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Provision of School Health Services to Private/Non-public Schools

In 1962, the legislature passed the School Nurse Act. This act was considered revolutionary at the time because it required equitable services be provided to students, whether they attended public or non-public schools. This law remains in effect today as Section 1402(a.1) of the Pennsylvania Public School Code.

The Department of Health regulations state in Section 23.51 "A child in private, parochial and public schools shall be provided with school nurse services in the school which the child attends;" and Section 23.52 "The school nurse services shall be provided through the public school system and the administration of this service shall be the responsibility of the public school administrator in consultation, as needed, with the private or parochial school administrator.

School nurse services are considered to be one of the mandated services (same as examinations and screens) and include the same nursing functions as those provided to students in public school buildings, such as assessment of student health care needs, development of appropriate plans of care, medication administration, first aid and emergency care, etc. Neither the law nor regulation distinguish differences in the level of service to public vs. non-public schools.

Many school districts include private and non-public schools as buildings being served in the School Health Annual Reimbursement Request System (SHARRS). The school district receives the same level of reimbursement for these students as those attending the public school buildings. Therefore, the expectation is that all students receive equitable nursing services from the school district. Provision of non-equitable services could adversely affect the school district's reimbursement.

Many of the nursing services can be performed by supplemental licensed health staff such as non-certified RNs and LPNs working in consultation with the CSN.

In addition, the Pennsylvania Public School Code (PSC) requires that schools educate students and provide a safe, healthy environment. The PSC (Section 1401 ) also requires that schools employ nurses. Section 1402(a.1) requires that "every child of school age shall be provided with school nurse services…" In the School Health regulations, 28 PA Code, Chapter 23, Section 23.74, it is a function of the school nurse to interpret the health needs of individual children.

However, school nurses don't just function under Educational law. They are licensed by the Department of State, Board of Nursing and licensure requirements are in effect regardless of the nurse's practice setting.  The Nurse Practice regulations require (49 PA Code, Chapter 21, Section 21.11) that nurses follow the "standards of practice and professional codes of behavior" published by the American Nurses Association as the "criteria for assuring safe and effective practice." The standards are "authoritative statements of the duties that all registered nurses, regardless of role, population, or specialty, are expected to perform competently." These standards outline the nursing process for provision of safe care (assessment, nursing diagnosis, outcomes identification, planning, implementation, coordination of care and evaluation).

School nurses cannot effectively follow these standards of practice unless they rotate through all of the buildings in their caseload assignment on a "regular basis". This could mean daily or it could mean 1-2 days/month. It depends on the assessment of student needs as determined by the school nurse.