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Please respond to the discussion post below.
250 words, APA format, and 2 references.
School nurses are governed by the Board of Nursing in their state, the state nurse practice act, and the nursing code of ethics, but also the department of education (“Iowa.gov,” 2021). This means that school nursing requirements and legal scope of practice may vary by state. The National Association of School Nurses (NASN) is an organization that works to define and set standards for school nurses nationwide. They do not set legal standards. They use position statements to measure ethical and practice standards (NASN, 2022). Iowa School Nurses Organization (ISNO) is the same organization at a state level (ISNO, 2022). The Iowa Department of Education has more specific regulations related to school nursing practice that provide detailed expectations (Munsey, 2011). There is no overseeing regulatory agency that holds school nurses accountable outside of litigation. Because of this, the is a wide range of practices within school nursing. Within the state of Iowa, I have met nurses who simply check in a few hours a week to ones that strive to meet the standards set by NASN and ISNO and are integral parts of the health care system in their area. I received no policy or procedure manual, very little instruction, and a lot of misunderstood responsibilities when I entered this position. With research, we are building a structure for the position.
The controversy we, the second school nurse and I, are facing is that our Superintendent does not understand, nor does he care to understand, what 21st-century school nursing is supposed to be. His advice last week was that we did not need a committee to bring care providers and staff together to coordinate care for students. If there is a student that needs help beyond giving medication and the minimal required management during school, we should contact public health and “make it their problem”. I explained that school nursing is a public health position and that the county nurses do not have the manpower to handle things that are well within my scope of practice. He stated that their lack of staff was not his problem. Regardless, the other school nurse who has junior high and high school and I are setting up health teams this year within our schools with the permission and participation of our principals to better coordinate care in all areas for our students. We are technically accountable to the Iowa Board of Nursing and will follow those guidelines, but expect some push back from our superintendent.
Ethical considerations are a struggle in our practice. I face teachers and staff who do not respect the privacy of students or fellow staff. I worked for three years to get our superintendent to move my desk. It was positioned right inside the door to the health office where those walking by and all students who came in could see confidential information I was working with and overheard many conversations about information seen in my office. The health office is constantly busy with students and staff, and it was impossible to work on health plans, documenting, and other sensitive information without others seeing it. I have been given a small private area at this time but have been informed it is only until someone else needs the space.
Also, we are governed by Family Education Rights and Privacy Act (FERPA) as a school, including the health records. This regulation is not as strict as HIPAA. The controversy is that records obtained from outside medical facilities are covered under HIPAA, but once in our system are considered covered by FERPA. Our computer systems are not HIPAA compliant, and it is a constant battle to limit those on staff that has access to the medical module of our system. FERPA only applies to schools that receive federal funding, so most private schools are exempt from FERPA and fall under HIPAA for the protection of health records (Gillard, 2020). I foresee a change in the future in how these records are protected but will likely occur after a lawsuit is filed. The evolution of school nursing will be an uphill battle.
Gilliard, K. W. (2020). Students’ Privacy Rights: Where HIPAA and FERPA Intersect. APTA Magazine, 12(8), 10–15.
Iowa School Nurse Organization (ISNO). (2022). https://www.isno.org/about-us/strategic-plan
Munsey, J. (2011). More than Band-Aids: An Overview of How Law Impacts School Nursing. Journal of Legal Nurse Consulting, 22(4), 17–22.
National Association of School Nurses (NASN). (2022). https://www.nasn.org/nasn-resources/professional-practice-documents/position-statements