While the role of the school nurse has changed dramatically over the years, it continues to evolve in the Miami-Dade area. Students at nine of the areas K-12 public schools in North Miami, North Miami Beach and Overtown receive primary care, mental health and dental services without ever leaving their school campus.
According to the National Association of School Nurses, there is a shortage of funded school nurse positions. NASN reports that a third of all school districts reduced nursing staff in the past year because of budget cuts, and a quarter of all school districts in the nation do not have nurses. According to the NASN, the average nurse-to-student ratio in Florida is 1 to 2,357, more than double the national average.
Yet, the unique Miami-Dade school program hopes to change that while also offering a potential model for school districts across the country that grapple with funding school nurses who care for student populations with diverse and growing needs.
For the past decade, the School Health initiative, led by the Department of Family Medicine and Community Health at the University of Miami Miller School of Medicine and UHealth University of Miami Health Systems, has provided primary care at school-based health centers in three high schools, two middle schools and clinics in four elementary schools.
Recently, thanks to a $4 million federal Health Care Innovation Award, the program added mental health to the primary care programs. The partnership was originally established to provide access to healthcare in a community that was primarily uninsured and without adequate access to the appropriate health resources, said Marcia Dodo, DNP, ARNP, FNP-BC, of the UMs Miller School of Medicine, who also serves as the clinic manager at North Miami Beach Senior High. The overall aim was to ensure a healthy and safe academic learning environment. Students who are healthy can remain in school and perform better academically.
The three-year HCI Award also is funding expanded dental services. Dodo said the award will allow the program to partner with local dental schools to provide preventive and restorative dental care to students, and psychiatric residents and fellows who can rotate through the school sites.
For instance, Nova Southeastern Universitys College of Dental Medicine has established a dental suite at John F. Kennedy Middle School, where 6th grade students are provided preventive dental care such as dental sealants and fluoride varnish. In addition, the University of Florida College of Dentistry will be delivering preventive and restorative dental care for students at all nine schools in the program. Last year we added community health workers to our team to assist families with Medicaid enrollment, Dodo said. At the beginning of the school year, we often provide services for school entry such as vaccinations and sports physicals. For the rest of the year, we see cases related to upper respiratory infections, dermatological conditions and others related to adolescents health risk behaviors.
These include depression, anxiety, tobacco and alcohol use.
The school health clinics also have a telemedicine component that can provide consults with specialists in dermatology, nutrition and psychiatry. By providing these health services onsite, Dodo said the clinics also reduce student absenteeism.
Since the inception of the school clinics, Dodo said there has been a decrease in the number of 9-1-1 calls made from the schools. Of the students seen in our health center about 87% return to classes [the same day], Dodo said. On a typical day, we provide services through scheduled appointments and walk-ins, laboratory services, and also address any emergencies that may arise [such as injuries received at school]. We have scheduled days for our telemedicine consultations and also provide health and wellness presentations for school health-related events.
In May, the clinics implemented electronic medical health records. In addition to keeping with the requirements of new healthcare laws, Dodo said the technology will enable clinic staff to monitor data more efficiently.
Jocelyn Lawrence, MD, assistant professor of family medicine and community health, who leads the team of nurse practitioners, nurses, medical assistants, social workers, a registered dietician, community health workers and others, said she hopes other groups across the country will mirror their efforts. We wanted to create a national model that would be successful, cost effective and that can be duplicated across the nation, Lawrence said.