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In light of shortage, certification process extended for school nurses

State House Bureau

October 01. 2017 9:41PM

CONCORD — With a chronic nursing shortage showing no signs of abating, the state has had to retreat from new licensing and certification requirements for school nurses at the request of the Board of Education.

Tougher requirements for school nurses hired after July 1, 2016, were supposed to take effect with the start of the school year, but a Legislative committee that presides over rules and regulations recently decided to give nurses affected by the new rules another six years to comply.

“The legislation kind of dictated that we implement the new rules now,” said state Sen. John Reagan, R-Deerfield, chair of the Joint Legislative Committee on Administrative Rules (JLCAR), which on Sept. 21 voted to extend the deadline for compliance to 2023.

“We didn’t allow time for the nurses without four-year degrees to meet these new qualifications, so we decided to fix that,” he said. “The school year was starting, and in theory these nurses would not be in compliance.”

Currently, all that’s required to be a school nurse is to have a nursing license from the state Board of Nursing, but HB 1193 passed in 2016 and signed into law by Gov. Maggie Hassan changed that.

The law states that school nurses hired after July 1, 2016, will also have to be certified by the Board of Education, just like teachers. While an associate degree is sufficient for a state nursing license, it would no longer qualify for school nursing certification, which will require a bachelor’s degree.

Candidates will also need three years of experience in pediatric nursing or related areas, and will have to commit to continuing education. Like teachers, they will have to be recertified every three years by the Department of Education, at a cost of $130 to $150, in addition to what they pay for their nursing licenses.

The proposal to allow six years for newly hired nurses to meet the new requirements was proposed by the Board of Education, whose attorney was present for the JLCAR deliberations.

“The Board of Education attorney was accompanied by an attorney from the Attorney General’s Office, and it was their opinion that the statute allows an indefinite period of time for us to accomplish this, and that six years was reasonable,” said Reagan.

Need questioned

Education Commissioner Frank Edelblut says the Board of Education was concerned about the disruptive impact of the new requirements.

“The state board was really interested in ensuring we would not create a situation that would be onerous on the schools,” he said. “We haven’t had any problems in the area of school nursing. This appears to be a solution in search of a problem.”

Edelblut said it is not the department’s role to propose that the Legislature revisit the issue, but he predicted that will happen. “I understand some legislators will be filing bills,” he said.

Manchester Public Health Director Tim Soucy was among those who testified against the new certification requirements at a public hearing in June. While the six-year extension is welcome, he still questions whether the change is necessary.

“I go back to the over-arching issue of whether there is a need for it,” he said. “If nurses are already licensed by the Board of Nursing, why is Department of Education certification even necessary? It will continue to place a financial burden on school nurses. Recruitment and retention will continue to be a problem.”

In Manchester, the Public Health Department handles the hiring of school nurses for the state’s largest school district.

“We have some great nurses here who are associate degree nurses,” said Soucy. “If I hire someone and say, ‘You have to get a bachelor of science degree in six years,’ that’s another barrier to hiring in a tough environment right now.”

Push for BS in nursing

The problem is particularly challenging in Manchester, he said, where some of the state’s biggest health care systems are aggressively recruiting nurses with much better pay, benefits and tuition reimbursement for continuing education than school districts can offer.

“We have some great health care entities in the community that will grab nurses and pay them a heck of a lot more than we can, so that’s already a competitive disadvantage for us,” according to Soucy.

He’s hoping that the Legislature will reconsider HB 1193 in its entirety. “If it goes back through the legislative process, we’ll see what comes out of it and decide how to proceed at that time,” he said.

The N.H. School Nurses Association supports the new requirements.

“The trend for the profession of nursing is a bachelor’s degree in science with a major in nursing and there are many states that see the value in this with state school nurse certification. We would like to see New Hampshire join the other New England states with this requirement,” said Linda Compton, association president.

Susan Kinney, who directs the RN-to-BSN program at St. Anselm College, says the National Academy of Medicine is pushing for a bachelor of science in nursing as the baseline credential for registered nurses by 2020.

“At this point, the goal is for hospitals to have 80 percent of their nurses with a BSN, so I think the same is appropriate for school nurses,” she said.

Supports extension

Nonetheless, Kinney supports the six-year extension, given the nursing shortage. In Manchester alone, the Elliot Health System and Catholic Medical Center combined are recruiting for 153 registered nurses, she said.

“I like the plan they came up with,” said Kinney. “They’re giving them six years to earn the bachelor’s degree. In our program, most of our associate degree nurses earn their bachelor’s degree in two to two-and-a-half years, so they’re giving them plenty of time.”

Sen. Dan Feltes, D-Concord, believes the JLCAR vote to allow six years for compliance went beyond the scope of the committee’s authority.

“Rules must conform to the statute, even if the agency or JLCAR disagree with the statute,” he said. “Here, the statute required at least a bachelor’s degree, but the rules allow for an associates degree. I think it is a statute that needs correction but we cannot simply ignore the statute during this rule-making process.”

Reagan disagrees. “That’s why we have the JLCAR,” he said, “so laws don’t just go into effect automatically. There is oversight of legislation and we were able to show a little bit of wisdom and judgment to allow it to get implemented in this way.”

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