framework of practi ce. St. Louis 1'9I SENT BY: 1-31-95
8:14AM :JA RIGGS LITTLE ROCK- 501 371 01 00:# 5/ 6 i I EDS rcornAt ::ORP P HOM l>34 HOCK AH 72203 iPSOT Coordinator County Social Services Section 1 - Patient Identificailon ORIGINAL EPSDT Provider County Office I I ! I I I I I I I I I I (ifif.NT ^LAS'aTwL 01 I I
in f-.AS{neiO5 H/t/Jelt,!' TvOJ*4 0^ AcSI0.NC& 71 I MO oToiftiH (91 OAY YEAR IF HXtIENT IS A AtniMHAL ilu ENttA NAME Of BCtCAHINU PM-BICIAN OTH^A health insurance CS^BMACiE (14> pnOtriOFfl KUIUSFR ! I I I I ^uEoicAL ft?coHo ><vMeen ( qi leNTSHNAME OF RiXN ANO ROliCV NUMRER)
RRlMAR* OiACNOtiK? 0^ NATUAC Of lN*ua* {4 DiAGnO^.S cooe ! I I iir I SECTION H - Social Worker Identification .i9i Signature Telephone No. Section III Examination Report Type of Test or Examination THOM iMl A. Basic Screening 1- Growth and NutritiorF 2. Oevolopmcn: Assessment ___3 unclothca Physical a. Neurological Eam________ b Cardiac Status____________ 4. Vision 5 Hearing____________________ g Teeth (Children under 3 yearsi 7. Let) Tests (Appropriate tor age and population group) a. Hematologic 6. Urinalysis _____C, Other (Specify) ____ B. immunization Status___________ C Other (Specify) date Of SCRviCf TO I u *uAce i I ttRwrW I : V20.2 3 c s a o z A S 2 z o z r Ml'31 j ijEX M'l' I 'mOH
*TiENTi Mtuc/MC loxo (&i >74feEAdcRi<5 (9) City (W I pnovioen PMONC NUMBER i 324-2161 i^AS CONDITION AClAKO To MS> A. PATlENrS eMPLOvMENT *3 Q AN ACC106NT ves no no APFOiNTMENTOATEdn MO ,OA< vn time. PM TO: PROVIDER NAMS ANO ADQRSSS (13| Little Rock School District PAY TO PROVIDER NUMBER 121047761 TYPE OF SCREEN (181 INITIAI. 4. PERIODIC X EPSDT Request Date or Certification Date Date SS-694 Sent to Provia er UJ t4. 2 O o u a LU H LU C o e c LM COMMENTS .J1I (A) (9 fC) (D) 7e) (F) (G) (HI (0 (J) (K) (L) (M) (2) T I JL X 4. Lu I + X I I -J- 1 C r'UL.L' Ofc&i.Hfae ^M'OCblkjRCS MfUicAL MiMViULi OR Su*aL.*CS 7V^'SwC0 40R t*CN 04'^1 GIVN ^^duMCooe liCiNTIFv I 0 Z1636 0 Z1637 I (fiFiA/ar (/wvttMi. stv^es 0^ ci^cwstmcisi Periodic vision Screeninq D LAMlNOfilS cooe V20.2 Periodic Hearing Screeninc V20.2 Thia 11 Io CBH'^r '"( -niofinaitoA pua. acourata aa/] compiefs. I ueoaniane ihai payment and sat stactfon o( tnis ciaim w.l ba hc/e Mbwai Siaia and rhai any taiM ^ima siatntA<a pf bocumantt or concaaii*^Ai ot a matanal lad may oa proiaeiiied unaar appi>cabia Ftdc'A> or 5iaia .'a*a No (?9> TOTAL CHAflGES ' ! doiitonai ePwgo* tot coAionsaD- mty-cm w>ii be mecie jrtyAAe payment wWi oe Aee>otd i D<y>TkeM ' Il ^a II I that tee aauvaa claimAn mr r.awA nar\ cAfFr^MHii ann inai ina aaaw* M ^ULL. that ire aouve claims lO' (^yownl r>a*e ocn cofrpManao artn in int ab<0T t<en turiMshod n lun cOrtifGance d*scrm-nattOrtl w>th'n mo ptOT%i>nt o( 1>tie 'Ji ot in* Proa'a* Civ>i Rfgrita Ac* ana iect-op Wn .y* Monao..nr. nd qi 19x3 IZMI COVSR6O 9Y INSURANCE !
?R Silling tzs
E CHARGES F 0**0 0^ UNIT5 G PROviDCR kduaea 105 NUUBSR 16 la 29 0 00 6. 66 1 1 1 6 4 -i ttl e Rock School District Little Rock School Dis trier 1 TOR qteice use (^iiSENT BY: 1-31-95 : 8:12AM :JA RIGGS LlTTLf ROCK- 5013710100:# 2/ 6 Little Rock School District Health Services January 24, 1995 To: Estelle Matthis, Deputy Superintendent I From: Gwen Efir^^ Co dinator of Health Services Through: Jo Evelyn Elsti , Director of Pupil services Re: Medicaid Reimbursement for Health Services Currently, the Little Rock School District is being reimbursed by the Medicaid program for selected services provided by our school nurses. Listed below are the amounts we have received since the onset of this program. Year Applications Filed S Received Medicaid Applications Fiigd S Received Private Insur. ! 91-92 Approximately 200 $1,387.26 None None 92-93 Approx iraately 1000 $11,471.37 Approx imately 1500 $59.00 93-94 Approximately 1100 $12,365.44 Approximately 1600 $29.50 We receive a total of $23.73 for the hearing and vision tests, and $50.50 for the EPSDT screening. If the screening is the child's initial screen, which is unusual because most children have been examined prior to age 4 o 5, the fee goes up to $80.00. Application Process I Applications were filed with the Medicaid office requesting the provider numbers that would allow us to bill Medicaid. Separate numbers are required for the hearing and vision screening and the Early Periodic Screening for Diagnosis and Treatment (EPSDT). I Nurse and Health Room Certifications Our nurses have been certified by the Arkansas Department of Health to provide hearing and vision screening
which is a requirement to receive a provider number. Eighteen nurses are now certified to do EPSDT, however only 9 health rooms have received the additional certification from the Health Department required for provision of the EPSDT. The additional equipment to meet the requirements costs approximately $500.00 per health room.SEyr .BY: . 1-31-95 : 8:14AM :JA RIGGS LIHLE ROCK- 5013710100:# 4/ 6 Pulaski County School District has used an electronic system which assists them with the billing and assures them of a more accurate ! medicaid number. I I I A staff person, who works half days does their It is uncertain how they handle the private insurance billing. The medicaid office has provided some information on the availability of using the electronic billing. However, it is to be recognized that even the electronic billing will take an individual's time and will only do the medicaid portion, which is the least time consuming. billing. take hiring someone individual was $640.00. to work after hours. we have accomplished both parts with The amount paid this I I I I As has been noted, some medicaid money comes from providing EPSDT physical examinations. Many more physical examinations have been provided than we have been reimbursed for. This relates to the I fact that EPSDT screens are provided according to a periodicity Several of our younger children have had a physical within the limited time frame and payment for the physical given by the school nurse was rejected. schedule. As parents become more aware of I this service, they may rely on the schools to provide it. Nurses, particularly in the Incentive Schools have been encouraging non participants who are eligible to apply for medicaid. also contribute to a greater amount of revenue. School nurses This could ! provided several clinics this past school year to give Kindergarten children their required physical examination. 1 t Increasing the number of certified health rooms will assist us in increasing revenue, year. We intend to increase this niimber by four thisI SENT BY: 1-31-95 : 8:15AM :JA RIGGS LITTLE ROCK- 5013710100:# 6/ 6 HS 36 9-93 LITTLE ROCK SCHOOL DISTRICT 810 WEST MARKHAM LITTLE ROCK, ARKANSAS 72201 Teacher's Name I I i i I Dear Parent: The Little Rock School District can be reimbursed for certain health services provided by our school nurses. hearing/vision screening and a modified health assessment. These include Medicaid is the main source'of reimbursement, but other insurance plans are also involved. We are asking every parent to complete the information below and return it to school tomorrow. Thank you, School Nurse (PLEASE PRINT) Child's Name Birth Date (Be sure that you use the name known by Medicaid or your insurance provider.) Insured Parent's Name Parent's SSN Is your child on Medicaid: Yes No If your child is on Medicaid, please indicate the number or send a copy of your Medicaid card. Do you have other health insurance? Yes No If yes, please provide the following information: Name of Plan Policy Number Name of Insurance company Address of Insurance Company **AAA***A*A*********************************1lr**W********w*** (TO BE FILLED IN BY SCHOOL NURSE) School Nurse Hearing Screening Date Results Vision Screening EPSDT EvaluationSENT BY: 1-31-95 : 8:13AM :JA RIGGS LITTLE ROCK- 5013710100:# 3/ 6 } i Student Medicaid Numbers Starting in the 1992-93 school year and continuing to the present we have requested medicaid numbers and private insurance numbers from students who were scheduled for hearing and vision screening. This includes Pre-Kindergarten, Kindergarten, first, third, fifth. I i seventh and tenth grades. insurance companies if we bill medicaid. We are required to bill private I Billing Process I When the forms with medicaid numbers are returned to the nurse, she uses the information to complete the HICFA form. A.) (see attachment This information is sent to the Health Services office where 4 copies are made and then sent to the Medicaid office. Forms that I indicate the child is on private insurance are completed with the results of the hearing and vision tests placed in the appropriate spaces, (see attachment B) . The bill is then sent to the insurance company. Concerns One would hope that the Medicaid reimbursement money could provide more financial benefit to the district. that it would fund positions. Initially, we had hoped Because of budget cuts in recent I years, the reimbursement money has provided funds to replace the budget reductions. The money has been used to pay part of the school physicians salary, purchase health room supplies, provide money to purchase more equipment for the health rooms and the cost of the person who does the billing. It should also be noted that 25% of the money received is to be returned to the state. Because of the time involved in the billing process, especially the private insurance, we have paid someone to work after hours to do the billing. This year, we hopefully will equip four additional health rooms so they can be certified for EPSDT. For consideration: Although we do not know exactly how many Little Rock School District students are medicaid eligible. it should be more that the 1000 that we are billing. It has been estimated that 10 to 15 % of our children may be medicaid eligible. We screen approximately 12,000 students which would result in 1800 being eligible. If we could get accurate medicaid numbers from more students and in some cases assist children who are eligible to get on the program, reimbursement. we could receive a greater amount of Sending requests home to parents for medicaid numbers has had limited response. Consideration should be given to obtaining this information when the child registers. The parent at that time could fill out the form providing the medicaid and insurance information, or a copy of the medicaid card could be made.Ooci IFTA Comcnl D 2 4 1995 r February 20, 1995 :0 Dear Dr. Williams and Little Rock School District Board of Directors: The Little Rock PTA Council is gravely concerned about the administrations proposed budget cuts pertaining to the school nurses. The decision to eliminate 19 registered nurses is quite shocking in view of the 1994-95 Little Rock School Board Priorities compiled just last September, 1994, in which Quality Nursing Services ranked third highest in priority. The PTA Council feels that the level and quality of nursing health care and services received by all students would be greatly diminished under this proposal and in the area schools would be virtually non-existent. Although it appears that most magnet and incentive schools would retain their school nurse positions, in reality these nurses probably would frequently be pulled to work at other schools that have no nurses. Consequently, the PTA Council feels that, ultimately, all our schools are at risk of losing the professional health care and services currently rendered to our children by the school registered nurses. The PTA Council is also extremely concerned about possible future plans to consider replacing the RNs (registered nurses) with LPNs (licensed practical nurses) and/or health aides. The knowledge and skills base of a registered nurse is significantly more appropriate in the school based setting in comparison to a licensed practical nurse. Neither an LPN nor a health aide possesses the specialized skills, judgment or knowledge necessary in providing the types of nursing care and services needed in our schools for our children. No parent wants his child to suffer the consequences or risks of mismanaged care given by inadequately trained personnel. During the process of identifying student health needs and intervening however necessary to meet those needs, school nurses provide innumerable types of professional services. In many cases, registered nurses are the only persons legally authorized under state public health regulations to complete the myriad of referral and evaluation forms for students needing special services. Consequently, the PTA Council feels that replacing RNs with LPNs and/or health aides would be comparable, theoretically, to replacing our classroom teachers with instructional aides. Many parents are greatly concerned about the continued assurance of basic nursing services received daily by their children such as administering medications and making pertinent observations, giving specific medical treatments, providing mental health observation and intervention, and providing observation and care for acute and chronic health conditions, such as diabetes, asthma, and head or other traumatic injuries. Every student has the right to a physically safe and emotionally secure environment in our schools, but will this right be severely compromised or, at worst, denied under this proposal? It must be noted that children in the lower socio-economic strata of our student population will undoubtedly stand to suffer greatly under this plan, because the school nurse is their only source of medical care for their health needs. The number of children in this category ranges from 100 to 150 ger d^. Currently, there are 1260 students in the LRSD served each day for acute illnesses and injuries, and over 1200 individual doses of medication are given daily. School nurses serve an extremely important function as health educators and advocates. As positive role models in developing permanent healthy lifestyles, they promote good health habits and illness prevention, carry out many health education programs, and work closely with students, parents and teachers regarding special health needs. Oftentimes the school nurse is the first and foremost person in whom a student will confide concerning personal problems and needs. Therefore, the nurses play a key role in providing support and intervention and handling the daily crises that arise. Therefore, the PTA Council strongly holds that in order for students to function at their highest learning ability and to have a successful educational experience, they must have access to the health services and education necessary to promote optimal levels of wellness. The PTA Council firmly takes the stand for maintaining health services as they are presently delivered and preserving the school nurse positions that we currently have. Thirty schools are covered daily with nurses while twenty schools are not covered
therefore, it would appear that the LRSD should consider adding school nurse positions rather than eliminating them. We also feel strongly that budget cuts should be made further away from the children, because school nurses directly serve 100% of the students in our district. At the last PTA Council meeting the members voted to make known to the LRSD Administration and the School Board of Directors our position on the proposed budget cuts affecting school nurses. Attached is a list of those members in attendance and the schools they represent. These individuals represent more than 13,000 PTA members in the LRSD. At a time when we are striving for safe schools, this situation certainly acquires a chilling perspective if we are to lose our school nurses and, as parents, suddenly feel that our children are truly in an unsafe environment. The Little Rock PTA Council sincerely hopes that you will give strong consideration to our viewpoints regarding this issue and will not make any changes in the current school nurse program in the proposed budget cuts. Sincerely, 'T Ata UJ Deobie Glas^w, President Barbara Mills and Debbie Velez, Council Representatives Little Rock PTA Council cc: Honorable Judge Susan Webber Wright Ann Brown, ODM LRSD Administrators Gwen Efird and School Nurses PTA PresidentsName T, ^&'AfwS Little Rock PTA Council School/PTA Office J lx ^<1^3 TV Xi (.j./U Home Address/Phone 013Z..O 6n , '^^Sggvj-fV?>M.vo &a}n L.rZ V\a2) 7/aJii VJ<A L (so/^S-. d OJlCPiM. Ci-yS'- vi, 6^' ^>'1, CL^r^ I Q ' Oe c< f^
k .. -^, - t < '4-- u h.-t .< / a I a-. 1 Name 9ro-K L Little Rock PTA Council DATE: School/PTA Office /-^C\r lUy Ph Home Address/Phone [^39 '"^teckirMr/ 177.2 ? C R i^f 1311 ?. ksTi rl A-f} I ./ / / 7L/1U/ n 6^ Q'Tu^ax^ . <E levtubv' t^e Bl' s. 7U<oor^ i r\ (A ?'t > KjAdd/K^-. C^bCn'a'i} I CA -'t' V, a 1 - t L^l{4Ay 1- 'i^lr.-:. ^16 '^^X: /i'-'i I I / O I :k t cb Id -^' ' - ><> 1-^' di: 4'' K003 005 :rf 41 '>11'1 a 1'04 OG.- '? 1' > I J m i . 1 A t f T
J nc J i' : - ur -c V.o:
i Cl ? _ J . Vli )05 - :.e t 1 . r J-,' rl' Ph' P i .J- ! h
k M'-p tk'' r
,[r!- f ^5 * Ktrfij? T^v bt*/hr K'ct'. a . 'vaKv Pl!, a <,-fv pter i -paii'' !1P
t , .pr, 'tl'P-'P 'r* ). -.'-(ri'Office of Desegregation Monitoring United States District Court Eastern District of Arkansas Ann S. Brown, Federal Monitor 201 East Markham, Suite 510 Heritage West Building Little Rock, Arkansas 72201 (501)376-6200 Fax (SOI) 371-0100 July 25, 1995 Ms. Gwen Efird 207 Barton Street Little Rock, AR 72205 Dear Gwen: Congratulations on being named Arkansas School Nurse of the Year! Its an honor you so richly merit. Those of us who are privileged to work with you and be inspired by you know what a deserving recipient you are. Im just glad that so many people outside Pulaski County know it too. You make a very important difference for the children and parents of this community and state, Gwen. Tlianks for your brave leadership, your caring stewardship, and your steadfast, loving service. You have my abundant respect and gratitude, not only as a monitor, but as a very grateful Mom. Lots of love, ?\nn S. Brownp <30 py c-ta Little Rock School District 810 West Markham Little Rock, Arkansas 72201 To: Franklin Parent Involvement Team From
^Frances Cawthon, Assistant Superintendent Date
October 13. 1999 OCT i 3 I3S9 O?RCOF CSESOnCKMONlTORlfiQ Thank you for the concern you expressed regarding the nursing services at Franklin Academy. I, like you, would like to see a full time registered nurse in all of our schools. However, the way Franklins budget is currently allocated will not allow for that service. The Campus Leadership Team may consider shifting resources to allow for a full-time nurse. This would be a campus-based decision including all members of the Campus Leadership Team. Many of our elementary schools that do not receive the extra benefits of double funding also have high percentages of students in the categories that you enumerated in your letter. While your students at Franklin do not receive as many services as we would like to provide, there is certainly no discriminatory treatment in the budget allocation. Although Franklin is still a double-funded school, they are currently over their double funding by approximately 580,000. I'm sorry I couldn't give you a more satisfying answer. I do appreciate the interest, energy, and concern that the staff and parents have given expressing their ideas and making the inquiry. Please continue working through the Franklin Campus Leadership Team. Your combined efforts can assure the school's priorities are best met within the budgets capabilities. co: Ann Brown John Walker Junious Babbs Ethel DunbarOctober 6, 1999 r Am -s' .ij i d isa Mrs. Frances Cawthon Assistant Superitendent OCT I 3 1933 RE: Nurse Rollins - Reduction of days at Franklin Elementary CFiCEOF OESESREGAnONMOarrORiNG Dear Mrs. Cawthon: We the parents and staff of Franklin Elementary wish to express our concerns relative to the reduction of our schools nursing service. During the Incentive School inception, it was decided at the time (by the Courts) that each Incentive School would have additional staff that the area elementaries did not have. Those persons were identified as being a full-time nurse, social service worker, art specialist, music specialist, counselor, physical education, and a theme specialist. Double funding was c-------- support this extra staff and to aid with the desegregation efforts of identified schools. established to Over the past few years, from 1989 to the present, our students have had access to said persons to assist with their many educational, physical, social, and emotional needs. With the re-writing and Court approval of the new Desegregation Plan, changes have been made that has and continues to negatively impact Incentive Schools. First, class sizes increased, second, programs were eliminated, and now services are being denied. were Our children at Franklin School, for the most part, are in a high risk category. Many of these students come from homes where drugs are used, siblings are gang members, parents are incarcerated, education is not valued, little or no medical care is provided, and domestic violence is a way of life. The school nurse along with the counselor and social service worker functions as a team in securing and/or providing services for our students. According to recent research from At Risk to Excellence, Three decades of research on school reform has led to the identification of four basic elements that students need from their schools
relevant schoolwork, a nurturing and supportive environment, opportunities for academic success, and help with personal problems. Unfortunately, studies of schooling for students at risk of academic failure demonstrate that schools often fail to address the special circumstances including economic, family, community, ethnic, and racial statusthat characterize students placed at risk (Natriello, McDill, & Pallas 1990). We cannot afford to fail our students. Removing Nurse Rollins from our building two days per week is taking away, to a strong degree, the basic / element to provide assistance with personal problems. To reduce the day services of the school nurse at Franklin Elementary School means taking away a service that our students, parents, and staff need so desperately. Please know that Franklin is the largest Incentive School with the greatest need and should be given priority consideration when it comes to meeting the needs of the students and proposedOffice of Desegregation Monitoring United States District Court Eastern District of Arkansas Ann S. Brown, Federal Monitor 201 East Markham, Suite 510 Heritage West Building Little Rock, Arkansas 72201 (501)376-6200 Fax (501) 371-0100 To: Frances Jones From: Melissa Guldin /A Subject: Franklin Nurse Date: October 28, 1999 As we discussed this morning, I have been reviewing the correspondence regarding the reduction of the Franklin nurse from a full-time position to one that is .6 FTE. I have copies of the petition signed by Franklin parents and staff and your memo responding to their concerns. Elements of your memo have raised questions about the budget that neither I nor Skip Marshall could find answers to in the September 1, 1999 LRSD Budget. In the second paragraph of your memo, you note that Franklin (or possibly the incentive schools as a whole') are 'over their double funding by approximately 580,000. No matter how we compared budget projections and actual budgets or expenditures, we never arrived at any difference of 580,000. Could you please send further explanation for how that figure was determined? I would also appreciate receiving a copy of the formula that the district used to allocate the nursing staff among the elementary schools. When we talked, you mentioned state requirements for nursing services, but I do not have a copy of that allocation formula. Thank you for taking time to look into this matter. I look forward to hearing from you. CC: Ethel Dunbar01/10/2000 16:39 501-324-0543 LR SCH DIST PUPIL SV PAGE 01 Little Rock School District Health Services To
Margie Powell Deseg Monitoring Dept. From: Margo Swanson, RN Coordinator of Health Services Jan. 10, 2000 Re: Number of School Nurses in LRSD LRSD currently employees 33 school Each school has nurses for their 49 schools one nurse assigned to it. FTE, soon to be 1.4 FTE ---- Tu:
.: ThuJ^.o^iy 1 Central High has 1,2 Call me if 2161. you need more information. pager 569-0244, office 324-TUESDAY, JANUARY 31, 1995 ** t ! O/>1/ Nau<n*n*r Martha Rossi Engelberger Students remember nurses compassion BY SANDRA COX Democrat-Gazette Staff Writer dren, her husband said. Working as a school nurse would Wherever Martha Rossi En- make that possible. gelberger went, whether it was When she got a job with the a fast-food restaurant or the Little Rock School District, mall, she would likely hear a former student call out, Hey, Nurse Rossi. she fell in love with her role. She worked for several years at different schools, in- Engelberger. a nurse with eluding Pulaski Heights Junior the Little Rock School District High. Pulaski Heights Elemen- for 26 years, often saw as many tary and Forest Park Elemen- as 75 children a day. Her tary schools, said Gwen Efird, motherly compassion helped coordinator of health services heal the numerous broken for the Little Rock School Dis- arms. legs, upset stomachs and other ailments the districts pupils experienced. trict. I would get requests during the summer to make sure she All of the kids just loved would be reassigned to those her and admired her, said her schools, Efird said, There husband. Bob Engelberger. Before retiring in 1991. she earned numerous achieve- ments for her nursing, including the 1986 School Nurse of the Year award and the 1981 and 1986 Superintendents Citation for Outstanding Service. Martha Engelberger are probably a lot of grown-ups in this town who remember her as their school nurse. Bob Engelberger said that was often the case. We hardly ever went anywhere, whether it be the mall or out to lunch, she didnt run North Little Rock died Sunday from cancer. She was 66. Her choice of nursing as a of into one of her kids some- where, he said. Though she remarried, she was still called Nurse Rossi profession made sense. Her by many students. grandfather. Dr. W.M. Bums, wasnt only a well-known Not only was she a caring nurse, she also was quite North Little Rock physician skilled. For example, she had but also was the citys mayor the knack of correctly diag- and the man for whom the citys largest park was named. Her view of her grandfather likely played a role in her decision to be a nurse, her husband said. She also had experience nosing ailments, her husband said. Several doctors said. Well, you dont need us, he recalled. Shortly after her first husband died, she was reunited with children. As a girl, she with her high school flame. helped watch over her younger While the relationship hadnt siblings and did chores from worked out when they were in cooking to washing. their teens, sparks flew in A graduate of North Little adulthood, Bob Engelberger Rock High School, where she was a cheerleader, she resaid. In 1977, the two married. In her spare time, Martha ceived nursing training in a Engelberger gardened, visited school at St. Vincent Infir- with her grandchildren and mary. read novels, including best- .About the same time, she sellers by John Grisham and also married Bill Rossi. They Danielle Steele. were married for 30 years. He died in 1975, Bob Engelberger the children. And her thoughts were with said. As a young woman, she Anything she could do for the kids, she would do, her worked for local doctors and at husband said. She was devot- Arkansas Children's Hospital. ed to that. She was a really But when she became the compassionate person. She mother of two. she wanted a worried about everybody else job that would allow her to spend summers with her chil- and never worried about herselfAugust 1 2. 2 0 0 2 School nurses tout noble profession Promote successes of keeping students healthy, workers advised BY CHRIS BRANAM ARKANSAS democrat-gazette SPRINGDALE The little girl was always sick. A Springdale school nurse looked mside the childs mouth and found rotten teeth. She missed so much time. One disease after another, recalls Barbara Ludwig, who coordinates nursing lor die Spring- dale School District. The girl had been absent so many days during her kindergarten year she had to repeat the grade. Over the summer, Ludwig coordinated with the family who had dental in- surarice to get the girl to a dentist to have her teeth cleaned. The next year she was like a new child, Ludwig said. Smiling and happy. She did exi tremely well. Nurses serve a function in schools that is often overlooked by administrators, principals and parents, said Darlene Cheatham, a former school School nurses salaries The National Association of School Nurses mailed a school nurse survey to 4,000 randomly selected school nurses throughout the United States in the spring of 2001. The association said 2,700 nurses responded to several questions, including how much they made. Only 67 percent reported they were on the same district pay scale as a teacher. $60,000 or more: 11.9% $12,999 or less: 2.7% $40,000 to $59,999: - 34.4% SOURCE: National Association of School Nurses nurse in Lincoln. They keep children healthy, she said. We need to promote ourselves, Cheatham said. We need to communicate our successes. $13,000 to $27,999: 17.8% r 1,000 to 1,999: ?^33.2% Artensas Democrat-Gazetta/GREG MOODY School nurses from Northwest Arkansas gathered at the Jones Center for Families in Springdale last week to do just that. The second School Nurse Summer Institute, last held in 2000, was sponsored by area hospitals and organized by nursing professors at the University of Arkansas, Fayetteville. The conference was two days after UA announced the results of a survey that revealed aspects of statewide school nursing, including low salaries and administrative headaches. We dont have a really good nurse-friendly environment in this state for school nurses, said Marianne Neighbors, interim director of UAs Eleanor Mann School of Nursing. Schools ask nurses to maintain records, manage immunizations, administer first aid and perform health screenings for students and staff, according to the survey. These tasks could be delegated to support persoimel, UA nursing professors said. Most of the school nurses spend a lot of time hi data management, Neighbors said. They See NURSING, Page SBNursing Continued from Page 1B spend so much time doing reports. The school nurses do get tied down with minutiae. Neighbors and her colleagues determined that nurses should be spending more time on policy de- velopment, health education, school health fairs and professional development. Karen Kerr, nursing coordinator for Gravette schools and past president of the Northwest Arkansas School Nurses Association, said the public sees her job as simply treating head lice and attaching Band-Aids. We are so trying to let [parents] know what we are doing, Kerr said. Theres so many people who dont realize what we do. We want to be recognized professionally because we have a college education. Cheatham spent 21 years in Lincoln before moving on to the UA Health Center in 2001. Our role as a nurse is a social worker, a teacher and a nurse, Cheatham said. IMMEDIATE NEEDS The person hired to be an advocate for the states school nurses in February said most school districts are meeting the bare minimum in providing nursing services. State health and education regulations only mandate school nurses to be licensed. The guidelines recommend a 1-nurse-per- 1,000 students ratio, which isn't enforced. The National Association of School Nurses, the nations largest nurses group, recommends a ratio of one nurse to 750 students. We have some immediate needs that need to be addressed, said Susanne Tullos, the state school nurse consultant for the state departments of education and health. Tullos was hired with funds from the voter-approved Coalition for a Healthy Arkansas Today, commonly known as CHART, a plan that organized the spending of Arkansas share of the master settlement with major tobacco companies. The Tobacco Settlement Proceed.s Act provides $60 million to the state each year. Tullos said she wants to be a voice in government for school nurses. My vision is to position Arkansas as the national leader in the delivery of school health services, Tullos told the group at the nurses institute. Arkansas is one of only 13 states to mandate school nursing services, according to the national nurses association. Most of Arkansas school nurses are licensed nurse practitioners, Tullos said. These types of nurses, who cant perform the same tasks as registered nurses, make less tlian their counterparts. According to Occupational Employment Statistics in 2000, a report of the U.S. Department of Labor, Arkansas 17,610 registered nurses earned an average of $38,770 a year. The states 11,850 licensed practical nurses averaged $24,340 annually. Tullos improvement plan starts with raising salaries, she said. Kerr, who has directed Gravettes school nursing services for 18 years, figures the average school nurses salary in Northwest Arkansas is $25,000 a year. The school nurse profession is under the jurisdiction of the Arkansas State Medical Board. The state Board of Education doesnt require certification for school nurses, only licensure, so districts pay their nurses like the rest of their noncertified employees. Noncertified jobs include custodians, bus drivers and maintenance workers. Kerr, a registered nurse, said her pay used to be the same as a beginning custodian. She successfully lobbied for a better salary. I want to see [children] get good health care, Kerr said. If it means making less... until we can get the school boards to recognize that certification. Ludwig is paid as a noncertified employee in Springdale even though she earned her National Board for Certification of School Nurses. Tullos said shes seen a salary as low as $8,000 a year, but she doesnt know if that was for a part- time or full-time position. 1 could never live on what 1 make as a school nurse, said Lydia Bush, who is the only school nurse for the Eureka Springs School District. "Its not that [school officials] are mean, Bush said. Theres only so much money. So often you run up against that brick wall of money. PAPERWORK, PAPERWORK Still, more registered nurses are joining the school ranks, according to the National Sample Survey of Registered Nurses, conducted by the U.S. Department of Health and Human Services. In 2000, 3,8 percent of registered nurses in the country worked in schools. The percentage was 2.7 percent in 1W2. New school nurses are finding they are responsible for an array of school health needs, especially in Arkansas. Arkansas Childrens Hospital in Little Rock has seen an 800 percent increase in child cases of obesity-related type 2 diabetes, known as adult-onset diabetes, accordr ing to the state Department of Health. On July 18, an associate professor at University of Arkansas for Medical Sciences in Little Rock told a legislative panel that 1999 data showed 10.9 percent of students in Arkansas were obese, compared with a national average of 9.9 percent. The kids, sometimes, are not getting health knowledge at home, Neighbors said. Thats why school nurses need to step up their efibrts in teaching children proper nutrition and basic hygiene. Neighbors said. School nurses dont have the time to deal with overall health education because they are bogged down in paperwork, according to the UA survey. School nurse Linda Wilkins, who oversees 950 students at Shiloh Christian School in Springdale, said working with people is at the heart of nursiilg, not administrative vvdfR. Wilkins referred to a woman who rose to fame during her work during the Crimean War in Europe in the 1850s. Florence Nightingale is the mother of nursing, Wilkins said. I guarantee you she didnt go into that battlefield with a notepad. The Education of All Handicapped Children Act, passed in 1975 and later known as the Individuals with Disabilities Act, has meant a broader role for school nurses in dealing with children who have medical problems, Tullos said. School nurses usually are the ones who fill out the numerous forms for these children, she said. They are almost always the only qualified person to give constant attention to medically fragile students. Even with their responsibilities. some nurses attending the conference in Springdale said they dont have much equipment. Teresa Ben, who started at Bentonvilles Lincoln Junior High last year, said she was surprised when she found she didnt have a wheelchair or even crutches for students. Our goal is to keep [students] in school, Kerr said. Healthy children learn.
This project was supported in part by a Digitizing Hidden Special Collections and Archives project grant from The Andrew W. Mellon Foundation and Council on Library and Information Resoources.