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School Health Program Places a Nurse in Every Public School

In 1997, only one in four schools in the School District of Palm Beach County, now the 11th largest in the nation, employed a full-time nurse. Volunteers and school staff, without formal training, filled the gaps as best they could. To remedy this shortage of trained nurses, the Health Care District of Palm Beach County launched the School Health Program to keep students healthy and ready to learn by providing a registered nurse (RN) in every regular public school. The program has streamlined and improved health care for Palm Beach County students by providing more than 200 dedicated school nurses and implementing the first electronic health records system in a Florida school health program.

Correcting a long-standing problem

In 1973, the Florida state legislature passed the School Health Services Act, which required all county health departments to provide basic school health services. But Palm Beach County’s health department struggled to meet this mandate under its existing budget. At the time, funding for school health services allotted only $2.24 per child each year. In 1988, voters in Palm Beach County passed a referendum that established the Health Care District “to provide comprehensive planning, funding, and coordination of health care services delivery,” including preventive health services and community nursing services.

School health quickly became a priority for the Health Care District. In 1997, the Health Care District’s board allocated $500,000 to the school nurse initiative and directed staff to implement a School Health program in every school for the 1997-1998 academic year.

“The Health Care District Board supported the creation of a model school health program for public school students in Palm Beach County,” says Ronald J. Wiewora, MD, MPH, the Health Care District’s CEO and chief medical officer. “Thanks to their vision, today the program serves as one of the largest and most comprehensive in the country.”

In the beginning, the health department transitioned technicians who had conducted student health screenings to the Health Care District, and many nurses employed by local hospitals to work in schools also transitioned to the School Health program.

Today, more than 200 RNs from the Health Care District serve more than 177,000 students in more than 160 regular public schools. Under a joint funding agreement, the Health Care District and Palm Beach County School District provide more than $15 million a year for the program.

Sharing data

The School Health program was developed using the “data-driven management model,” which uses demographic, encounter, and outcome data to indicate progress toward the objective of the program. In 2000, the Health Care District implemented a robust EHR system and was the first program in Florida to implement a comprehensive EHR system for school health.

The program allowed school nurses to track students’ medical history each year and to update or monitor student health conditions. The program maintains system-wide data, including students’ medical condition and the reason for their visit to the school nurse. The nurses also provide data, including reports on immunizations and communicable conditions, that are essential to community health and for the annual report the Health Care District files with the state.

Solid leadership drives positive outcomes

The dedication of the Health Care District’s leadership was critical to the program’s success. In May 1997, the consultant engaged to develop a roadmap for the program acknowledged the Health Care District’s leadership role in the program and recommended that the District assume full leadership responsibility.

Because of this strong leadership, the Health Care District’s School Health Program touted notable achievements during the 2011-2012 academic year. For example, 80 percent of students who received first aid from their school nurse were able to return to class the same day. School nurses also accomplished the following:

  • administered more than half a million medications to students (medications are no longer administered by nonmedical staff or parent volunteers)
  • reviewed 48,833 immunization records provided by school administration
  • conducted 165,456 health screenings, including scoliosis and body mass index screenings
  • reviewed more than 72,000 student health records –75 percent more than were reviewed during the 2006-2007 school year
  • increased their identification of chronic health conditions by 65 percent
  • developed 2,582 health care plans for students with health conditions – 45 percent more than five years earlier

Thanks to the Health Care District of Palm Beach County, the vast majority of students who begin as kindergarten students in the School District of Palm Beach County and graduate high school will have benefitted from having had access to a school nurse throughout their entire primary and secondary educational career.

For more information about the Health Care District of Palm Beach County’s School Health Program, please contact:

Robin Kish
Administrator of Public Affairs
Health Care District of Palm Beach County


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