New York City has the largest school district in the United States, serving 1.3 million students in over 1,800 schools. It is comprised of five boroughs, separated by various waterways. Here is a list of the boroughs in descending order according to student population: Brooklyn, Queens, Bronx, Manhattan and Staten Island.
The OSH (Office of School Health) is a combined program of the Department of Education (DOE) and the Department of Health and Mental Hygiene (DOHMH). Gail Adman, BSN RN, MPH, is the director of nursing for the OSH. There is a nursing director in each borough comprised of a network of supervisors and nurses. Each network’s ratio is 30-40 nurses per one supervisor. In addition to the OSH, several private school nurses are employed by their individual schools and practice independently.
District 75 is an organization within the DOE that provides citywide educational, vocational, and behavior support programs for students who are on the autism spectrum, have significant cognitive delays, are sensory impaired, and/or are severely emotionally challenged. District 75’s schools and programs are located at more than 310 sites with supervisors and nurses forming their own networks.
All OSH elementary and intermediate schools use an invaluable electronic software tool known as Automated Student Health Record (ASHR), which has greatly expanded the ability of school nurses to care for students. It also assures that records are immediately available when a student transfers schools. Another effective tool found on the OSH software is all health/nursing forms are available in different languages, which is important as many different languages are spoken by the students and their caretakers.
Ten percent of students are diagnosed with asthma in NYC. Elementary school nurses teach students with asthma through the Open Airway for Schools program. Students who complete the program take more steps to manage their asthma, which leads to having fewer absences, and less severe asthma episodes. The program is taught twice a year. Each school has a stock supply of Ventolin and Flovent. The Flovent initiative started in 2016, and students with persistent asthma can receive this controller medication from the school nurse each morning. There is also a large population of students who receive Ventolin pre-exercise as this has proved to decrease asthma episodes.
School nurses also implement the Healthy Options and Physical Activity Program (HOP) to assist children and families in developing healthy lifestyles. If any student’s BMI is greater than 99th percentile, then he/she is offered the option to join the program. The program consists of a clinical assessment, health education, nutrition counseling, and referrals to available resources in the community. OSH has also currently implemented two new programs, Connecting Adolescents to Comprehensive Health (CATCH) and Screening the Student at Risk (STARS).
All OSH nurses are required to attend conference days where updates and yearly data collection are discussed. There are also mandatory online training courses where information is exchanged. Telephone conference calls are held monthly within each network. Newly hired school nurses receive a six-week orientation, which includes working with a preceptor.
As you can see by the information I have shared, the NYC Office of School Health has taken several initiatives to improve the health and well-being of students. I look forward to your comments and questions about similarities, or differences between this structure and school health services in your area. Please let me know if you are interested in short articles about any other zones in our statewide organization.
Mary Fitzpatrick, BSN, RN, NCSN