School Health and Nursing Services for Students with Disabilities in the Public School Setting
by Tanya A. Alvarado
The provision of nursing services to school aged children can be far reaching, particularly when one considers that in Pennsylvania there are approximately 2.1 million school aged children, 501 school districts, 100 charter schools and 12 full time comprehensive vocational technical schools. Pennsylvania law requires that all school aged children receive school health services, such as medical and dental examinations, five health screening for growth, vision, hearing, tuberculosis, and scoliosis, assessment for school immunizations and nursing services. However, children with special needs have added protections under federal and state law, which require the provision of additional school health and nursing services, if necessary to allow the student access to his or her educational program in the least restrictive environment.
Under the IDEA and Section 504, students with disabilities may be entitled to additional school health services and nursing services as a “related service.” These federal statutes define related services as developmental, corrective and other supportive services that are required to assist a child with a disability to benefit from special education. School nurse services are services that can only be provided by a licensed registered nurse who is certified by the Department of Education as a school nurse. In contrast, school health services are services that may be provided by either a qualified school nurse or by a qualified and trained layperson.
Although school entities are required to provide nursing services, they are not required to provide medical services – services that can only be provided by a licensed medical doctor. To distinguish whether a requested service is a nursing service (as a related service under IDEA) rather than a medical service, one should consider two questions: whether the student with a disability cannot attend school without the services, and whether the service can be provided by a school nurse or a qualified layperson. Under the IDEA and depending on the child’s individual needs, school health and nursing services may include clean intermittent catherization (“CIC”), suctioning of tracheotomy tube, helping the child eat at lunchtime, changing a quadriplegic child’s position in his or her wheelchair during the day, administering a nebulizer treatment, becoming knowledgeable about addressing a ventilator malfunction, medication administration (allowed by nurses only), and training in emergency procedures for the child.
A child who receives school health or nursing services should have these services identified in an Individual Health Care Plan (“IHP”) and Emergency Care Plan (“ECP”), if necessary. The school health team develops the IHP and ECP, and includes the student, parents, school nurse, Section 504/IEP Coordinator, teachers and staff who have primary responsibility for the student. With these services, the IDEA and Section 504 have enabled the school entity, nurses, and family to work together to design an individualized program that would allow students with disabilities to attend school in the least restrictive environment.