Dear Ohio School Nurses, Before I begin my report , I want to give a huge THANK YOU and a HUG to the school nurses in the Cleveland area. The tragedy with the school shooting is a nightmare that hits too close to home!! I can only imagine the fear and horror of the situation. My thoughts and prayers go out to all of those involved and everyone that is dealing with the aftermath. May God be with you!!

There has been a lot happening around the state and with school's focusing on student wellness, school nurses are more and more in the spotlight. We have had OASN representation at many functions and meetings. I will attempt to list some of them. We had OASN representation at:

• The ODH new School Nurse Conference. This resulted in several new memberships in regional organizations and several new memberships in OASN/NASN.
• The ONA Leadership summit (remember April 2, 2008 is the date for Nurses at the Statehouse sponsored by ONA).
• Discussion at Otterbein College regarding school nurse licensure.
• A wellness summit meeting with Ohio's First Lady Strickland.
• Statewide conference for Nutrition Supervisors.
• The by-law committee has been busy with revisions to the OASN by-laws to make them reflect the working committees of OASN. These changes, after the approval of the board of directors of OASN, will be brought for a general membership vote at the annual meeting during the OASN conference.
• Speaking of which, the save the date cards have been sent for the OASN conference. The conference is April 4-6, 2008 at Sawmill Creek Resort in Huron, OH. Plans are underway and it will be a conference packed with vital information for school nurses. So mark your calendars now and be sure to attend.

Sincerely,

Kathy Inderbitzin, RN, BSN, MEd.

OASN President
president@oasn.org

Some Items of Interest: School Clinics

• Letters have been sent to school superintendents whose school districts are on the "fast track" for renovation or construction of buildings. The letter explains that OASN has been working with the Ohio School Facilities Commission to develop recommendations for school clinics. Accompanying the letter was the list of recommendations that many of you contributed to. If you are a school nurse in a district that is in the process of renovation or construction and want to know if your superintendent was sent a letter, contact me at exdirector@oasn.org.

SWOSNA held its first general membership meeting for the 2007/08 school year on September 20, 2007 at the Holiday Inn, Dayton Mall. Fifty-one people attended the meeting. Catherine Strunk RN, BSN was the speaker presenting "A Psycho-educational Approach to Suicide Prevention." The November 8th General Membership Meeting will be held at the same location with the educational topic as "Ethical Dilemmas in School Nursing" presented by Stacy Flint , Kathy O'Dell and Crystal Thornton.

Announced in the newsletter and at the meeting were the recipients of the following awards: Cameos of Caring 2007 is Geneva Connally; NCSN Award is Andrea Smalls; Martha Carrick Scholarship is Chris Lazares Berry.

Membership is at 100 members which is only 55% of the membership recorded last spring. Two new members were received during the New School Nurse Orientation in Columbus. The SWOSNA BOD is concerned with the membership drop and are investigating possible causes.

The SWOSNA Board is also looking into two new initiatives for SWOSNA. The first is to select a Regional School Nurse each year. This school nurse would then be nominated for the Ohio School Nurse of the Year. Secondly, SWOSNA is assessing the need and feasibility of adding active marketing to the Public Relations Committee. SWOSNA would like to be seen as the school health expert in the southwest area of the state. A task force has been developed and is meeting to discuss strategies for both of these initiatives.

Joan Hlinomaz, RN, BSN, MS, NCSN
Southwest Ohio Representative to OASN

SEOASN had their Fall Meeting on November 1, 2007, the evening of the Children's Hospital School Health Update in Dublin, OH. Approximately. 12 members were present. Lesa Slack, SE Pres. presided over the meeting.

New members were introduced and introductions were done for everyone. Dues were collected and the following items were discussed.

• Concerns for the email distributed by Dorothy Bystrom were discussed. Concerns for delegation were discussed.
• Also addressed concerns for administration of OTC (Over the counter) medications by non-certified staff.
• Questions related to substitute school nurses were asked. Some questioned the legality of using LPNs and non-certificated RNs
• Annette addressed these issues and stated that she would get clarification from the board members at the OASN meeting on Sat. Nov. 3rd. SEOASN members were invited to attend the meeting if they wished.
• Lesa also addressed the need for election of officers for our spring meeting in Athens or Jackson in 2008. Location and date to be announced.
• Common concerns for individual schools were address and discussed.
• Meeting was adjourned.

Respectfully submitted,

Annette Scott, RN, BSN
SE representative to OASN

The COASN Board met in September at La Chatelaine Restaurant to set the goals and program for the year. The first dinner meeting for membership was held October 18th at the Arlington Banquet and Catering Center in Upper Arlington. The CNE topic was "The Impact of Family Violence on School-Aged Children: A Multidisciplinary Approach." The event was well attended with 53 present and among those were 6 first year members. Membership for this year is already at 100. A healthy financial picture was presented to the board by the treasurer Laurie Tufts with a balance of $4868.50. This year's president is Lisa Kaufman from Columbus Public Schools. Check the COASN website, www.coasn.com, for the January and spring general meeting dates and CNE topics. The newsletter will be published in the fall, winter and spring.

Goals for this year:

1. To increase awareness of the profession of school nursing in the community, in
2. To increase membership and involvement from all 14 counties.
3. To offer three CNE programs during the year.

COASN BOARD for 2007-2008

President - Lisa Kauffman (lkauffman5976@columbus.k12.oh.us)
Past President - Kate King
(KKing1153@columbus.k12.oh.us) President Elect/Nominations - Juanita Smith
(juanitasmith20@hotmail.com)
Vice President - Carolyn Bernard (cbernard5541@columbus.k12.oh.us)
Treasurer - Laura Tufts ( latufts@core.com )
Secretary - Shelly Jenkins (shellyjenkins@surfink.com) OASN Rep - Joan Keith (jkeith7518@aol.com )
Membership Chair - Carol Lynne O'Neil (coneil9958@columbus.k12.oh.us)
Hospitality Chair - Teri Ponzani
Newsletter, Public relations, and Library - Amy Hotler (ahotler@columbus.rr.com)
Web Site - Ginny Black (ginny715@columbus.rr.com)
Public Relations & Library - Amy Hotler
Research - Kim Carpenter

Respectfully Submitted,

Joan Keith, RN, MEd, NCSN

NEOASN held a "Kick-off" meeting to start the new school year on August 20th at the Shaker Campus of University School. Our speaker for the evening presentation was Dr. Ellen Rome, a pediatrician with the Cleveland Clinic who is board certified in adolescent medicine. She updated us on "Issues in Adolescent Medicine." She fielded questions on a wide range of topics including the HPV vaccine, medications for depression and anxiety, substance abuse data, obesity and nutrition, and resources for parents. The NEOASN board voted to make a contribution of $100 to the new OASN Education and Research Endowment Fund. This contribution was made to honor Diana Tirpak, a past president of NEOASN and OASN, as well as a National School Nurse of the Year.

The slate of officers for the NEOASN Board for 2007- 2008:

President--Elizabeth Anderson (earni2001@yahoo.com)
Past President--Deb Aloshen (trekker975@aol.com)
Vice President--Tish Perin (mperin@us.edu)
2nd Vice President--Pam Katz (pkatzm@hotmail.com)
Secretary--Cathy Fedor (jfedor@zoominternet.net)
Treasurer-- Lisa Mason-Smith (lbc55@sbcglobal.net)
OASN Rep.--Mary Massey (massey1234@aol.com)
Membership--Chris Bell (chris3040@aol.com)
Newsletter--Susan Inscore (scorein@aol.com)

NEOASN held their Fall Meeting on Saturday, October 27th at the Cuyahoga County Board of Health office. After a breakfast of omelettes, fruit, and muffins, we had a brief business meeting. Along with reports and updates, we voted for the by-laws change that will allow e-mails to be used as an acceptable form of communication for meeting notification, newsletters, executive committee business in emergency situations, and advance notice of future proposed amendment changes.

Our speaker was Lisa Metz, RN, from the Division of Pediatric Nephrology at Rainbow Babies and Children's Hospital. Her topic was "Pediatric Hypertension" and she gave statistics about increasing rates of hypertension that go along with the increasing obesity rates. She explained that hypertension is defined differently in children and every member present was given a laminated chart that correlates pediatric BP with age and height percentiles. The charts differ for boys and girls. She encouraged early identification of children with hypertension and gave suggestions for ways to help these kids.

We will hold the next meeting in February so as not to conflict with the OASN and ODH conferences later in the spring. The board will meet again in January to finalize plans.

Mary Massey
NE Rep. to OASN

Amy Rettig, Practice Consultant from the Ohio Board of Nursing (OBN), attended the OASN Board meeting on Nov. 3, 2007 to review the newly OBN adopted School Nurse Decision Making Models for Medication Administration and Nursing Tasks. Special emphasis was placed on the Medication Administration algorithm, specifically, clarifying the significance of Section 3313.713 ORC. The medication law in Chapter 3313 came to us in the 1980's allowing school districts the option to give medications in the school or not. Local school boards must adopt a policy either authorizing medication administration or prohibiting it. If medication administration is authorized, the policy must designate who is to administer medications. If unlicensed school personnel (non-nurses) are designated the authority to administer medications, which can be any medication including insulin, then the school nurse may be involved in providing training, consultation, and evaluation to ensure safety for students.

For example, if Joe the janitor has been designated by the school board to administer medications then the nurse does not have accountability of delegation because Joe has been designated the authority to administer medications. The nurse may train, consult, in-service, and possibly provide a performance evaluation. It may be appropriate for the School Nurse to convey to school administration that, "Joe is just not getting it."

It is important to look at the school board policy for medication administration. Nothing in the education law says that the nurse must provide the training although the school board policy may require this. It may be helpful that a policy be set up so that the nurse is not the only person designated to administer medications. Generally, except as specified in OBN rules, unlicensed persons cannot be delegated the ability to administer medications by a nurse. Administration of medications is part of the definition of the practice of nursing as a registered nurse. Rule 4723- 13-05(C), OAC allows nursing delegation of only the following over-the-counter medications: eye drops, ear drops, suppositories, foot soaks, enemas, and topical medications to be applied to intact skin, to unlicensed persons. However, Rule 4723-13-05(C), OAC provides an exception for situations in which unlicensed persons are "otherwise authorized by law", which allows for those unlicensed school personnel designated by school board policy the authority to administer medications. The School Nurse is not required to delegate to those individuals so authorized by school board policy because the definition of delegation, as stated in Rule 4723-13-01(C), OAC states that delegation is the transfer of responsibility for the performance of a selected nursing task from a licensed nurse authorized to perform the task to an individual who does not otherwise have the authority to perform the task.

In the case of emergency situations, EpiPens, Diastat, Glucagon & oxygen may be considered emergency medications and Section 4723.32(D), ORC provides that in emergency situations anyone can perform a nursing task. The nurse can still provide training in the use of these medications, similar to the idea of training CPR to staff, so that these emergency medications can be given more safely. This was carved out as an exception to nurse licensure so people could receive emergency care.

Section 3313.713, ORC, although understood fairly well by school nurses, has caused confusion with school administrators who believe that unlicensed school personnel (non-nurses) can be designated the authority to perform nursing tasks in addition to medication administration. Nursing tasks require nursing assessment and are child specific and time specific, meaning that the school nurse cannot delegate to anyone/everyone the task of catheterization, or tube feeding, or other nursing tasks to another school employee who would then perform that task on any/every student who needs that procedure. It might become necessary to withdraw the delegation to do a nursing task should the student's condition warrant. Delegation can be withdrawn at any time. The Ohio Department of Education may need to provide some clarification in education law with OASN assistance. The unlicensed practice of nursing is a felony and can be criminally prosecuted by the local prosecutor.

Further clarification was provided in regards to LPN practice. The scope of practice of an LPN (licensed practical nurse) is basic and the LPN contributes to the plan of care. It is outside the scope of practice for an LPN to practice independently as a School Nurse without the direction of a RN or physician.

The bottom line is safety for students and is a public health issue.

To review the School Nurse Decision Making Model , please visit the Ohio Board of Nursing website at: http://www.nursing.ohio.gov/P DFS/Practice/SchoolNurseModel0907.pdfs .
Contact Amy Rettig, nurse practice consultant, at the Ohio Board of Nursing office for further clarification in regard to the School Nurse Practice Model or other practice-related questions.

NASN NEWS YOU CAN USE

As we continue to report about the Endowment Fund, we are pleased to share that it continues to grow and now stands at over $14,000. In an effort to expand our OASN Awards and Programs, you will soon be receiving a letter containing detailed information regarding the Fund, along with a pledge card. This is OASN's way of providing everyone an opportunity to contribute to Ohio school nursing by sending in a donation to the Endowment Fund. Remember, there are various classifications of "angels" depending on the amount of an individual's cumulative contributions and every donation, large or small, is greatly appreciated.

As a donor you have the following Rights and Privileges:

To be informed of the organization's mission, the way the organization intends to use donated resources, and its capacity to use donations effectively for the intended purpose.

To have access to the most recent financial statements, by the publishing of a yearly summary report.

To be informed of the identity of those serving on the governing board and to expect prudent judgment in stewardship responsibilities.

To receive appropriate acknowledgement and recognition.

To be assured that information about their donations is handled with respect and confidentiality. To feel free to ask questions and receive prompt and truthful answers.

Our OASN Education and Research Endowment Advisory Committee and your OASN Board, working through the Columbus Medical Association Foundation, continue to adhere to these rights and privileges on a daily basis.

In the next Newsletter, I plan to share some background information about CMAF so that you will be better informed regarding their work and the numerous grants and awards they have initiated to help improve the health and welfare of children in our area.

Norma Nikkola, Endowment Chair
nnikkola@earthlink.net Donate online

Please see the OASN web page section Annual Conference. The save the date information and bio for the keynote speaker are posted. Thank you to Joe Kraus our graphic designer for all of his work. Joe is married to Marie Kraus the NW rep to the board.

The Save the Date cards were mailed out in mid October. If you did not receive yours please contact Maureen Knowles.

The agenda is set for the conference. All speakers have been confirmed and are excited to be joining us. We will have 3 very full days of interesting and timely presentations.

The first volley of vendor letters have gone out. We are actively seeking financial support for the conference. Promedica Hospital Corporate community Relations Vice President has been contacted and has set a meeting for October 31, 2007 to review our request.

Please remember that we will be requesting Regional Basket and the OASN Reps are asked to take our request back to their regions. Sandy Urquhart will manage the Silent Auction again this year, so begin to look for items you would care to donate.

Respectfully submitted,
Maureen Knowles
Vice President

An Endowment event is being planned on April 4, 2007, to coincide with the 2008 annual conference. This year's theme is titled, "Taste of Ohio". The event will feature several wines from Ohio wineries, along with delicious hors d'oeuvres . Additional information will be provided in the OASN conference registration packet and in the Winter edition of the newsletter.

Norma Nikkola

Renee Besecker and I recently met with representatives from the Ohio Department of Health and the Ohio Board of Nursing. The purpose of the meeting was to discuss the decision making models that were developed by OBN in regard to medication and treatment administration in schools. Each school district policy is different and the school nurse is advised to look at the board policy to see how medications/treatments are to be administered in their school district. The school board policy should be compared against the School Nurse Practice Models that are on the OBN website. The medication laws that effect nursing practice were not changed; however, new wording was added to help clarify what is being done in schools. For additional information on this topic, you should consider attending the OASN conference where Amy Rettig, practice consultant for OBN, and Holly Fisher, general counsel for OBN will address the members and explain nursing practice regulations.

After this meeting we went to the ODH to gather information for the meeting with the governor. The information that we desired to include for the meeting was the initial results of the 2006 ODH survey that was done with randomly selected schools around the state. The goal is for ODH to have this report completed by our conference time.

Later that day, Renee and I met with Governor Ted Strickland. This was an informative meeting with twelve professionals representing groups from around the state. Representation included counselors, psychologists, social workers, hunger alliance coalition, art educators, special ed. educators, physical education, and school nurses. Also present was Bill Harman, legislative director and John Stanford, executive assistant for policy education. The governor began by explaining the new budget and the implications of the budget as it relates to education. He then explained the vision of education reform that is being explored for Ohio. The Achieve Company in Washington DC completed a report that details changes that Ohio may want to consider for educational reform. As we reviewed this document, we tried to fit school nursing into the proposed plan and found that the Coordinated School Health Model is an exact fit for this reform. We shared with the governor the work done by Dr. Pat Cooper and showed him the reality of the ratio of school nurses to pupils in Ohio. We discussed the "Snapshot Report" for 2007 that was compiled by Nancy Moska with case study examples of how health services needs are being addressed in schools across the state. We shared the "reality" of school health services in Ohio that Eva Garcher compiled by cross referencing the reported "nurses" from the ODE website and the nurses that are reported on the OBN website. We talked and they listened.

This has been a long process, but I feel that those who can make a difference for school nursing in Ohio are beginning to listen to our cries. I want to THANK school nurses in Ohio for responding to our request for information either this time or ANYTIME in the history of OASN. School Nurses really ARE the VOICE for children in Ohio. Stay tuned for the next development!!

Respectfully submitted,

Kathy Inderbitzin RN, MEd, NCSN
OASN President 2006-2008

In the March 2008 elections the position of Treasurer is open. As per our by laws, I am to remain on the board as a consultant for one year. I am able to do this and hence as new incoming Treasurer, you will have some guidance. I would appreciate our members to give serious consideration as to who is willing to run for Treasurer.

As a Treasurer you need to be comfortable with computers, detail oriented and be able to attend the quarterly meetings. Quick Books is the software OASN is using. The bank we are using is Fifth Third and hopefully one is handy for the incoming Treasurer. OASN does take credit cards and this is all done through Quick Books. The executive director has a debit card which has cut down on a lot of check writing for the Treasurer.

The majority of your work is making entries into the computer ledger, making deposits, reconciling the books monthly. Where my help as consultant for one year will be in looking at budget, helping with the list of accounts and our annual tax filing.

If this position interests you and you have a desire to serve your professional organizations, please contact me: Debra Stoner, at mstoner@columbus.rr.com