HNRS Team Meeting Minutes

May 21, 2003

Those present: Vicki, Selina, Michelle, Aylee, Patrice, Kathy, Diane,

Melissa, Nancy

Absent: Sue

1. Nancy reviewed new policies pertaining to parental consent for students

to receive HNRS services and policies pertaining to handling student health

records. Student health records are regulated by both HIPAA and FERPA and

the two sets of federal regulations are not always consistent with each

other. Our policies may need to be changed as these conflicts are

gradually clarified by the courts.

Key components of the new policies are that:

a. Student health information is NOT to be shared with school

staff unless it is necessary for the child’s academic progress or it is

necessary for the child’s safety or the safety of others. And, even under

these circumstances, we need to be very careful about what we share and to

whom we share it. Medical diagnoses are not to be shared without informed

consent and the “rule of thumb” is that, whenever possible, it is better to

describe health problems in functional terms (such as attention problem due

to medication) rather than actually providing the diagnosis, even if you do

have permission to do so. The intent of HIPAA is to encourage health

providers to be much more conscientious about what we disclose and to

whom. At the same time, it is recognized that, if we’re to be useful to

the school, we need to be able to exchange information with school

staff. I would urge you to review the policies carefully and try to find

ways to convey the information that is important without revealing

information that should be confidential.

b. The other major change is that we need to notify parents

whenever their child is seen by HNRS staff (unless, of course, the child is

old enough to obtain services without parental consent and requests that

the visit be confidential). Nancy is going to investigate the cost of

having a “clinic visit form” printed on NCR paper so that a xerox copy will

not need to be made. Vicki suggested that this form could be revised in a

manner so that it could be used as a visit note rather than having to

document twice. This is something that I’ll look into this summer.

Questions/issues raised from this discussion included:

- we need a release of information form that can be given to

parents to sign before releasing info to the schools; Selina mentioned that

ESD has a form that we might be able to use

- Selina thought that scoliosis screening results should be in the

education record rather than the student health record

- Aylee asked if the letter to parents could be more specific in

section where it speaks about services that can be offered without parental

consent. She asked if letter could specify “physical and mental health

education in classroom” so that parents will know that they may be working

with students in these type of activities.

- Vicki suggested that Lee make up a packet of forms to be given

to parents when a child registers late. (Lee & I just took care of this.)

- Selina suggested that envelop for returning the health history

info, consent forms, etc be addressed to the school and be marked as

“confidential - to be opened by school nurse only”, rather than having

these sent to OHSU, which was the original intent. (Lee & I also discussed

this & will make sure this happens)

- Michelle and Vicki talked about the student nurses and the fact

that the HNRS nurses are to co-sign what the student nurses have written in

student health records. This then brought up the issue of what the student

nurses should & should not be doing in the schools when the nurses aren’t

with them. A policy is needed in this area.

2. Vicki and Sue will be changing places in a few schools next

year. Vicki will be in Elgin, Imbler, and Cove and will also be doing some

administrative work pertaining to the HNRS, including visiting the school

sites regularly. Sue will be in North Powder and Union.

Nancy asked if HNRS staff felt a need to have periodic meetings of

the staff who are assigned to a particular school. After discussion, it

was decided that we’d continue having monthly HNRS team meetings and that

staff who share disciplines (ie, Aylee & Patrice, the FRCs, and the nurses

& NPs) could meet together occasionally as needed to discuss ideas,

problems, etc. If the staff assigned to one school feel a need to meet,

this could also be arranged but, at this time, we decided not to expect

these meetings to happen.

3. Nancy shared the core components of the HNRS philosophy (community

ownership, school ownership, prevention focus, family-focused care,

holistic) and asked everyone to help brainstorm goals for the coming year

that would be consistent with this philosophy. The goals that were

selected were as follows:

a. Plan to have some HNRS representation at the school board

meetings early in year and at end of year.

b. Identify existing groups (if at all possible) that are willing

to serve in advisory capacity for the HNRS. Plan to have HNRS rotate

attendance at these meetings. For example, one month the nurse

practitioner would attend, the next month the nurse would attend,

etc. Nancy explained that she would like staff to share their ideas/plans

or their accomplishments with these committees so that 1) the committee

members can learn more about what the HNRS is doing and 2) the committee

members can help troubleshoot problems we may be having or can provide

suggestions about what services/activities we might offer. Some time was

spent talking about North Powder & Elgin and how difficult it has been to

find an existing group in these two towns. Nancy said that she will work

on this next fall, with the HNRS staff and the school superintendents.

c. Health fairs will be conducted in Cove, Elgin, and North

Powder again next year (and possibly in Union). We decided that these

would be focused on all grades and, for the older students, would be

student-driven (ie, they will develop the projects). It was mentioned that

some (perhaps all) of the rural schools bused kids to the safety fair at

the armory shortly after our health fairs had been held, so we decided that

we should check with the schools next year to see if they planned to do

this again – and, if they do, then there would be no need to replicate

these activities in the rural towns. Finally, Nancy asked if the fairs

could happen prior to spring break so that nursing students could be

involved in planning them – it was thought that they could happen in March.

d. Aylee and Patrice agreed to organize an alcohol and drug

awareness week in their schools. This may happen in the fall.

e. Vicki will take the lead in planning the flu shot clinics and

the cholesterol screening events. These will happen in the fall and Feb or

March.

f. Finally, Vicki suggested that we plan some activities around

national “walk to school day” which happens in the fall. Kathy asked if we

might also plan a bike rodeo in conjunction with this. This will happen

whenever the national day occurs, sometime in the fall.

In regard to all of these activities, it was suggested that

someone meet with the teachers early in the year to get their input on

health education events they’d like to have us help with, to discuss our

plans with them & to obtain their input on the best dates to hold these events.

4. Nancy distributed the performance appraisal forms and asked that

everyone complete these and bring them to their meeting with her. She will

be scheduling individual meetings with staff in June, after the

satisfaction surveys are tallied and after she’s had time to meet with all

school supts. In completing your performance appraisal form, please think

of a few (1-3) goals for next year.

(PS - One thing that I didn’t mention in the meeting is that all

of the directors of the various clinical programs at the Sch of Nsg have

been meeting to try to develop policies and protocols related to records,

performance appraisal, quality assurance, etc. It seems that all of our

clinics have been operating rather loosely and we’re feeling a need to

tighten things up a bit and to also make policies consistent between our

clinical practices whenever that is possible. I just finished developing a

“tool” for self-appraisal that all nurse practitioners will be asked to use

starting next year. Similar appraisal tools/policies will be developed for

other staff and I may be getting your input into this as this happens. In

the meantime, please bear with the rather simple form that we’re using

right now.)

That, I believe, is all that we discussed. Good meeting

everyone. And great food! Thank you, Patrice, for hosting this event. I

will be in touch with each of you shortly to schedule a time for our

private visit.

Nancy