Page 16 - Leadership Matters March 2013 issue.pub

16
The school nurse dilemma
Daniel Patrick Moynihan once
said, “Everyone is entitled to his
own opinion, but not his own
facts.” There is a good deal of
opinion offered here. Hopefully it
is supported by enough fact that it
maintains credence.
This article about the school
nurse situation comes from a
number of perspectives. First is
that of a long time — and long ago
— school principal. The second is
that of the former Executive
Director of the Illinois Principals
Association (IPA), and the third
from the memory of a school nurse’s husband with an
old axe to grind.
This issue has been around for a long time.
According to the Illinois Revised Statues, Section 10-
22.23 of The School Code of Illinois, Boards of
Education are empowered to employ registered
professional nurses, and that all
school nurses employed after July
1, 1976 must hold a School Service
Personnel Certificate, Type 73.
School nurses hired prior to that
date were “grandfathered” into the
system.
Section 21-25 of The School
Code outlines the Type 73
Certificate and the Illinois Nursing
Act outlines duties and
qualifications for Certified School
Nurses (CSNs). In reality, and in
keeping with The School Code, any
school nurse who has been
employed for less than 36 years
should be a CSN. That is not the case. For a host of
valid reasons, school districts have hired Registered
Nurses (RNs) who do not hold Type 73 certificates,
and ISBE has not aggressively forced the issue.
The issue now seems to have boiled down to who
is qualified to make recommendations regarding
educational interventions, accommodations or
modifications based on the findings of a student’s
medical review. In other words, who can attend an
Individualized Education Plan (IEP) meeting and
make a placement recommendation.
There are a number of categories of licenses
issued to nurses by the Illinois Department of
Financial and Professional Regulation (IDFPR),
including:
 Licensed Practical Nurses (LPNs), who have one
year of medical but no academic training;
 RNs, who hold two-year Associate Degrees in
Nursing but no academic training;
 RNs with three years of training and a diploma but
no degree or academic training;
 RNs with Baccalaureate Degrees;
 Advanced Practice Nurses (APNs) with a
graduate degree or post-masters certificate; and
 CSNs, which are RNs and hold ISBE Type 73
certification.
Here is the tough part: Only RNs with
Baccalaureates, APNs and CSNs are qualified to
conduct medical reviews, and only CSNs are qualified
to make educational recommendations. The issue of
making educational placement recommendations will
be revisited.
I was a fortunate rookie principal in that I had a
very competent school nurse for our 650 students.
We did not share her time with
other buildings. She was an RN,
and this was before the advent of
the CSN requirement. She did all
of the usual school nurse duties
like keeping immunizations up to
date and dealing with injuries and
illnesses. She also checked on
absentees for “real” illnesses and
made home visits that kept our
Average Daily Attendance (ADA)
high.
And, she attended IEP
meetings with well-crafted
medical reviews. No one
questioned her qualifications or
competencies. The Type 73 did not exist then and
everything worked very well. Over the course of 20
years as a high school principal, I worked with a
number of RNs, none of whom had CSN credentials,
and, again, everything worked very well.
During my years at the IPA, this issue surfaced a
couple of times and faded away, but I gained an
appreciation of its impact on schools and school
districts. I also came to understand the importance of
“a place at the table” in dealing with government
agencies and the influence that the Illinois Nurses
Association (INA) and the Illinois School Nurses
Association (ISNA) had with the legislature and the
State Board. The CSN rules and regulations did not
originate with school people or legislators but with the
(Continued on page 17)
Dr. David Turner
Clinical Assistant
Professor at the
University of Illinois
Springfield (UIS)