The OSH has more than 1,500 nurses assigned to New York City pubic and non-public schools, the largest and most diverse school district in the U.S. The student population ranges from pre-kindergarten through high school and comprises both general education and special education students. In conjunction with this responsibility, we are trained and prepared to respond to New York City emergencies.

OSH nurses are called upon to provide nursing services in emergency shelters, and we responded to the World Trade Center disaster. In addition, we are prepared to mobilize and help operate points of distribution centers that would distribute medications in the case of a biological disaster involving anthrax or smallpox. OSH nurses have also been involved in initiatives that require mass immunizations for New York City mandates and have responded to disease outbreaks.

Hurricane Relief

When Hurricane Sandy devastated the region, our nurses responded. The wreckage and aftermath created by Sandy continues to impact the day-to-day role of the OSH team tending to displaced and traumatized students and families.

Our nurses were activated to assist in setting up and staffing more than 65 evacuation centers and multiple shelters throughout the five boroughs. These "New York's Most Trusted" served our city and cared for the displaced while also balancing the personal demands of family and friends also affected by Sandy.

In one Queens evacuation center, OSH nurses assisted with coordination of resources and care of more than 500 people, ranging from a newborn of 7 days to a 90-year-old. In addition, school nurses responded to contingency plans to relocate displaced students and families who lost their loved ones, homes and cars so they could attend school without loss of skilled nursing services.

History

Nursing presence within the school system goes as far back as 1902, when the focus was to reduce health-related absenteeism.1 Historically, medically and psychologically fragile students received their education at home, were taught in separate buildings or were institutionalized.

In 1973, the Section 504 of the federal Rehabilitation Act was passed, prohibiting discrimination against any person in any program or activity receiving federal funds. This legislation opened the door to place nurses in the school setting to meet medical needs, allowing students to be educated in the least restrictive environment. Today, school nurses provide well, acute and chronic care for all children, including those with special needs.

Disease Management

The role of the school nurse continues to expand in response to the increased medical acuity of the student population. The forefront of school nursing remains focused on reducing health-related absenteeism, with a new focus on health promotion and disease prevention through nursing education.

Today, with better healthcare, chronic diseases are diagnosed earlier and treatment options vary. A student in the New York City public school system diagnosed with diabetes in the first grade will be put on an insulin pen, then progress to an insulin pump. OSH nurses are trained to respond to various aspects of diabetes care, and they were an integral part of the development of a nationally recognized program for management of the disease.

Serving the needs of the students of New York City's school system is complex. Daily nursing encounters provide nurses the opportunity to teach students disease management skills to decrease the effects of chronic disease and foster health promotion. In the school setting, nurses can see the entire spectrum of medical and psychological disease, covering all specialties in healthcare.

One objective of the OSH is to educate families and equip students with tools to better manage chronic illness. This is accomplished by fostering positive change in their lifestyle and connecting them to the resources within their community. Prevention, early detection and treatment of these disease entities are key. School nurses teach students the skills required to follow their medical regimen while monitoring compliance to medications and diet. These lifestyle changes affect school attendance, grades, interpersonal relationships and lifelong physical and psychological well-being.

Adding to the complexity of care, New York City is known for its population density and cultural diversity. The OSH provides ongoing professional development in cultural sensitivity, and communication between students, their families and nurses presents daily challenges. Nurses have to continuously develop creative means to convey important healthcare messages to ensure understanding.

Education

National health goals such as the CDC's "Healthy People 2010" plan continue to directly influence the creation of new initiatives. Locally, the Healthy Options and Physical Activity Program in Schools initiative was developed to address obesity. Additional programs spearheaded by OSH include:

• screening the at-risk student;

• focusing on mental health issues;

• connecting adolescents to comprehensive healthcare; and

• addressing reproductive healthcare issues such as STDs and pregnancy.

To address absenteeism and encourage students to better understand and manage their asthma, a comprehensive program for asthma was developed. This asthma initiative includes a course given by the elementary school nurses called Open Airways (OAS). OAS was developed by the American Lung Association for students with asthma in the fourth grade. The goal of the initiative is to ensure students receive regular medical supervision and are not overly restricted in their activities.

EHR

The development of the Automated School Health Record (ASHR) assists in communicating medical history as students transfer from school to school. The electronic health record follows the student to any school the child is registered in within New York City's public school system. The OSH staff has immediate access to the history, conditions, doctors' orders and reports, without having to wait for the transfer of paper records. The ASHR also is responsible for syndromic surveillance throughout the city.

The school nurse is the sole medical professional within the building and often works with limited resources. By using the nursing process and evidence-based practice model, the school nurse is autonomous and self-directed. The dynamic role of the school nurse has changed over the years and continues to expand in response to the ever-growing needs of the children of New York City.

References for this article can be accessed at www.advanceweb.com/Nurses. Click on Resources, then References.

Diane Arfsten, Angela Burke, Karen Rodriquez and Marianne Traverson are supervisors in New York City's Office of School Health. Diane Triunfo a borough nursing director.