Missouri Association of School Nurses Archives

School nurse group hopes Missouri districts will put federal aid toward hiring nurses

April 12, 2021 By Alisa Nelson

Missouri’s K-12 schools are getting a big chunk of change in the latest federal coronavirus relief package. The U.S. Department of Education says $1.95 billion total has been designated for Missouri schools. The plan also includes funding for a program to increase student internet connectivity for virtual learning and aid for nonpublic schools.

Missouri Governor Mike Parson speaks to schoolchildren and teachers in mid-Missouri’s California School District on September 9, 2020 (photo courtesy of the governor’s Flickr page)

Linda Neumann, with the Missouri Association of School Nurses, says the group hopes the state’s school districts will consider using some of the federal funding to hire school nurses.

“The Missouri Association of School Nurses is hoping that in Missouri, they will invest the federal funding in a way that will effectively achieve safer classrooms in schools, to improve the physical and mental health and academic success of children. Part of this involves hiring school nurses in those schools that do not have access to a school nurse,” says Neumann. “If they need school nurses or if they need a counselor or maybe they can expand the number of school nurses they have so that one school nurse doesn’t have to cover three schools.”

Neumann tells Missourinet a 2020 state Education Department report shows about 20% of Missouri public school districts do not have a nurse.

“For some students, the school nurse is their actual health care home because of lack of access in their community, especially in some of our rural communities. That tends to be where there is a lack of school nurses right now, where not every town has a doctor, dentist, or a pharmacy, but they have a school. If that school has a registered nurse there to take care of those kids, that school nurse can really fill in the gaps, find resources, and have resources brought in. “It’s not that schools don’t appreciate having a registered nurse there. It is often a budget issue,” she says.

Neumann says in the early 1990s, about 50% of Missouri public school districts did not have a school nurse on hand. Then, an effort began to tax smokeless tobacco products and designate that revenue toward putting more nurses in schools.

In 1995, Missouri allocated $5.4 million annually for 15 years for school health services, which increased school nurses in schools to 99.7%. That funding ended in 2010. As a result, not all school nurse positions were sustained.

For the schools without a registered school nurse, some have a health aide. Others rely on their principal or an administrative assistant to field health problems. Without a school nurse, Neumann says the level of expertise and care the kids are going to receive is not going to be the same.

According to the state Department of Health and Senior Services, there are more than 72,000 Missouri K-12 public school students with asthma, some 27,000 have life-threatening food allergies, about 7,300 suffer from seizures, and more than 2,200 have Type 1 diabetes.

“This doesn’t even mention the impact that COVID-19 has had on kids,” says Neumann. “COVID-19 has definitely disrupted learning of students and compromised their physical and mental health. We have seen anxiety and depression go up tremendously in our state both in children and adults during covid.”

Neumann says having a school nurse on staff helps to reduce student absenteeism.

“When a registered nurse is there to help manage those chronic health conditions, like asthma and diabetes, those are things that the healthier we can keep the kids the more they can be in school,” she says.

Neumann cites The Journal of American Medical Association showing the benefits of investing in a school nurse.

“Their determination was that in schools, for every dollar invested in a full-time registered school nurse, that society would gain $2.20,” she says.

When administrators or school boards are determining how many school nurses are needed, Neumann says the schools should keep in mind student safety.

“That means nurse to student ratio and it really varies depending on the health needs of the students and the social determinants of the population,” she says. “If you have 700 kids that are all well, one school nurse is sufficient. But if you have eight kids with Type 1 diabetes, three with seizure disorders, three with sickle cell, a kiddo with chemotherapy – there are just so many factors that play into that.”

Missouri has about 550 traditional public school districts and charter schools serving roughly 900,000 students.

Missouri bill would lower school immunization requirements

April 5, 2021 By Alisa Nelson

Missouri children attending daycares, K-12 public schools, or public higher education schools might not be required to get vaccinated against certain illnesses – if they have a “conscientious belief” opposing the immunizations. State Representative Suzie Pollock, R-Lebanon, is proposing the change for vaccinations against polio, rubella, rubeola, mumps, tetanus, whooping cough, diphtheria, and hepatitis B.

Current state law allows student vaccination exemptions for religious and medical reasons.

Her bill would also mean the state’s roughly 120,000 K-12 private, parochial, and parish school students would not have to get those vaccinations.

Missouri Capitol (Photo by Alisa Nelson)

Pollock says the state needs to reign in schools and local health departments.

“They require forms. Some schools and health departments require that the form be put on card stock or have a certain seal, or that they have to make an appointment with a nurse and watch a video. The difficulties just keep mounting and they make it more and more difficult every day,” Pollock says.

The legislation would only require the meningitis vaccination for Missouri college students living in publicly owned housing.

During a House committee hearing, Pollock, a registered cardiovascular invasive specialist, says more than 72 vaccination doses are required of students by the time they are 18, but most in the first four years.

“In 1982, there were 24 doses. And today, there are over 72 doses. There are no studies that they (vaccinations) are making them better,” says Pollock.

Linda Neumann, with the Missouri Association of School Nurses, says 31 doses are required before age 18 – not 72. She tells Missourinet the bill would weaken the state’s immunization requirements for kids at a time when other states are strengthening theirs.

“We believe that childhood immunizations are safe and effective. This is a real pivotal time for us. I hate to see us loosen our requirements,” she says. “Children in – it doesn’t matter what their setting is – whether it’s public, private, or parochial, they all deserve to live healthier and be free of communicable diseases. We have seen what’s happened with COVID-19 and what can happen with a communicable disease.”

Another example she points to is the measles.

“It’s extremely contagious and can lead to all kinds of things that you don’t want like blindness or brain damage, which is possible from the very high fevers. But thanks to the measles vaccine, we went from four million cases annually to in the year 2000, we were declared measles free in our country. But unfortunately the decline in the vaccination rate has led to a return to a measles outbreak,” she says. “In 2019, we had 1,282 cases, I believe, in the United States.”

Neumann cites a study saying about 40% of parents against vaccinations oppose them for philosophical reasons and another 60% oppose them due to inconvenience. She says there has been a huge effort, especially in Missouri, to increase access to students whose parents might not have the means to get their children to an immunization appointment.

“There are schools that have immunization vans come out during the summer to help run kids through before school starts,” says Neumann. “We’re doing everything we can to make it easier on parents, but we need parents’ help too. We understand that there are truly religious exemptions, but we also understand that not having your child immunized just because it’s an inconvenience leads to a bigger population that’s not immunized and we start losing herd immunity. We know that herd immunity works.”

Pollock calls the legislation a freedom bill.

“It separates and weakens government overreach into our private schools, businesses, and property,” says Pollock.

Neumann says she understands that people have rights and liberties.

“But we all have those rights and liberties. We have a right to feel protected from communicable diseases when we have vaccine to prevent these things,” says Neumann.

The Missouri House Elementary and Secondary Education Committee has voted 10-6 in favor of the bill. The House Rules Committee is considering Pollock’s measure.

To view House Bill 37, click here.

Missouri’s school nurses are on the front lines of COVID-19 response within classrooms

October 12, 2020 By Alisa Nelson

Missouri’s school nurses are playing key roles during this COVID-19 day and age. The state has about 1600 school nurses among Missouri’s more than 500 K-12 public school districts.

Missouri’s school nurses are on the front lines of COVID-19 response within classrooms

Linda Neumann, director of the Missouri Association of School Nurses, tells Missourinet school nurses have been going above and beyond the call of duty during the pandemic.

“It’s amazing how many of them volunteered to help coordinate the food deliveries, make porch visits so their kiddos with known high-risks or with social emotional needs had contact with their school nurse, and making phone calls to parents or grandparents to see what supports they needed,” she says.

They have spent countless hours collaborating with public health agencies and healthcare experts learning about the novel virus. Additionally, Neumann says school nurses must do coronavirus antigen testing within schools if their school decides to do testing. About 46 Missouri school districts do not have access to a school nurse.

She says the number of students living with mental health conditions have been “off the charts” for years and she expects the problems to increase due to the coronavirus, along with substance misuse among youth.

“There’s just so much that is going on with our kids in Missouri – it’s not just COVID-19. But COVID-19 has really added to the complexity of children growing up everywhere. When you lose someone to a pandemic and in some cases there are children that have lost multiple family members, this has just added to it all. And then our kids with social emotional disorders, to take their routines and turn them upside down has been really tough on them,” says Neumann.

According to Neumann, kids being diagnosed with ADHD, post-traumatic stress syndrome, food allergies, anxiety, bipolar disorder, and depression have climbed over the years.

Neumann says school nurses have been highly encouraging families to get their flu vaccinations this year.

“That’s the last thing you want is to get the flu and COVID-19 at the same time,” she says. “And you can very well get those viruses at the same time. Flu vaccines are so important, especially for our kiddos with chronic health conditions, especially for those kids that have asthma. It’s just imperative that they get their flu vaccine as soon as they can,” says Neumann.

She says fewer students visited a doctor over the summer to get their immunizations.

“I think a lot of that was fear of going to a pediatrician’s office. They have all their safety measures in place. They need to see those kids. Just because we are worried about COVID-19, doesn’t mean that we can’t have outbreaks of pertussis (whooping cough). We don’t want another run of the mumps or measles,” she says.

Education leaders have talked about the benefits of having students in school, including for their cognitive development, social and emotional needs, nutrition, among other things. Neumann says many students also get their primary healthcare from school. The school nurses serve as the bridge between health and education.

“We help meet those unmet health needs. We asses the children. We come up with interventions. We find resources for the kids. We are the eyes on the children,” says Neumann. “We have kids in school that are on respirators. We have kids in school that need tube feedings, that need catheters during the day. We help manage the kids that have Type 1 diabetes. We do a lot of health education, especially for kids who are newly-diagnosed with a food allergy, or newly-diagnosed with asthma or a seizure disorder or whatever it may be. We can provide education for not only the student and the parent, but making sure that our staff understands at least the basics of what that diagnosis is and knowing what to do in case of an emergency.”

State data shows about 112,000 K-12 public school students have a chronic health condition.

Nuemann says parents are busy and trying to make ends meet.

“We have parents that are single parents and they are working two jobs,” she says. “They are doing the best they can to raise their child. They don’t have time to take off to take their kids to the doctor. So, we try to fill the gaps.”

Molly Ticknor is the executive director of the Show-Me School-Based Health Alliance of Missouri, an organization supporting school-based health program sustainability and continued growth. The Missouri School Boards’ Association is the financial sponsor of the alliance and it also provides the alliance with administrative and financial management backbone support.

According to Ticknor, about 520,000 public and charter school students have access to at least one type of an external school-based health program in Missouri. The program could be focused on physical health, mental health, dental health or telehealth-based.

Ticknor says 79 Missouri counties have access to a school-based health service. There are regions of the state without access to such programs, especially some counties in northwest and southeast Missouri.