Administrator’s Guide to Health Services

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Health Services Defined

Health Services represents the component of a comprehensive school health program that directly services the individual child and monitors health trends within the district. It includes both the school nurse programs and the school based health center programs. The goal of health services is to remove the educationally relevant  health obstacles to learning by ensuring access and/or referral to primary health care services, managing chronic disease conditions during school hours, preventing and controlling communicable disease and other health problems, providing emergency care for illness or injury, promoting and providing optimum sanitary conditions for a safe school facility and school environment and providing educational and counseling opportunities for promoting and maintaining individual family and community health.

Nurse Timeline

Nurses follow a time line that assigns activities to various months. These are in addition to face to face, treatment and triage student encounters. The daily triage and treatment of ill and injured students and staff, and the time involved in contacting parents and physicians, when indicated, takes precedence over monthly activities.

However, these monthly activities are essential for an efficient health room. Please familiarize yourself with this timeline and allow appropriate office time to complete these essential activities. The execution of these activities should be considered in the nurse performance evaluation.

Please click here to view the nurse timeline for the 2014-2015 school year.

Review of this timeline with the school nurse is a requirement of the WELLNESS POLICY.

Nurse Evaluation

As with teachers, the building administrator is responsible for evaluating nursing performance on a regular basis. The performance evaluation of a school nurse should follow the same process as teachers, using the nurse timeline as a guide for specific clinical expectations. If a nurse has an unsatisfactory evaluation, Health Services administration should be notified.  . The Assistant Director of Health Services is, by training, in the best position to evaluate the standards of clinical care. Health Services Administration will work closely with the building administrators in performance evaluation if there are any concerns.

Nursing Organization – Liaisons

There are liaison nurses representing each network. These are working school nurses who receive a stipend. Their purpose is to: (1) provide two way communication between central health services office and the cluster nurses, (2) to provide collegial support and mentoring and (3) support mandated monthly data collection. They are mentors, NOT supervisors or administrators. Nurse clusters meet each month.  These meetings are mandated by the Massachusetts Department of Public health and your nurse is expected to attend. The individual school benefits from the mutual information sharing that keeps the nurse updated on the latest medical advances.

Back Up Nurse Coverage

Nurses are expected to find a substitute nurse for any planned absences. Unplanned, unanticipated absences will be covered by 6 nurses based in health services. However, in the event that there are more than 6 absences on any given day, there still needs to be an additional back up plan. Each cluster is responsible for developing a back up nurse system in the event that a nurse is not available to cover her school. The back up system is a safety net and does not replace arranging for substitutes for planned absences. Principals should discuss with their nurse the plan for absences and who and how to access the back up nurse system. As a last resort and if all the appropriate measures have been taken, central office will assist a school in addressing their medical needs.


Anaphylaxis is a sudden, severe, potentially fatal, systemic allergic reaction (LTA) that can involve various areas of the body. Symptoms occur within minutes to two hours after contact with the allergy-causing substance, but in rare instances may occur up to four hours later. Anaphylactic reactions can be mild to life-threatening. The most common allergens in children are food (especially nuts) and bee-sting.

Because of the life threatening nature of this condition, it is essential for schools to develop and implement care plans for all children identified with life threatening allergic reactions (LTA).

This includes the delivery of medication through an EPI-PEN injector. The state regulations allow for non -licensed personnel to administer this medication to children with known life threatening allergies once they have been trained by a licensed person such as the school nurse. Administration of this medication must happen immediately and cannot wait for the arrival of EMS or a back up nurse. Therefore, if you have any children who require EPI-PEN administration, you must have staff that is trained to administer it, in addition to the school nurse. Please call health services if you have any questions.

 Condom Availability

Click  here to view mandated video for all staff on  DEVELOPING the condom availability team (CAT).  This video provides guidance on MAKING REFERRALS for sexual health services.

Medication Delegation – Field Trip

The state has given permission to the Boston school system to delegate the administration of student medication to trained staff when the student is on a field trip. Only the school nurse can train the staff in administration. The only time non-licensed staff may give medication is on a field trip and in the case of a life threatening allergic reaction and EPI-PEN administration. Where developmentally appropriate, some children may self-administer their medication, once a parent-approved plan is in place. School nurses need to know when field trips are occurring so that they can  be sure that staff  know how to assist the student in  managing  their medical condition

Medication- Over the Counter

Nurses have the option of dispensing over the counter medication (Tylenol, Advil, etc) with written permission of the parent/guardian. The principal and school nurse should discuss whether the school is exercising that option.

Communicable Disease

If there is a case of an infectious disease such as meningitis, tuberculosis, chicken pox, pertussis, etc, at your school- please make sure that central office is notified immediately. You should be aware that all students and staff who are susceptible to chicken pox (i.e. have no record of having had disease, or vaccine or blood test showing immunity) MUST, by state regulation, be excluded from school.

Once Health Services is contacted, we ensure that the Boston Public Health Commission is notified. We have years of experience in efficiently managing these issues in conjunction with the health commission. We will also inform the Superintendent’s office of the magnitude of the event, based on our experience. We appreciate that any communicable disease encounter is disconcerting and we will do our best to provide all the supports you need.


If a child does not have immunizations up to date, they must be excluded from school until they provide documentation. This is a state regulation so please support your nurse in his/her efforts to collect this information. Nurses should be aware of children who have no documentation of immunizations and should be actively contacting the parents.

Staff should be notified at the beginning of the year that they should have all their immunizations up to date, including the vaccine that prevents adult whooping cough (TdaP). 

Please view our Immunizations Page for more information.

Emergency preparedness

If 911 is called at your school, please be sure that the nurse is aware (if she s/he has not been part of the response) ;Health Services is tracking and trending  all the calls. Please note that the school nurse should not be the staff person who accompanies a student to the hospital as this will leave the school medically uncovered.  Once Emergency Medical Services, arrive- the nurse is no longer  the incident commander and EMS assumes control. Staff accompaniment to the hospital is for the students’ emotional support and serves as a parental stand in until the family arrives. Should family not be able to arrive in a timely manner and every effort has been made to communicate with the family,  the staff may then leave the scene after addressing any questions with the ER staff..

All nurses have been asked to review their role as “Risk Analyst” as outlined in the BPS School Safety Contingency Plans. We have also asked them to think through a contingency plan for those special needs students who have medication (i.e. insulin) or other technology needs (suctioning) should there be a prolonged shelter in place. It is also helpful for each classroom teacher to have, in the classroom, a list of emergency contacts for each student that can be easily accessible and transportable should the classroom need to evacuate. Computer access to this information may not be possible during an event.

The district is preparing for flu and Norovirus outbreaks by instituting a basic infection/hygiene program. Pamphlets for home and materials for the school nurse will support students in using the proper hand washing and cough and sneeze etiquette to decrease germ spread.

Surveillance – BMI

The city is doing surveillance of all children in grades 1, 4, 7, 10 (in public and parochial) for a marker for obesity. (Overweight is the term preferred with children) This measurement, BMI (body mass index), is weight in relation to height matched to standards for age and sex. Children whose BMI are at or above the 85% are at risk for overweight while those who are at or above the 95% are considered overweight.  Letters are sent home to parents/guardians each year in these grades informing them of the results. Please discuss with your nurse when the surveillance activities are occurring in your school.

Health Room Audits

Health services Central office would like to support you in reviewing the effectiveness of your health room. Please call us to schedule a review.

Chronic Disease Management

Although children with medical special needs have been clustered in several schools, more and more schools are seeing increases in the number of students with chronic disease.  Most children with special medical needs can participate in the regular classroom. We will provide support and training to your school nurse if you have a child with special medical needs so that the child can have full participation in school activities. We cannot, however, re-deploy nurses after the deployment process has been finalized. It is, therefore, essential that families be informed at registration that full time school nursing is not available in all schools. The school nurse is expected to work with the support team so that all accomodations are known to the classroom teacher and all staff who work with the child, from secretaries to lunchroom monitors to bus drivers.

Health education and other non acute care activities

The nurse does not need to assess every paper cut and stomach ache. The most successful health rooms allow administration time for the nurse to conduct classroom health education activities or to enter the data and manage the tracking of the medically complicated students. Just as teachers need class preparation time and time to correct homework, nurses need time for clinical follow-up and preparation of health plans. Please meet with your nurse to discuss how this administration time can fit into the rhythm of your school’s academic day.

Playground Safety

Nurses will be posting signs in the health office reminding children not to pick up unknown items from the playground. Children are being encouraged to tell an adult if they find an item on the playground. This is to avoid picking up used needles, sick animals, sharp objects, used prophylactics, etc.

Do Not Resuscitate

Children who are terminally ill may have a Do Not Resuscitate order. The child’s physician submits Comfort Care/DNR Order verification to the Office of Emergency Medical Services in the Massachusetts Department of Public Health. Comfort Care is a process that ensures that the DNR is valid and provides guidance in creating the in-school response. The following website provides further information:

The school nurse, in conjunction with the Health Services office will assist the school community in understanding and honoring the Comfort Care plan.

Sports Clearance

The school nurses must review all pre-participation sports physicals to ensure that all children are able to participate safely and that any accommodations are in place before any practices or games commence.

The following schedule facilitates the pre-participation clearance process:

Fall Season: All students (including those trying out) must be cleared by the end of June of each school year. Middle school students interested in participating in the fall season at the middle school level or high school level must be cleared by the middle school nurse. The middle school nurse will forward clearance information to the appropriate high school.

Winter Season: All students must be cleared by November 15 of every school year.

Spring Season: All student athletes must be cleared by March 15 of every school year.

Home and Hospital Instruction and  Application

The Home and Hospital department provides tutoring for children who are unable to attend school for health reasons supported by a physician statement.For a building administrators guide to Home and Hospitals and applications for tutors, click above link.

Weather Watch

We frequently receive calls about “How cold is too hot or too cold to allow a child to play outdoors?”. If you live in Alaska  or Florida, there may be  differing perceptions, but this Child Care Weather Watch is a chart that will provide guidance. The local weather service also posts warnings for temperature extremes. This will also be posted on the Administrator and Parent Tabs.