Wrapping It Up

Our action plan for HB No. 1896 included contacting the legislators who supported the bill, contacting possible supporters of the bill, keeping our blog updated on changes of the bill, interviewing a school nurse in the Waynesboro Public School District, and actively responding to comments on our blog.

For our first plan of action, we contacted Delegate Lionell Spruill, Sr. and Delegate Rosalyn Dance. Delegate Spruill's Chief of Staff, Susan Johnston Rowland, responded by thanking us for our interest in the bill and stating that the bill will not come back into session unless reintroduced in 2012. We have not yet received a response from Delegate Dance.

The possible supporters of the bill we chose to contact were Delegate Mark Obenshain, Delegate Robert D. Orrock, Sr, and Delegate R. Steven Landes. Delegate Obenshain responded by expressing his support for increasing opportunities of nurses in more rural areas of Virginia, and by thanking us for providing him with additional information about the legislation on school nurse to student ratios. Delegate Landes responded by reaffirming the importance of reducing the ratio for the benefit of student care, but with concern that government funding is necessary for this change to be initiated. We have not yet received a response from Delegate Orrock.

We have been following our bill closely but have not yet seen any updates for the 2012 session. We plan to continue to check the status of the bill for future changes as the Spring session approaches.

We spoke with a school nurse at William Perry Elementary School for our key informant interview. From her, we learned vital information about the services school nurses provide, many of which are much more advanced than first aid and wound care. She believes that decreasing the ratio would make her care more efficient and that an increase in hiring registered school nurses would help to provide high quality services to students and attend to the increased need for health services.

We have responded to any key concerns and comments posted on our blog thus far. This is not only enhancing our knowledge about the subject at hand, but also providing information to our peers about updates on the status of HB No. 1896.

In reflecting on our experience, we have gained understanding of the need for public health awareness in schools and across the nursing spectrum. Nursing is not just a profession found in hospitals, but throughout the community, even in rural areas. Increasing this awareness is necessary to provide the high quality care that students with developmental delays, special needs, and advanced medication requirements call for. By becoming familiar with public health policy and potential changes that could influence health care, nurses are more likely to take action to modify health services that may not be adequate. We hope to see HB No. 1896 reintroduced in the 2012 session and that changes are brought about in the near future.

Delegate and Legislator Outreach

Key Stakeholders Contacted:

Lionell Spruill, Sr. - Delegate Spruill is a Democrat representing the 77th district of Virginia. He is the chief patron of HB No.1896. He is a member of the Health, Welfare and Institutions Committee and has been actively involved in other bills regarding health care concerns.

Rosalyn R. Dance - Delegate Dance is a Democrat representing the 63rd district of Virginia since 2005. She has a history in Nursing, receiving her Bachelors of Science in Nursing from Virginia State University in 1986. She is also a co-patron of HB No.1896.

Mark Obenshain - Delegate Obenshain is a Republican representing the 26th district of Virginia since 2003. He is a member of the Board of Directors for the Harrisonburg Education Foundation.

Robert D. Orrock, Sr. - Delegate Orrock is a Republican representing the 54th district of Virginia. He is the Chairman for the Health, Welfare and Institutions Committee.

R. Steven Landes - Delegate Landes is a Republican representing the 25th district of Virginia. The 25th district encompasses the city of Waynesboro, part of Rockingham County, part of Augusta County and part of Albemarle County. He is the Vice Chair of the Education Committee as well as a member of the Student and Daycare Subcommittee.

Bill Updates:

There have been no new developments with Bill HB No.1896.

Taking A Position

Bill 1896 states there needs to be a 1:1000 nurse to student ratio in school systems. We believe this ratio is a step in the right direction; however, we would like to see the ratio decrease even more. It would be beneficial to the health of the student body and ideal if the ratio were to be 1:500. We recognize that this number is difficult to achieve due to financial and resource constraints, but this bill kick starts an effort to provide more efficient healthcare to students.

The National Association of School Nurses (NASN) proposed Ratio Bill H.R. 2229 to Congress in 2009 and again in 2011 as a National bill requesting the requirement of a decreased nurse to student ratio at 1:750 in the public school systems. While this is a National bill, our state level bill should also work toward this goal. At present, over 50% of US public schools do not have a full time RN. This percentage varies from state to state, and within urban and rural school districts. http://www.nasn.org/portals/0/legislation/NASN082011Advocacy.pdf

The need for school nurses has increased vastly, as students enrolled in schools today have more complex medical conditions and needs. Some of these needs entail asthma, food allergies, obesity, diabetes, vision and hearing difficulties, dental problems, mental and behavioral problems (autism, ADHD, etc.), and those who need prescribed medicine for both acute and chronic conditions. For many of these children, contact with a school nurse may be the only access they have to healthcare. For these reasons, in addition to others, it is imperative that this bill is passed to ensure that students receive the individualized care they require.

The key legislators and stakeholders of this bill were previously identified under the Governmental Objectives posting in the Political Influences section.

Our action plan includes:

- Contact the legislators supporting this bill, Lionell Spruill Sr. and Rosalyn R. Dance, and invite them to view our blog.

- Contact possible supporters of the bill to encourage their endorsement on the stance of decreasing the nurse to student ratio in public schools.

- Keep our blog updated on the current events related to this bill and topics associated with it.

- Interview a school nurse in the Waynesboro Public School District.

- Actively respond to comments posted on our blog page.

Governmental Objectives of Bill 22.1-274

Governmental Objectives:The governmental objectives of House Bill 1896 is to amend Bill 22.1-274. The main purpose of this revision is to increase safety of students by ensuring that the nurse to student ratio legally is at least 1:1000. This is an important concept in that there needs to be a registered nurse in the school for administration of all medications, namely insulin and glucagon, first aid injuries, CPR/AED emergencies, and general illness.

Political Influences:Lionell Spruill Sr. has served in the Virginia House of Delegates since 1994, and is a chief patron of House Bill 1896. He was born in Virginia and has four children, so he is well aware of the issues in Virginia school systems. His committee assignment includes the Health and Welfare Institutions Committee, of which he is also a subcommittee member. He has been the chief patron for multiple other bills over the past five years that encompass both healthcare aspects and involvement with school boards. Delegate Rosalyn R. Dance has been a member of the Virginia House of Delegates since 2005, and a retired registered nurse. She is assigned to the Appropriations Committee, which is a jurisdiction of state budget matters for health and human services and public safety. (http://legis.virginia.gov/)

Potential Impact of the Policy Change on Nursing:

The current school nurse-to-student ratio has many school nurses questioning whether or not school administrators recognize their role as being more than just givers of first-aid. With decreased funding for healthcare in schools, school nurse positions are not meeting necessary standards for providing high quality care to students. These cutbacks suggest that the school districts are not recognizing the increasing, complex, and chronic health problems of the students or contributions of the school nurse.

Through a key-informant interview that we conducted at William Perry Elementary School in Waynesboro, VA, we learned that the school nurse provides many services to students that districts may not know of, including diabetes care, medication administration, tube feedings, and psychosocial support or counseling in addition to first-aid and wound care. School nurses are hassled by constant interruptions and not enough time to finish work because of the lack of role delineation between school nurses and teachers, which causes stress experienced by school nurses. The high student-to-nurse ratio not only increases the stress, but also creates an inadequate work environment for the nurse to provide all services needed. High quality nursing care is not just something needed in hospitals. It is needed in all health communities, including schools where there is an increased need for health services by school nurses.

With more evidence of childhood obesity, diabetes, asthma, and other chronic conditions, there has been an increase in the need for medical attention in the school environment that can only be treated by a medical professional, such as a registered school nurse. Due to the lack of registered nurses being hired in schools, there are many untrained personnel providing care to students. In order for the proper care to be given to students with such chronic conditions, the school has to accept the need for registered school nurses in the building because untrained personnel cannot provide specific services related to these conditions. Individualized high quality nursing care can only be given to students if the ratio of registered school nurses to students is decreased. Clarification of the school nurse role may promote more effective health services in elementary schools, allowing for better and more individualized healthcare given to students.

Sadik, Nancy, "The School nurse role as perceived by elementary and middle school teachers" (1992).Master's Theses. Paper 358. http://scholarworks.sjsu.edu/etd_theses/358

Virginia House Bill No. 1896

We are analyzing House Bill No. 1896 to amend and reenact § 22.1-274 of the Code of Virginia, relating to school health services. In § 22.1-274, the bill stated that each school board in VA should strive to employ nursing services consistent with a ratio of at least 1 nurse per 1,000 students as of 1999. The new bill requires rather than suggests this ratio in each school building. This bill also proposes that nursing services shall include the administration of all medication to students. The new bill would no longer require the Board of Education to determine how school health funds are allocated. In keeping with § 22.1-274, nursing services will still be required to have current certification and training in CPR, insulin and glucagon administration, and emergency first aid.

To view the entire text of the proposed bill, visit: http://leg1.state.va.us/cgi-bin/legp504.exe?111+ful+HB1896

The sponsors of this bill are Delegate Lionell Spruill, Sr. and Delegate Rosalyn R. Dance.
Delegate Spruill, the Chief Patron of the bill, is in committee assignments for:
- Counties, Cites and Towns
- Health, Welfare and Institutions
- Privileges and Elections
Delegate Dance, the Co Patron of the bill, is in committee assignments for:
- Appropriations
- General laws
- Privileges and elections

This bill was proposed on January 11, 2011 and was left in the Education Committee on February 8, 2011.

Having been submersed in the local school systems this semester for our Community Health Practicum, we have noticed there is a lack of licensed on-hand nursing services for the student populations. Although we did not know the number of students at each school, it was clear that the need for nursing staff was greater than what was available.

The issue at hand is, even though it was suggested in § 22.1-274, there is not a ratio of 1 nurse per 1,000 students in these schools. This presents a dilemma for school health screenings and individual student medical attention.