These questions (UPDATED October 2008) were asked during a videoconference on the Role of the Licensed School Nurse (LSN) in the Special Education Process which was held on February 16 and March 9, 2005.

While all districts adhere to special education rules, the process and some of the terms may be different within districts. It is important that you always clarify the special education process with your special education director.

• The purpose of this webpage is to give the Licensed School Nurse guidelines for his/her role in the special education process.
• Special Education means any specially designed instruction and related services to meet the unique cognitive, academic, communicative, social and emotional, motor ability, vocational sensory, physical, or behavioral and functional needs of a pupil as stated in the Individual Education Program (IEP) plan.
• Why do school nurses need to know about the special education process?
  1. There are federal and state legal mandates that must be followed for students who are being evaluated and those students who are already in special education.  People who are disabled are protected under the law and have rights, privileges, and protections that are meant to afford them equal opportunity under the law:
     • The Education for All Handicapped Act of 1975
     • Individuals with Disability Education Act
       • 20U.S.C. Chapter 33
       • 34C.F.R.300
     • Minnesota Statue 125A
     • Minnesota Rule 3525
  2. Students who are in special education have a higher incidence of chronic health conditions:
     • Licensed School Nurses (LSN) often work with students who have chronic health conditions, and there exists a strong probability that the LSN will be working with children who are in special education, or students who are being evaluated for special education.  The LSN is a resource to educational staff on how health conditions are impacting the student in his, or her, educational environment.  For the LSN to function in this integrated role between health and education systems, they must have the knowledge of the special education process to ensure compliance and Best Practices.
  3. Other Benefits of Understanding the Licensed School Nurse (LSN) Role in the Special Education Process:
     • Ensures that the LSN understands the role of being an IEP Health Related Service Provider on the IEP for students who are in special education with health needs requiring nursing services.  The LSN may be listed as an IEP Health Related Service provider on the IEP.
     • Assists the LSN with understanding the essential components of an Assessment of Health/Physical Status and when this assessment should be completed.
     • Ensures that nursing time on the IEP is documented.
       • Documentation of time on the IEP is required for reimbursement. School Districts in Minnesota must seek reimbursement for IEP health related services that are on an IEP.
       • Many school districts will use the amount of time that is documented on IEPs for use as indicators for the number of school nurses needed and the amount of nursing time assigned to a school.
     • Updates school nursing practice to meet mandated state and federal laws and standards of practice.
     • Ensures that students with health needs receive the necessary nursing service that will contribute to their educational success.
  4. The following document is available for your use.  The Role of the Licensed School Nurse in the Special Education Process was developed by the Special Education committee of the School Nurse Organization of Minnesota.

Once you are familiar with the above document "The Role of the LSN in the Special Education Process", the SNOM Special Education Committee recommends that you use the following tool, Licensed School Nurse Assessment of Health/Physical Status, as a guide when conducting special education nursing evaluations/assessments for initial IEPs or 3 year reassessments.  This tool includes the essential components for an LSN evaluation/assessment according to standards of nursing practice.

• The following tools are available to the Licensed School Nurse to use when completing health assessments on students ages 14 and older.
  1. Depression Checklist:  Depression in adolescents often looks different than we picture depression among adults.  The checklist, developed by SAVE, can be used as part of the LSN health assessment of the transition age student to pick up depression symptoms.
  2. Adolescent Autonomy Checklist - Health Care Skills:  The LSN assessment of transition age students should include an evaluation of how the student is learning to manage their own cares.  This checklist was developed by the Washing State Children with Special Health Care Needs (CSHCN) Program, Adolescent Health Transition Project and is used with their permission.
  3. Questionnaire "Are you ready to manage your own health care?" and Discussion Tool:  Pacer Center partnered with St. Paul Public Schools nurses to develop this questionnaire under a "Healthy and Ready to Work" grant. The LSN can use this questionnaire and discussion tool with students and families to gather information for the transition age student's health assessment.

• Resources for Physically Impaired
• Resources for Traumatic Brain Injury

  For more information, contact Deb Williamson, Statewide Specialist for PI and TBI at 612-638-1532 or dcwilliamson@district287.org. To subscribe to the P/HD Listserv, contact Deb Williamson.

• SaveThisBrain.org - The Traumatic Brain Injury Center at Hennepin County Medical Center has launched a brain injury awareness and prevention program titled SaveThisBrain.org. This website will teach visitors about brain function, give prevention tips and link them to www.HCMC.org and other websites for more information about brain injury. The highlight of the website however, is the ability to "build your own brain". As you learn about the different lobes of the brain, you can drag in pictures that represent the function of the lobe and that symbolize what you as an individual like to do. You can then print your own brain, email it to a friend or post it on the website gallery. While anyone can build their own brain, we find that ages 8 and up (or any age familiar with how a computer works) enjoy this interactive site.

• Fact Sheets for Chronic Health Conditions
  • As part of the Other Health Disabilities Low Incidence Project, these fact sheets were developed in collaboration with the Other Health Disabilities Specialist, School Nurses of Minnesota (SNOM), and the Region 10 Physical Health Disabilities Network.

• Fact Sheets from the Minnesota Association of Children's Mental Health

These answers were generated from questions asked by school nurses in Minnesota during a videoconference on the Role of the Licensed School Nurse (LSN) in the Special Education Process which was held on February 16 and March 9, 2005.

State Special Education Funding for School Nursing Services through Electronic Data Reporting System (EDRS)

Salaries for essential personnel who are teachers, related services, and support services staff members are reimbursable for the following services (MR3525.1310):

1. Child find and pupil identification
2. Necessary short term indirect or consultative services that are provided in conjunction with regular education prereferral activities to an individual suspected of having a disabling condition to determine whether referrals for assessment shall be made;
3. Evaluation, progress reporting, and IEP planning for individual pupils:
4. Instruction or related and support services to pupils who have an IEP;
5. Parental involvement and due process:
6. School psychological services and school social worker services provided for pupils identified as emotional or behavioral disorderd
7. Other related services provided in conjunction with the instructional program as outlined in the pupil's IEP
8. Paraprofessional services provided under the direction of a a regular or special education teacher or a related service provider
9. Program coordination;
10. Due process facilitation, not including attorney costs for suit preparation

School health services is one area where there is a need to assure that the time being reported for reimbursement is documented with time study samples.  If there is a documented need for the health care services in an IEP and there is a statement(s) of need in the adaptations and time listed on the Service Grid of the IEP, then the individual who is providing the health care service is reimbursable.

A license school nurse or a nurse licensed by the Board of Nursing (RN, LPN) may be reimbursed for direct health care services provided which is number 4 on the time study sample.

Only a Licensed School Nurse who is licensed by the Minnesota Department of Education may be reimbursed for the other special education activities in the time study.  Evaluations/assessments for special education requiring a Health Assessment must be provided by a Licensed School Nurse. (Memo from CFL Norena Hale, 2003).

The time study sampling should be completed in an assignment where nursing services are provided to the general education students as well as special education students.  Only those related services which enable a student to benefit from his/her special education and which are over and above the services normally provided to general education students are reimbursable.  Services such as screening, first aid, student intakes, and attendance issues that are normally provided to all students cannot be claimed on the time study sampling as a special education or related service.

The time is reimbursable through EDRS when the school nurse is assigned to a block of time that is exclusively a special education program, or site.  The time study does not need to be done when the nurse is providing nursing services for a population that is exclusively special education.

It is recommended that personnel complete four to five time study samples per year.  These samples should be equally spaced throughout the year (for example: September, November, January, March, and May).  The duration of the sample is for five consecutive days.

The time study form allows the employee to record the time spent on various activities so as to determine the portions of the day that are reimbursable as special education or related services that are being provided by "essential personnel": as defined by MR3525.1310.

Side One of the time study does not need to be completed by the School Nurse.  Side one must be completed by all staff who provide direct instructional services.

Please review the MDE Time Study Sampling Instructions.

MDE Time Study Sampling Form (Sides 1 and 2)

School Nurse Organization of Minnesota (SNOM) Guidelines For Completing the Minnesota Department of Education Time Study Sampling Form

A guide was developed by SNOM in collaboration with the Minnesota Department of Education, Division of Special Education, Funding and Data Unit, to assist Licensed School Nurses in completing the Special Education Time-Study Sampling.  This guide will help the Licensed School Nurse identify those activities that qualify for state special education funding.  The activities listed in this guide are not all inclusive.  Individual Licensed School Nurses should contact MDE regarding activities that are not listed as to whether that activity qualifies for state special education funding.

Guidelines for Licensed School Nurse Time Study Worksheet School Nurse Organization of Minnesota Time Study Worksheet for Licensed School Nurses

How Do School Districts Claim Reimbursement for School Nursing Services?

1. Find out who does the EDRS reporting to the Minnesota Department of Education in your school district
2. Review the Time Study Sampling Instructions.
3. Complete the time study four to five times per year following the time study directions
   • The time study allows the school nurse to record the time spent on various activities so as to determine the portions that are reimbursable as special education or related services as defined by MR 3525.1310.
4. District reports time in EDRS that is documented from the time studies
   • The FTEs from all the time samplings completed in a school year are then averaged to get an FTE for the special education reimbursable time for the employee.  The average of the samplings is the time worked in special education and may be reported on EDRS for reimbursement.