The Hippo


Jun 2, 2020








School nurses
Recent changes to hiring requirements

By Ryan Lessard

 A legislative committee just passed an exception to requirements for school nurses in a bill that became law last year. School nurses are required to have a bachelor’s degree under the new law, but after some public health officials said this would impact recruitment, a bit of wiggle room was written in.

New rules
According to a copy of the new rules, school nurses are still required to be BSNs with three years of experience in pediatric medicine or a related field, but under the tweaked rules, those who are hired after July 1, 2016, are allowed to have only an associate’s degree provided they obtain their bachelor’s within six years. Those hirees are called a School Nurse I and must demonstrate enrollment in a bachelor’s program.
Before the law change, any registered nurse licensed with the state was allowed to be a school nurse. Many RNs have just an associate’s degree. The new law also created a new certification process through the Department of Education. Those who were hired before or on July 1, 2016, were grandfathered in under the designation School Nurse II. If they only have an associate’s degree, they are not required to get a higher degree, but they do have to go through the new certification process. School Nurse IIIs are hired as BSNs.
Susan Kinney is the director of the RN-to-BSN program at Saint Anselm College. She said the students in her program graduate with associate’s degrees to become RNs, enter the workforce and continue their education in a hybrid program to ultimately obtain their bachelor’s. It can take as little as 15 months to complete, but Kinney said most of her students take two to two and a half years to complete the bachelor’s.
So allowing six years to get the bachelor’s degree “is very generous,” Kinney said.
Kinney said she was among those concerned that the new law would put a significant hamper on a school’s abilities to hire school nurses. She still has some reservations but thinks the fix passed by the Joint Legislative Committee on Administrative Rules on Sept. 21 is a big step in the right direction. 
The new law is part of a national push to raise the bar for nurses. Kinney said studies have shown better patient outcomes when hospitals have a higher rate of BSNs. Most recently, the state Department of Education jumped on the bandwagon. Along with the New Hampshire School Nurses Association, it supported the new requirements.
Republican Sen. John Reagan was a co-sponsor of the bill and the chair of the JLCAR committee that approved the rule change. He said there wasn’t any opposition to the bill.
“It went through pretty easily, which probably explains how we missed what was going to happen [with recruitment],” Reagan said.
He said it was also part of a national priority in the medical industry to recognize more nursing specialities — in this case, school nursing. But the main reason was to ensure kids in school have the best possible care.
“The school is often the first filter catching serious problems with children that people at home aren’t paying attention [to] or don’t understand,” Reagan said. 
The reason people like Kinney and Manchester Public Health Director Tim Soucy — who testified at a Board of Education meeting about the issue in June — thought the new law would make it harder to recruit school nurses is that it’s already hard enough. We’re currently experiencing a nursing shortage across the board, we don’t graduate enough BSNs to meet the demand, and schools already pay less than hospitals, Kinney said.
“I actually looked last week on two hospital hiring websites and counted 153 open staff nurse positions just in [Manchester] alone,” Kinney said.
Given more competitive compensation in hospitals, along with benefits such as tuition and certification fee reimbursement, Kinney thinks most BSNs will choose to work there instead of schools. It’s been Kinney’s experience that schools do not invest as much in nurses’ professional development. Plus, certification requires school nurses to pay a $75 fee they didn’t have to pay before, on top of state licensing fees. The NCLEX exam fee is $200, the RN license application is $100 and the background check fee is about $40.
“School’s don’t pay much. So you’re asking a nurse who’s getting paid less to do more. [Which] is just kind of a predicament, I think, for recruiting,” Kinney said.
The new certification requires 45 hours of continuing education to renew every three years. The current RN license requires 30 hours of continuing education every two years. DOE attorney Diana Fenton said the same education hours can be used for both so long as they meet the school nurse focus criteria.
Still, while school nurses may get paid less, Kinney and Reagan agree the schedule is a lot more family-friendly, especially for parents of school-age children.
Soucy said in testimony that the new rules are a “vast improvement” over the initial set but still thinks requiring associate degree holders to be enrolled in a BSN program “will hamper our ability to recruit and retain qualified applicants.” 

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