school nurse practices and recommendations for vision screening in washington state

Vivian Lyons

SCHOOL NURSE PRACTICES AND

RECOMMENDATIONS FOR VISION

SCREENING IN WASHINGTON STATE

17 Question survey, created by OSPI, WA BOH, and WA DOH

Distributed to school nurses via the SNOW list-serv and OSPI School Nurse Corps Nurse Administration.

SNOW membership – 516Survey responders – 519

SURVEY

92.44% RN2.46% ARNP1.1% LPN2.5%

Certificate or Diploma

1.5% Other

WHO YOU ARE

License Held

RNARNPLPNDiploma or CertificateOther

DEGREES HELD

PhD ADAD+BSN AD + MNAD+ MD AD + OtherBSN BSN + MNBSN + Med BSN + OtherMN MN + PhDMD Other

District Size

Class I

Class II (2,000 or fewer)

Both

WHERE YOU WORK

0.10.20.30.40.50.60.70.80.9

1

0 50 100 150 200 250

FTE

FTE

HOW MUCH DO YOU WORK?

0-5 6-10 11-15 16-20 20 +0

20

40

60

80

100

120

140

160

Years as a School Nurse

EXPERIENCE

Less than 500

501-750

751-1,000

Greater than 1,000

0 50 100 150 200 250 300 350

Number of Students in Your Caseload

Respondents

CASELOAD

One week or

less

1-2 weeks

2-3 weeks

3-4 weeks

More than 4 weeks

0

20

40

60

80

100

120

140

How soon are children re-screened?Time as a factor

HOW SOON ARE CHILDREN RESCREENED?

Preschool

2

4

6

8

10

12

0 50 100 150 200 250 300 350 400 450

GRADES SCREENED

Volunteers

Nurse Teams

School Nurse

Non-nurse trained

employees

Other

0 50 100 150 200 250 300 350 400

WHO COMPLETES THE INITIAL SCREENING?

Volunteers

Nurse Teams

School Nurse

Non-nurse trained

employees

Other

0 50 100 150 200 250 300 350 400 450 500

WHO RESCREENS?

3.5% screen students for color vision on an annual basis

10% include near vision0.8% include depth perception7.9% include tracking5.4% include convergence3.7% include asymmetry4% include light reflex4.9% include cover/uncover

73% of you only screen for distance, even for a student referred to special education

OTHER SCREENING?

Snellen Letters

Sloan Letters

Illiterate E

Titmus

HOTV

Photoscreener

Stereofly/Randot

Hand Chart

House/Apple/Umbrella

Other

0 50 100 150 200 250 300 350 400

Series 1

WHAT TESTS DO YOU USE

Challenges (52% responded) Changes (43% responded)

CHALLENGES AND CHANGES

Challenges

Changes

0% 20% 40% 60% 80% 100%

TimeTestOher

Responders requests

Questions were voluntary – low response rate for the open-ended questions

Response variety No statistical significance testingAnonymous responses

ANALYSIS

FTE

Type of Test

Increase Testing

0.00% 20.00% 40.00% 60.00%

11+ Years Expe-rienceBSN + MNTotal Responders

YEARS EDUCATION VS. YEARS EXPERIENCE AND CHALLENGES

0-5 6-10 11-15 16-20 20+0%

5%

10%

15%

20%

25%

30%

35%

TimeLinear (Time)Type of TestLinear (Type of Test)Increase TestingLinear (Increase Test-ing)

YEARS EXPERIENCE AND REQUESTS

0.1-0.5 0.6-0.9 10%

5%

10%

15%

20%

25%

30%

35%

40%

Time as a constraint vs. FTE

FTE AND CHALLENGES

RESCREENING

School Nurses are overworked! Vision screening is not the choke point – there is a

need overall for more support and caseload balance.

CONCLUSIONS

Eliminate the requirement to rescreen before a referral if a registered RN conducted the fi rst screening.

Change the test used from Snellen to “current best practices as defined by the American Optometric Association” with an option to include other approved tests if the recommended test does not fi t the student needs.

Require the state to increase funding when it increases mandates.

Provide more vouchers for glasses.

RECOMMENDATIONS