Where’s the Nurse? Bill Would Change How Virginia Schools Provide Healthcare

A proposed bill could prompt changes in schools across the Commonwealth.

RICHMOND – We’re at a point where kids get a major bit of their healthcare from school nurses. However, in Virginia schools, you might not have an actual nurse filling that role.

Since Virginia’s Standards of Quality don’t require districts to hire registered nurses, they at times find a nursing assistant or staff member with medical training. To put it in perspective, there are 133 school districts in Virginia, serving more than 1.26 million students. According to the Virginia Association of School Nurses, there are only 113 nationally certified nurses currently employed in public schools.

That’s where Del. Dawn Adams comes in. Her House Bill 1736 would require each school district to employ at least one school nurse for each elementary, middle and high school. And let’s be clear. That means one nationally certified, registered nurse. The bill defines a school nurse as a registered nurse engaged in the specialized practice of nursing. .

The Issue in Virginia Schools

“The bottom line is our kids are getting more and more of their healthcare – and many, many kids are getting more of their healthcare – in schools. Which, you know, is not optimal, but it’s a fact,” Adams said. “When you go to the school nurse, it’s important that parents understand that it is, in fact, a nurse.”

However, the term nurse as it relates to a school nurse currently has no set boundaries in Virginia. Differentiation for the position occurs across the commonwealth.

“Currently, a school nurse can be anybody from a registered nurse, an LPN or just a neighbor down the street who wants to help out,” Adams said. “What that means, though, is that you have various levels of understanding for what the expectations should be of a school nurse. And parents really don’t have good transparency about what their expectations should be of a school nurse.”

Since children exhibit serious illnesses at young ages including diabetes, asthma and other health-related issues, Adams suggested a school nurse have specific education and training.

“Optimally, you want that person as a baseline – if you’re going to call them a nurse, to actually be a nurse,” Adams said. “But there is also an issue of scope of practice, meaning if I’m a registered nurse, I can do these things. If I’m an LPN, I can do these things. But then, an LPN actually cannot work without having the supervision of a registered nurse or a physician. That is because there is critical thinking that is a part of a registered nurse, that you get extra training to be able to perform. You do assessment and evaluation, which is not in the scope of practice for an LPN.”

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Changes Pending in Virginia Schools

Adams expressed that the change is that of nomenclature – basically, a designation.

For example, when a person visits a doctor, they expect treatment from a white coat, medical professional with a degree from a medical school – not a hiker with no post-secondary education fresh off of the Appalachian Trail. Sure, the hiker probably has some great first-aid skills and knows about emergency treatment options. However, calling the hiker a doctor doesn’t make him one. Therein lies the issue with the term school nurse.

“It’s a nomenclature issue and it’s a transparency issue,” Adams said. “And then if there are other healthcare providers in the school system, they’re not going to be called school nurses. At least then, parents know. You have a school nurse, that’s what it is. Anybody else will be called something else.”

The alteration doesn’t mean Adams – a doctoral prepared nurse practitioner with nearly 35 years of clinical and administrative healthcare experience – wants anyone to be out of a job.

“If a school does not have a registered nurse as a school nurse, they need to change whatever that provider’s title is going to be,” Adams said. “And it shouldn’t be grandfathered that a school nurse is anything but a registered nurse because that’ll just muddy the water and sort of takes away from the clarity of the issue.”

The Process

Adams prefiled the bill back in August. However, that doesn’t mean it went straight to the top for approval. There’s an entire process for a bill to become a law.

Currently, Adams said HB1736 is in the introduction phase.

“Once it is introduced, it has to go to a committee assignment. From committee assignment, it will get assigned to a subcommittee. It will get voted on if it passes out of sub. If it goes to committee and passes out, it goes to the floor. If it goes to the floor and passes out, it goes to the senate,” Adams said. “It goes to their committee, sub committee and then it has to go to their floor and then back out.”

HB1736 will go up for offering on Jan. 13, 2021. The delegate stressed the importance of the change.

“It’s incumbent upon us to sort of make sure that we prepare the staff within the environment that children are to the best of their ability. We’re seeing kids are getting their healthcare there. They’re also having increased illnesses. They’re also having increased needs that are health related,” Adams said. “So we want to make sure that they get quality care so that there’s just no concern and worry that they might be getting sub-optimal, substandard care. And I don’t mean that to be harsh or derogatory to people who aren’t registered nurses. It’s just that there’s a level of expertise and understanding and training and knowledge that is unique to that role. And I think that is preferable when we’re talking about an independent role within a school system that is specific to the health needs of our children.”

Amie Knowles reports for Dogwood. You can reach her at [email protected]