Policy Memo: Lack of Access to Healthcare Services in Hawaii Public

Schools

To: Hawaii Department of Health and Education

Subject: Lack of Access to Healthcare Services in Hawaii Public Schools

From: Jeanise Royos

Date: 11/05/2014

Introduction
A current problem in Hawaii is a lack of access to health care services in the public
school settings. The lack of access to health care in the school setting is the result of having an
inadequate amount of trained medical professionals and lack of state funding for the schools.
Lack of access to health care services in schools increases absenteeism and compromises student
safety. Current legislation has passed the HI-HB1440 Hawaii Keiki: Healthy and Ready to Learn
Program to require state funding to address the issue. The amount of funding for the Hawaii
Keiki: Healthy and Ready to Learn to Program is inadequate in order to provide sustainable, cost
effective, and quality healthcare to students in the public school setting.
History and Background
Currently, federal guidelines require one school nurse for every 750 students (National
Association of School Nurses, 2013). In the 2013-2014 school year, Hawaii Department of
Education had three school nurses for 180,000 students. Hawaii is in the ranking for the top five
worst states for nurse to student ratio (National Association of School Nurses, 2013). The current
public health school nurses in Hawaii are consultants to the health school aides in every school.
The current requirement of a health school aide is a high school diploma and certification in
CPR. In response to the inadequate training of health aides, the US Department of Labor made
grants available to train all health school aides free of charge.
Despite the training given to the school health aides, one school nurse in every school
will still be needed to provide the safe and quality care the public schools need. There has been
an increase of students dealing with chronic illnesses and more complex serious medical
conditions since 1975 when the government mandated that schools need to accommodate
disabled students. School nurses are qualified to assess, analyze data, develop plans of care,
promote interventions, and evaluate outcomes which are not in the scope of practice of student
health aides. Research shows that students under the supervision of a health aide are three times
more likely to get sent home for an ailment than a student at a campus with a registered nurse as
explained by Mary Boland, the dean of University of Hawaiis nursing school. To increase the
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Policy Memo: Lack of Access to Healthcare Services in Hawaii Public

Schools

number of nurses in the school system, Hawaii legislature provided funding for the Hawaii
Keiki: Healthy and Ready to Learn program to decrease the amount of absenteeism. In 20122013, 41 percent of students were deemed chronically absent by missing 10 percent of school
days according to Debra Knight, a principal at Nanaikapono School. One out of three students
with disabilities were chronically absent over the last four years according to Hawaii State
Department of Education. Lawmakers have approved about $1 million dollars for two school
years to obtain more nurses in the school setting. Despite funding for the 2016-2017 school year,
the program needs to obtain $500,000 more on its own.
Possible Policy Solutions
Even though the lack of healthcare in the public school setting has been a problem for a
while, the state Department of Health, Department of Education, and University of Hawaii have
finally been developing possible solutions within these past two years to address the problem by
developing possible solutions:

Grants from the Department of Labor were given to Kapiolani Community College to
fund a program to certify school health aides through formal training free of charge. The
goal of the program is to have all school health aides certified by 2018 (UH Manoa and

Hawaii Department of Education, 2014).

Allowing student health aides or nurses to administer daily medication for chronic illness.
There are not enough nurses in the school setting to administer medications. Hawaii preservice requirement HRS 320A-253 allows health aides to assist students to take
premeasured oral and topical medication with parental and physician consent. School
health aides are also able to administer premeasured emergency medications. People
argue that the health aide is not trained to safely assess the severity of illness or to
evaluate for adverse effects of medication administration. There are also problems about
storing medications like antibiotics, narcotics, and psychotropic medications in the health

room.
Allowing students to administer their own medication. Controversy arises because of the
possible misuse of drugs and liability issues. Parents dont provide children with needed
medication and are not there to enforce compliance. In 2008, NASN found out that 72
percent of school nurses have students in their schools with known allergies and parents
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Schools

have not provided children with epinephrine pen which is the emergency drug needed for
a severe allergic reaction. Many students are bringing their own medication to school and

using it without consent forms or supervision.

Get changes to states Medicaid plan so the DOE can be reimbursed for the health
services that are provided in the public schools. If approved, nurses can administer
immunizations or provide case management and receive federal reimbursement. The
problem is that even if the school is able to receive reimbursement, there is currently not
enough nurses and supplies in the school setting to provide those services.

Recommended Solutions
Amy Garcia, a Registered Nurse and executive director of the National Association of
School Nurses, explains that a nurses role has changed because she is seeing kids who usually
dont go to public schools end up in public schools with ventilators, asthma, obesity, and closely
monitored diabetes. Garcia adds that 13 percent of kids are on medication for more than 90 days.
I am writing to increase funding to provide quality and safe health care in the public school
system to enable kids to have optimal school performance. My solution is to (1) utilize the
Licensed Practical Nurses in the school settings which will be more cost effective than
Registered Nurses, (2) turn school health rooms from an educational setting into healthcare
settings with needed supplies seen in clinics/urgent care in order for health services to be charged
to Medicaid and get reimbursement; this will also alleviate the amount of patients seen in the
already busy primary care settings, (3) utilize the grants given for student health aide
certification to be used for more nurses in the school setting; the nurses can then train and
delegate student health aides on campus while providing nursing care, (4) the Department of
Health can take portions of funds from policies that support health in Hawaii schools like
Wellness Guidelines to employ a Registered Nurse who will be able to teach staff and students
health curriculum (nutrition, physical activity, drug/alcohol abuse, sexual behaviors etc.) and
research and advocate for certain problems specific to the school.
The solution I propose is to increase funding in the public schools to provide a licensed
nurse in every school to meet the demands of the students growing complex health care needs.
The success of providing quality and safe services will be determined upon a decrease in nurse to

Policy Memo: Lack of Access to Healthcare Services in Hawaii Public

Schools

student ratio, decrease of absenteeism due to health related problems, and nurses being able to
provide medication, teaching, screening, and referrals to Hawaiis public school students.