The summer flew by. We are counting the days until next summer, or maybe to retirement. No matter what you are counting, everyone knows that our students are relying on us to keep them healthy. I heard a wonderful thought about children who might be referred to as “frequent flyers” from a nurse who is very dear to my heart. My friend stated that she calls those students her “daily vitamins -taking them no matter what.”

I had an opportunity to visit Denver, Colorado over the summer for the Annual National Association of School Nurses Conference. At the NASN conference, school nurses were referred to as the School’s Chief Officer of Health. I like that title, but we can’t use it in Pennsylvania, so keep it in the back of your minds with our super nurse emblem.  The national conference always offers many valuable programs each summer. If you are unable to attend next year, keep in mind that for a fee, there is an option to live-stream the conference that allows you to partake in the educational programs without being physically present.

In July, we held the 19^th PSEA Department of Pupil Services Annual Conference at the historic and beautiful Nittany Lion Inn, in State College. As always, the conference was thought provoking and time well spent for the participants. The school nurse section featured the Dexcom and Medtronic representatives who discussed the Dexcom 6 process, Medtronic-MiniMed 67, and the closed loop system. The general sessions included a new way of looking at the grieving process, dangers of vaping tobacco, and the new digital world. Additionally, the breakout sessions included the following topics: medical marijuana, immigration, and my favorite, the Advocacy for Children and Education training. I am looking forward to attending our 20^th Annual Conference in 2020. Additionally, PSEA recorded a few sessions for Act 48 credits, and those courses will be posted on the PSEA’s Professional Learning Exchange soon. 

You can also check out these two upcoming training opportunities in the PSEA Northeastern and Eastern Regions: 

Northeastern-DPS-conference-flyer-2019.pdf

Easternregion_save-the-date.pdf

In closing, as we listen to the crickets, watch the beautiful chrysanthemums bloom, hear the school band practicing, and feel that cool crisp air, remember you are an awesome nurse. As your plate fills up this year, try to enjoy each course served. Keep in mind, our students are counting on us every day of this school year. Have a wonderful 2019-20 school year! 

Best –

Alice Uhrich

Diabetes – National Association of School Nurses Conference (NASC) and PSEA Department of Pupil Services Annual Conference shared valuable information on the care of students with diabetes who use the Dexcom 6 and/or the Medtronics system. Medtronics shared an app that you can download and use to run practice scenarios. Attached is information for you:

ADA-CGM-Guidelines.pdf

Medtronic_Minimed-670g-School-Nurse-Guide.pdf

Diabetes-advisory-For-DPS-Dec-2016.pdf

School Jurisdiction - is a topic discussed at every meeting whether it is in your local school, state level meeting, or PSEA School Nurse Section meetings. NASN covered this topic in their session titled “School Nurse Legal Responsibilities for Students Before and After the Bell” presented by Elizabeth Clark. This presentation equipped you with the information needed to not only educate yourself to better understand, but it gave you the resources to educate your administrators and advocate for the safety of our students before and after school as well as on field trips. As a reminder, we do not delegate in Pennsylvania.

Attached information for you:

NASN-Position-Statement-After-School.pdf

NASN-Position-Statement-Field-Trips.pdf

Definition-of-School-Sponsored.pdf

References-on-School-Jurisdiction-From-DPS-Conference.pdf

CPR in Schools Act 7 2019   the CPR/AED toolkits for schools may hopefully be available mid-Oct.

More Important Topics

Immunization updates –

There are outbreaks across the commonwealth involving both Measles and Mumps:

• Temple University more than 100 cases of mumps reported this year. They now have more stringent vaccination requirements, like Penn State University, to keep their campus safe.

• York had a measles outbreak that required quarantining people. FYI – if someone was exposed to measles and they have no symptoms but visit many establishments, they can still spread the virus in those areas visited. The measles virus is highly contagious, and it stays in the air environment up to two hours after the infected person has left the room.

• The Immunization manual has been updated but is waiting review and approval. Do not confuse Meningococcal conjugate or MenACWY (Menacta and Menveo) with Serogroup B meningococcal or MenB vaccines (Bexsero and Tr, umenba) They are not the same. Children ages 11-12 should get a meningococcal conjugate vaccine, with a booster dose at age 16. Teens and young adults (Ages 16-23) also may get a serogroup B meningococcal vaccine, but it is currently not required for school.

• Pre-school and child-care fall under the childcare immunization guidelines. They must have all the ACIP- recommended immunizations- this includes Hepatitis A and the yearly flu vaccine.

More Important Topics

There are outbreaks across the commonwealth involving both Measles and Mumps.

• Temple University more than 100 cases of mumps reported this year. They now have more stringent vaccination requirements, like Penn State University, to keep their campus safe.

• York had a measles outbreak that required quarantining people. FYI – if someone was exposed to measles and they have no symptoms but visit many establishments, they can still spread the virus in those areas visited. The measles virus is highly contagious, and it stays in the air environment up to two hours after the infected person has left the room.

• The Immunization manual has been updated but is waiting review and approval.

• Do not confuse Meningococcal conjugate or MenACWY (Menacta and Menveo) with Serogroup B meningococcal or MenB vaccines (Bexsero and Tr, umenba) They are not the same. Children ages 11-12 should get a meningococcal conjugate vaccine, with a booster dose at age 16. Teens and young adults (Ages 16-23) also may get a serogroup B meningococcal vaccine, but it is currently not required for school.

• Pre-school and child-care fall under the childcare immunization guidelines. They must have all the ACIP- recommended immunizations- this includes Hepatitis A and the yearly flu vaccine.

What spurred July’s PENN LINK? Tdap noncompliance.

A nurse manually reviewed her school’s immunizations and found hundreds of student immunization records that were not in compliance due to the timing of the administration of the Tdap vaccine. Nurses from across the state were also noting non-compliance with the correct timing for Tdap administration.

Please refer to the PA Department of Health letter you received that is dated Aug. 12, 2019, and signed by Thomas McCleaf, Director.

Tdap-letter---signed-20190812.pdf

News on medical exemptions and immunizations

Medical exemptions should only be written for children when the vaccine would endanger their health. Medical exemptions should not be written because the timing of a vaccine is not within the required intervals, and the physician believes the child is adequately immunized.

A school district should never encourage a parent/guardian sign an exemption form to aid in the convenience of enrolling a child into school. If an outbreak occurred, that child would be excluded from school. And if a child died as a result of that outbreak, the parent could take legal action against the nurse or district.

There are NO Exemptions for students wanting to attend college. Exemptions are only an option in the school age child – NOT at the college level.

Students who jump a grade level - Students may start the year as a junior and then “jump” to their senior year to graduate early.  (Yes, this happens.)  That child is required to receive their second MCV within the five-day window or be excluded. THERE IS NO 30-DAY PROVISIONAL!!

Homeless students – McKinney-Vento Liaison

Homeless students still need all immunizations.  Every school district has a McKinney-Vento Liaison who is federally hired and paid to assist these homeless students. This includes providing transportation to health care appointments and making sure they get immunized in a timely manner.  In order to find the liaison for your school, use this link: Directory Center-School Homeless Liaison

Confusion about a 30-day provisional period for transferring students

When a student transfers to your school from another school, in state or out-of-state, you have 30 days to obtain their immunization record from the previous school. However, as soon as you obtain the immunization record, the five-day window begins. If you receive the immunization records when the incoming child registers to enter your school, there is no additional provisional time for them. If you receive the student’s immunization record on the 10th day of their enrollment, then any immunizations need to be completed within five-days. The student does not get a 30-day provisional period, unless you don’t get the record until day 30.

Foreign exchange student immunizations

When reviewing immunization records for students coming from other countries:

• Make sure the polio is the trivalent IPV (tOPV). Even though it is not given in the U.S. anymore, OPV or oral Polio vaccine is still given in other parts of the world. IPV is required, so make sure it is IPV. 
• Make sure the meningitis vaccine is for meningitis A (MCV4). Foreign countries vaccinate for meningitis C that is totally different and doesn’t replace MCV4.

 Medical appointment/medical certificate- Students with Special Education Needs

A medical certificate is written by the doctor to verify the date the child is medically able to receive and will receive the next vaccine in the series.  The child should be medically up to date before the medical certificate is written.  A medical certificate is NOT a note from the doctor or health clinic stating an appointment time in the future because the office does not have a sooner appointment available or has run out of vaccine and is waiting for new supply. 

 Ex:  MCV #2.   Student has five days (or shorter if your district has this rule) to provide proof of the immunization.  MD certificate says the appointment is Sept. 10, and this is the seventh day of the senior year.  Please know, this is not adequate information.

CDC vaccine schedule

PA CODE for immunizations

We need to hear from you!

School Nurse Section met on Sept. 20 in Harrisburg. The next meeting will be a virtual meeting in the winter 2020. Your region representative is available year-round to help you get your questions answered. Please reach out to your region representative today to share your concerns, questions, and success stories!

Welcome to new PSEA School Nurse Section region representatives, Patti Dempsey and Kelly Keegan!

Thank you to those School Nurse Section board members who retired. Thank you to Barbara Magnotta and Barbara Filer who were fortunate to retire this June. Barb Magnotta shared five- years with the DPS committee and SNS board as their Legislative representative. She also served as a Western representative.  Barb Filer shared two years with the SNS board as the Eastern region representative. Thank you both for choosing this path in your life.  Please enjoy your retirement years!

Happy Retirement wishes to Jill Clodgo - PA DOH School Health Director.