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