School nurses must be knowledgeable about the special education process because federal and state legal mandates must be followed for students who are in special education or are being evaluated for special education. Students 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:

Federal Special Education Regulations

• 20U.S.C. Chapter 33
• 34C.F.R.300

Minnesota Special Education Regulations

• Minnesota Statute 125A
• Minnesota Rule 3525

Definition of Special Education
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 (Minn.Rule3525.0210, Subp. 42 retrieved January 5, 2011, from http://www.revisor.mn.gov/rules/)

The Role of the Licensed School Nurse in the Special Education Process

• Participates as a member of the special education team
• Completes, as needed, an assessment of student’s health and physical status including all essential components as listed in the Licensed School Nurse Assessment of Health/Physical Status
• Interprets medical and health information that impact the student in their educational environment
• Assists in completing the evaluation report
• Assists in determining special education eligibility
• Assists in developing the individualized education program (IEP) plan
• Determines if the student needs nursing service as a related service on the IEP
• Documents a statement of the nursing services provided to the student, when the service will begin, how often it will be provided and for what amount of time, and where it till be provided.
• Develops Individual Health Plan, Emergency Care Plan and evacuation plan when needed
• Seeks reimbursement for health related services on an IEP

Minnesota Department of Education Q & A: Related Service, 3-17-2011 retrieved March 29, 2011 from http://education.state.mn.us/mdeprod/groups/Compliance/documents/FAQ/019946.pdf

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.

Frequently Asked Questions Regarding the Role of the Licensed School Nurse in the Special Education Process
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.

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

State Aid for Special Education funding is available for school nursing services through the Minnesota Department of Education Electronic Data Reporting System (EDRS). Salaries for essential personnel who are teachers, related services (includes school nursing), 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. Nursing is reimbursable if there is a statement on the IEP describing the need, services required, including frequency, location and duration.

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.