Leadership Matters - March 2013

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.

 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.

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 Dr. David Turner Clinical Assistant Professor at the University of Illinois Springfield (UIS)

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

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

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)

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:

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