District nurse outlines scope of school nursing, flags rising chronic and mental-health needs

Nicole Edwards, the new district nurse for ISD 318, told the Grand Rapids Public School District board that school nurses provide daily care, manage chronic conditions and act as frontline responders for students’ physical and mental-health needs.

Edwards said the district currently has 10 full-time nursing positions — “6 registered nurses, 3 licensed practical nurses, and then, myself as the LSN” — and that total student enrollment the nurses serve was 3,936 when she last checked. She described a broad range of duties: administering prescribed and over-the-counter medications, managing insulin pumps and tube feedings, creating individualized health plans, and monitoring communicable diseases to ensure compliance with state laws and regulations.

“School health services play an integral role in the health of students by addressing social determinants of health,” Edwards said. She reported that, as of April 9, the district had completed 3,525 vision screenings (397 referred for follow-up) and 2,427 hearing screenings (134 referred). She also said that, as of April 29, school staff had administered 9,978 prescribed medications districtwide.

Why it matters: Edwards told the board nurses support classroom attendance and academic success by helping students stay healthy and by connecting families to care. She also said nurses are seeing an increase in both chronic physical conditions — such as asthma, allergies, diabetes and seizure disorders — and mental-health needs across grade levels.

Board members asked clarifying questions about hearing follow-up, billing for services provided to homeschooled and private-school students, and the district’s preparedness for cardiac emergencies. Edwards said nurses perform initial hearing screens and rescreens; if a student fails twice, the nurse contacts the parent or guardian and refers the student for further evaluation. On billing, she said nursing costs are coded to either the general fund or the special-education fund depending on duties, and that special-education evaluations billed for homeschool or private-school students typically fall to the special-education funding stream. A board member noted that some of those responsibilities stem from a federal requirement related to special-education proportionate share.

On AEDs and training, board members discussed recent state-level legislative proposals that would expand AED and cardiac-response requirements. Edwards noted that every school in the district currently has at least one AED and that all district nurses are Basic Life Support (BLS) certified. Board members and staff discussed the trade-offs between adding new mandatory training and the ongoing replacement costs for AED batteries and pads.

Edwards reviewed district partnerships that support nursing work: the Lions Club assists with vision screenings, Itasca County Public Health runs fall influenza clinics, Campus North nursing students help with screenings and job shadowing, and the district has a nonmonetary standing-order contract with Grand Itasca for medication orders and consultation.

Program strengths and challenges included strong interdisciplinary and community collaboration, consistent procedures and training across schools, and staff commitment. Edwards also flagged operational challenges: increased demands for chronic-disease management, higher mental-health needs, substitute-nurse shortages and turnover among nursing staff, and the emotional toll of dealing with complex student health and welfare issues.

Board discussion ended with the chair and members thanking Edwards and recognizing National Nurses Week. Edwards invited further questions and said nurses try to follow up after referrals but did not have district-level percentages for how many referred students received corrective care.

Edwards’ presentation was discussion only; no formal board action was taken on the health-services report.