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Opening a Charter School Health Office

School nurses should relish the opportunity to set the standards of care for their patient populations.

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Occasionally in life we are given a clean slate, an opportunity to design a program from scratch, and the ability to define our role. Such is the case with a school nurse hired to be the first school nurse of a charter school.

It is vital for the school nurse to not only recognize the opportunity, but also to acknowledge that the window of opportunity for establishing the role of the school nurse can pass quickly.

Utilizing a multitude of resources that are available through professional organizations such as the National Association of School Nurses (NASN), enlisting a mentor for support and guidance, and searching for opportunities to align with the school culture will help ensure the school nurse's success in establishing a coordinated and effective school health program.

Establishing School Nurse Role

The Standards of School Nursing Practice and Professional Performance serve to clarify and frame the many facets of the school nurse role in a start-up school.

Read More

School Nurses & Emergency Preparedness

School nurses can play a lead role in preparing for emergencies on campus and in the community.

The standards serve as a definitive guide for role implementation, interpretation and evaluation. This resource may be used along with state nurse practice acts, NASN position statements, and other relevant state laws or statutes in determining the adequacy and competency of school nursing practice.

If not already distributed to you, request a job description. If none exists, offer to assist in writing a job description for the school nurse. Determine if school policies and forms related to student health are in existence, and review the policies.

Also inquire about established crisis plans. From setting meeting times with administrators to ordering needed resources, the nurse will need to assert her own participation while developing a comprehensive plan for a coordinated school health program (see Table 1 for the first processes to initiate programming).

The charter school nurse must have a personal foundation of networks established through local, state and national school nurse associations to provide a support system. Since the school can be a single standalone institution, the charter, the charter nurse may be the only nurse in his/her organization. Establishing membership in the professional school nurse associations will serve as a resource for the multiple issues that may be encountered.

Credentialing varies by state. Is certification as a school nurse required in your state? Identifying and establishing a relationship with another certified school nurse as a mentor will assist in answering this plus many other questions.

Table 1: First Processes to Initiate Program

Collect resources, e.g., a statewide school nurse orientation manual, if available, and/or a leading school nurse text with orientation information.

Access state laws related to school nursing. Familiarize self with nurse practice act and regulations on delegation, if any.

Establish school nurse mentors and membership in professional school nurse associations.

Establish communication opportunities to the reporting administrator, school physician, social worker and teaching staff; conduct orientations/meetings.

Determine which school policies related to school health are needed, according to state law; and how you will contribute to them. Review job description.

Establish technology access, e.g., school software program, email account, printing, copying, fax, phone, etc.

Examine school environment and determine any immediate hazards to occupant's health and safety.

School nurses across the country continue to report that educators do not understand the role of the school nurse, or how the nursing skills and abilities can contribute to student success.2 Do you want to feel valued?

As the first school nurse, seize the window of opportunity and offer to prepare a presentation for staff describing the many roles of a school nurse. Also increase their awareness of the incidence of chronic health conditions in children, notably asthma, diabetes, seizures and severe allergies.

Become informed by accessing NASN's many tools including the two publications, NASN School Nurse and The Journal of School Nursing. Your confidence will soar when you access the NASN website for the position papers, issue briefs, and NASN Radio programs for relevant, timely information.

The nurse will assist the staff by teaching them to meet the healthcare needs of students on field trips as allowed per state delegation laws, and will contribute to school disaster management activities on wellness and safety teams.

The nurse will instruct the staff on their role in communicable disease outbreaks and assist with resources and instruction for health education lessons.

Most essentially, the nurse will free the teachers from taking care of health concerns such as dental problems, wound care, headaches, chronic and acute illnesses. The students return to class ready to learn.

Aligning With School Culture

Why is aligning with the school culture critical?

The school nurse's ability to integrate into the new school culture is vital to being effective in both starting up the health office and providing for the health and wellbeing of the community.

The culture of a charter school is cultivated continuously; the culture is the backdrop in front of which student interactions and learning occurs. School culture is defined as the shared beliefs and values that closely knit a community together.3

Misha Simmonds, Executive Director of University Heights Charter School (UHCS) states that "a strong school culture makes effective instruction possible."4 The culture is pivotal to a successful school. The culture is expressed through the words and phrases of the core beliefs and virtues, which serve to rewrite the future for each child.

The school nurse should view the child through the frame of the school virtues and repeat the core beliefs in communications to the students and staff. This assures that the nurse can integrate the health program into the daily life of the closely knit community.

A unique opportunity in charter schools exists: Using the daily 'morning circle' and assembly opportunities to present school wide health topics such as hand, cough or dental hygiene, nutrition and safety topics. During the morning circle, the school's core virtues are recited and reinforced to become an internalized code of behavior. An example is UHCS's core virtues of REACH - Respect, Excellence, Accountability, Caring, and Honesty.

Using this whole-school gathering, the school nurse can stand in as a community member, and stand out as the health expert aligned with the school culture. This exposure will ignite the school nurse's role in school health's program component of health promotion and health education component.

Setting Up the Health Office

Starting with an empty room, the school nurse will be establishing the school health office, the source location of the coordinated school health program.5

Using professional resources from NASN and nursing literature, the school health program will be developed in stages as the year progresses. The first stage will include planning the space for school health services and the functions occurring in the spaces (See Table 2 for steps in preparing the health room).

Table 2 Preparing the Health Room

Obtain first aid supplies for the most common health room visits and emergency situations.

Order age-appropriate screening and respiratory equipment.

Establish a system for medication storage and administration.

Order and arrange health room furniture with easy access to supplies, charts and privacy.

Prepare Health Forms on school letterhead and determine distribution opportunities, e.g., a registration event or student orientation day. Include on the forms: Emergency Information, Health History, Immunization Requirements and Medication Permission.

Determine student health concerns as health forms are returned, and with research on community health issues.

Order ample files and folders, color-coded by grade, if possible, to be kept in a locked cabinet.


While planning the space, don't forget about the need for a private area for assessments and parent meetings.

Additionally, a storage area is needed for the myriad of first aid and pharmaceutical supplies, a secure location for medication, refrigeration for ice packs and medications, ample lighting for assessments, and an age appropriate bathroom. The age and size of the children determine the type of vision, auditory and blood pressure screening equipment, oxygen and nebulizer tubing, and the size of the recovery couch, office chairs and tables.6

ADVANCE CONTEST!

Best Nursing Team 2013

Every team has at least one defining moment. What was yours for the past year?

Often overlooked in planning a health office budget are all the supplies required to set up a 'business' office; a computer, fax machine, copier, and shredder. The supplies needed and a thorough guide to setting up a new health office is found in School Nursing, A Comprehensive Text.6

Made From Scratch

The school nurse hired for a charter school has the opportunity to design the health program from scratch and define the role. The window of opportunity can pass quickly.

Utilizing the multitude of resources available from NASN, enlisting a mentor for support and guidance, and using the opportunities to align with the school culture will help ensure the school nurse's success in establishing a coordinated and effective school health program.

References for this article can be accessed here.

Laurie Rufolo is a school nurse at University Heights Charter School, Newark, NJ, and President of the Charter School Nurses of Essex County, NJ.


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