School Nurse Cooperative
Staff Development Opportunities for Nurse Cooperative Members
School Nurse FAQ
Vision and Hearing Screening Certifications
How do I register for a vision and hearing certification course?
Who leads the vision and hearing certification courses?
Who can become certified to conduct vision and hearing screening?
What ages/grades are vision and hearing screenings required?
- Screened within the first 120 days of admission:
- 4-years-old by September 1st
- Any students entering school for first-time (4 years through 12th grade)
- Screened within the School Year (preferable within first semester):
- Grades: 1st, 3rd, 5th, and 7th
- Handout: VisionHearing and Spinal Screening Requirements (texas.gov)
What eye charts are approved to test for visual acuity?
- Sloan Letter Chart
- HOTV Matching-Symbol Test
Is photoscreening allowed?
How long are my vision and hearing certifications valid for?
Where do I report my vision and hearing screening results?
When is the report due?
Where can I learn more about the vision and hearing screening requirements?
Spinal Screening Certification
How do I register for a spinal certification course?
Who leads the spinal certification courses?
Who can become certified to conduct spinal screening?
I am a Registered Nurse (RN) is spinal certification required?
What ages/grades are spinal screenings required?
- Girls – Required to be screened twice
- Age 10 – or fall semester of 5th grade and
- Age 12 – or fall semester of 7th grade
- Boys – Required to be screened once
- Age 13 or 14 - or fall semester of 8th grade
- Note: Schools must identify any students who do not fall into the grade category (i.e. student held back or promoted to different grade levels) and ensure they receive screening at the appropriate age.
- Handout: VisionHearing and Spinal Screening Requirements (texas.gov)
Where do I report my spinal screening results?
When is the report due?
How long is my spinal certification valid for?
Is there a recertification course for spinal screening?
Where can I learn more about the spinal screening requirements?
Unlicensed Diabetes Assistant Training (UDCA)
What is the requirement for Unlicensed Diabetes Assistants (UDCA)?
How many UDCAs are required per campus?
Who can lead the UDCA training for school employees?
When should the training be conducted?
- the enrollment of a student with diabetes at a campus that previously had no students with diabetes; or
- a diagnosis of diabetes for a student at a campus that previously had no students with diabetes.
How often is the training required?
Where can I find out more information regarding the UDCA training content?
Acanthosis Nigricans: Texas Risk Assessment for Type 2 Diabetes in Children (TRAT2DC)
What is screening for acanthosis nigricans?
What ages/grades must be screened?
When are the results of the acanthosis nigricans screening due?
How do I receive training on conducting screening for acanthosis nigricans?
Where can I get additional information on acanthosis nigricans?
Where do I located the K-12 immunization requirements?
How often do the K-12 immunization requirements change?
When is the Annual Report of Immunization Status due?
Where is the Annual Report of Immunization Status data submitted?
How long can a student attend school if he/she does not have the required immunizations?
What is provisional enrollment?
Is provisional enrollment 30 school days or 30 calendar days?
What students are eligible to receive provisional enrollment?
- Students who are homeless or in foster care;
- Students who are transferring from another Texas public or private school;
- Students who are military dependents of an individual who is on active duty with the armed forces of the United States
- Students who are in-progress receiving the required immunizations series, to remain enrolled the student must receive the following doses in the vaccine series on schedule and as medically feasible.
What are allowable reasons for individuals to obtain exemption from the immunization requirements?
- Medical contraindications;
- Reasons of conscience, including a religious belief;
- Active duty with the armed forces of the United States – this applies to active-duty military only, not to dependents of active-duty service members.
How does a parent or guardian obtain a conscientious exemption for immunizations form?
Does the form have to be notarized?
Can a copy of the vaccine exemption affidavit be submitted to the school?
How long is the conscientious exemption for immunizations form valid for?
Can a student enroll in school if he/she does not have the required immunizations and it is not eligible for provisional enrollment?
Can a LEA make a local decision to allow students to enroll in school despite being delinquent on vaccinations?
- the student has received the required immunizations;
- the student has a current conscientious exemption from on file; or
- the student is entitled to provisional enrollment.
Can the LEA accept immunization records from Mexico?
Where can I find more information on school immunization requirements in Texas?
Are school nurses required in Texas?
If a LEA hires a school nurse, does it matter if the individual is a Registered Nurse (RN) or Licensed Vocational Nurse (LVN)?
Where can a LEA access a copy of the RN and LVN scope of practice?
How is a school nurse defined in the Texas Administrative Code?
Where can a school nurse find additional information on School Health Services and resources for practice?
Who can administer medication to students?
Who can administer medications when the student is participating in a field trip or other off-site, school-related activity?
Are there any medications that students are allowed to possess and self-administer in the school setting?
- the prescription medicine has been prescribed for that student as indicated by the prescription label on the medicine;
- the student has demonstrated to the student's physician or other licensed health care provider and the school nurse the skill level necessary to self-administer the prescription medication, including the use of any device required to administer the medication;
- the self-administration is done in compliance with the prescription or written instructions from the student's physician; and
- a parent provides to the school:
- a written authorization from the parent, for the student to self-administer the prescription medicine; and
- a written statement from the student's physician that states:
- the student has asthma or anaphylaxis and is capable of self-administering the prescription medicine;
- the name and purpose of the medicine;
- the prescribed dosage for the medicine;
- the times at which or circumstances under which the medicine may be administered; and
- the period for which the medicine is prescribed.
- The physician's statement must be kept on file at the school.
- performing blood glucose level checks;
- administering insulin through the insulin delivery system the student uses;
- treating hypoglycemia and hyperglycemia;
- possessing on the student's person at any time any supplies or equipment necessary to monitor and care for the student's diabetes; and
- otherwise attending to the management and care of the student's diabetes in the classroom, in any area of the school or school grounds, or at any school-related activity.
Can a LEA administer over the counter (OTC) medications?
Where can I find additional information on medication administration in the school setting?
Cardiopulmonary Resuscitation (CPR) and Automated External Defibrillators (AEDs)
What staff must be certified in CPR and First Aid?
Are there requirements on offering CPR and automated external defibrillator (AED) training?
Are LEAs required to have AEDs?
Are LEAs required to have AEDs at University Interscholastic League (UIL) athletic practices and competitions?
Are students required to complete CPR training prior to graduation?
TAC §74.38 Texas Administrative Code (state.tx.us)
Does the student training have to result in certification?
Must the student training include a hands-on (psychomotor) component?
Who may instruct the CPR training for students?
Does completion of the required CPR training need to be documented on the student’s transcript?
TAC §74.5: Texas Administrative Code (state.tx.us)
Bleeding Control Training (STOP the Bleed)
Which staff are required to receive bleeding control training?
- each school district peace officer or school security personnel employed who provides security services at the campus;
- each school resource officer who provides law enforcement at the campus; and
- all other district or school personnel who may be reasonably expected to use a bleeding control station
Is the bleeding control training for staff an annual requirement?
Are students required to receive training on STOP the Bleed?
What bleeding controlled training courses are approved for use by the Texas Education Agency (TEA)?
Where should bleeding control stations at campuses be located?
Seizure Recognition and Training
Are school nurses required to receive training on seizures?
Are school district staff required to receive training on seizures?
Is the training required annually?
Where can I find the list of agency-approved seizure recognition trainings?
Individualized Health Plans (IHPs)
What is an Individualized Health Plan (IHP)?
Who can develop an IHP?
How does a LEA know if a student requires a IHP?
Where can I find additional resources and templates on IHPs?
Are schools required to send students home who have head lice?
Am I required to notify parents regarding cases of head lice on an elementary campus?
- (1) The parent of the child with lice (as soon as practicable but not later than 48 hours after becoming aware of that fact); and
- (2) The parent of each child assigned to the same classroom as the child with lice not later than the fifth school day after the date of becoming aware of that fact.
Can I send an electronic notice if there is a case of headlice on campus?
Do head lice carry disease?
Where can I find more information on head lice?
- Texas Department of State Health Services: Managing Head Lice in School Settings and at Home Managing Head Lice (Pediculosis) in School Settings and at Home (texas.gov)
- Includes handouts and downloadable fact sheets in English and Spanish.
- National Association of School Nurses: Head Lice Management in Schools: Head Lice Management in Schools - National Association of School Nurses (nasn.org)
- American Academy of Pediatrics – Pediatrics Journal Article: Head Lice Head Lice | American Academy of Pediatrics (aappublications.org)
What is the difference between HIPAA and FERPA?
Where can a LEA get more information on how HIPAA applies in a school setting?
- Texas Department of State Health Services: HIPAA School Health Information website School Health Information (texas.gov)
- Comparison of FERPA and HIPAA Privacy Rule for Accessing Student Health Data Comparison of FERPA and HIPAA Privacy Rule | State Public Health | ASTHO
What LEA staff are allowed access to student health/medical records?
Are parents/guardians allowed access to student health/medical records?
Where can a school find information on how long student health records must be maintained?
Is a LEA allowed to stock unassigned epinephrine autoinjectors?
Is a LEA required to stock epinephrine?
What staff training is required if a LEA adopts an unassigned epinephrine auto-injector policy?
- recognizing the signs and symptoms of anaphylaxis;
- administering an epinephrine auto-injector;
- implementing emergency procedures, if necessary, after administering an epinephrine auto-injector; and
- properly disposing of used or expired epinephrine auto-injectors; and
How often is the training on epinephrine auto-injectors required?
Can a physician provide a LEA with a standing order for epinephrine auto-injectors?
What reporting is required if epinephrine is administered on campus?
- school district, charter holder if the school is an open-enrollment charter school, or governing body of the school if the school is a private school;
- the prescribing physician of the epinephrine auto-injector, and;
- the commissioner of the Texas Department of State Health Services.
How does a school submit a report to the commissioner of the Texas Department of State Health Services (DSHS)?
Is a LEA required to stock asthma medication?
If a LEA has a policy to maintain and administer asthma medication, which students may be given the medication?
Can a physician provide a LEA with a standing order for asthma medication?
Where can a LEA learn more about asthma care in schools?
Is a LEA required to have a plan for food allergies?
How often is a LEA required to review/revise its policy for the care of students with a diagnosed food allergy at risk of anaphylaxis?
Where can a LEA locate a copy of the guidelines for the care of students with a diagnosed food allergy at risk for anaphylaxis developed by the Commissioner and legislated Ad-Hoc committee?
Are LEAs required to ask parents/guardians if their children have any food allergies when enrolling the students in school?
Where should a LEA file information provided by the parent/guardian regarding a student’s food allergy?
- Information provided by a parent/guardian regarding a child's food allergy, shall be retained in the child's student records, but may not be placed in the health record maintained for the child by the school district.
- Documentation the LEA receives from a physician regarding a food allergy shall be placed in the health record maintained for the child by the LEA.
- A registered nurse may enter appropriate notes about a child's possible food allergy in the health record maintained for the child by the LEA, including a notation that the child's student records indicate that a parent has notified the LEA of the child's possible food allergy. EDUCATION CODE CHAPTER 25. ADMISSION, TRANSFER, AND ATTENDANCE (texas.gov)
Where can a LEA locate Emergency Care Plans for Students with Food Allergy templates?
What is a Concussion Oversight Team (COT)?
Who should be on the Concussion Oversight Team (COT)?
What is the role of the Concussion Oversight Team (COT)?
Who is required to receive training over concussions?
- a coach of an interscholastic athletic activity;
- a school nurse who serves as a member of a concussion oversight team;
- a licensed health care professional (including an athletic trainer) who serves as a member of a concussion oversight team (LEA employee and volunteers)
- A physician who serves as a member of a concussion oversight team shall, to the greatest extent practicable, periodically take an appropriate continuing medical education course in the subject matter of concussions.
- A school nurse or licensed health care professional who is not in compliance with the training requirements under this section may not serve on a concussion oversight team in any capacity.
Where can I find more information on Concussion requirements in Texas?
Are LEAs required to follow bloodborne pathogen control standards?
- provide services in a public or private facility providing health care-related services; or
- otherwise have a risk of exposure to blood or other potentially infectious material containing bloodborne pathogens in connection with exposure to sharps.
A public school district clinic is considered a governmental unit and is required to meet the minimum standards. Texas Administrative Code (state.tx.us)
What requirements related to bloodborne pathogens are LEAs required to follow?
Where can I find a copy of the Texas Department of State Health Service’s adopted Exposure Control Plan?
What staff should receive training on bloodborne pathogens?
How frequently do staff need to complete training on bloodborne pathogens?
Should the LEA provide Hepatitis B vaccine to employees?
What must be included in the bloodborne pathogens training for employees?
Where can I find additional information on bloodborne pathogens requirements?
What is the role of the SHAC in regards to sexual education curriculum selection?
Does the human sexuality instruction taught have to be abstinence based?
- present abstinence from sexual activity as the preferred choice of behavior in relationship to all sexual activity for unmarried persons of school age;
- devote more attention to abstinence from sexual activity than to any other behavior;
- emphasize that abstinence from sexual activity, if used consistently and correctly, is the only method that is 100 percent effective in preventing pregnancy, sexually transmitted diseases, infection with human immunodeficiency virus or acquired immune deficiency syndrome, and the emotional trauma associated with adolescent sexual activity;
- direct adolescents to a standard of behavior in which abstinence from sexual activity before marriage is the most effective way to prevent pregnancy, sexually transmitted diseases, and infection with human immunodeficiency virus or acquired immune deficiency syndrome.
- teach contraception and condom use in terms of human use reality rates instead of theoretical laboratory rates, if instruction on contraception and condoms is included in curriculum content.
Can a LEA distribute condoms in connection with the human sexuality instruction?
Are LEAs allowed to separate students based on sex for the human sexuality instruction?
Are LEAs required to notify parents regarding human sexuality instruction?
- a summary of the basic content of the district's human sexuality instruction to be provided to the student, including a statement informing the parent of the instructional requirements under state law;
- a statement of the parent's right to:
- review curriculum materials; and
- remove the student from any part of the district's human sexuality instruction without subjecting the student to any disciplinary action, academic penalty, or other sanction imposed by the district or the student's school; and
- information describing the opportunities for parental involvement in the development of the curriculum to be used in human sexuality instruction, including information regarding the local school health advisory council.
Are parents/guardians allowed to opt their students out of participation in human sexuality instruction?
Are school professionals required to report suspected child abuse or neglect?
Are school professionals required to complete training over child abuse?
What school employees are required to participate in the training?
Is human trafficking considered a form of child abuse?
Where can a LEA find a list of trainings that meet the requirements of the Texas Education Code §38.0041?
Are there any required postings related to child abuse?
Where can a LEA find more information on child abuse and human trafficking?
Pregnancy Related Services (PRS)
What is Pregnancy Related Services (PRS)?
- The student is pregnant and attending classes on a district campus,
- A valid medical necessity for confinement occurs during the pregnancy prenatal period, which prevents the student from attending classes on campus, or
- A valid medical necessity for confinement during the postpartum pregnancy period prevents the student from attending classes on campus.
Are Pregnancy Related Services required?
What is Compensatory Education Home Instruction (CEHI)?
Where can a LEA find more information on Pregnancy Related Services?
School Health Survey
What is the School Health Survey?
Who should complete the School Health Survey?
When is the School Health Survey due?
Coordinated School Health
What is Coordinated School Health?
Is Coordinated School Health required?
What Coordinated School Health Programs have been approved by the Texas Education Agency (TEA)?
School Health Advisory Committee (SHAC)
What is a School Health Advisory Council (SHAC)?
What are the duties of the SHAC?
- the number of hours of instruction to be provided in: health education in kindergarten through 8th grade; and if the school district requires health education for high school graduation, health education, including physical health education and mental health education, in grades 9 - 12;
- policies, procedures, strategies, and curriculum appropriate for specific grade levels designed to prevent physical health concerns, including obesity, cardiovascular disease, Type 2 diabetes, and mental health concerns, including suicide, through coordination of:
- health education, which must address physical health concerns and mental health concerns;
- physical education and physical activity;
- nutrition services;
- parental involvement;
- instruction on substance abuse prevention;
- school health services, including mental health services;
- a comprehensive school counseling program;
- a safe and healthy school environment; and
- school employee wellness;
- appropriate grade levels and methods of instruction for human sexuality instruction;
- strategies for integrating the curriculum components specified by above in a coordinated school health program for the district:
- school health services, including physical health services and mental health services;
- a comprehensive school counseling program;
- a safe and healthy school environment; and
- school employee wellness;
- joint use agreements or strategies for collaboration between the school district and community organizations or agencies; and
- strategies to increase parental awareness regarding:
- risky behaviors and early warning signs of suicide risks and behavioral health concerns, including mental health disorders and substance use disorders; and
- available community programs and services that address risky behaviors, suicide risks, and behavioral health concerns
- appropriate grade levels and curriculum for instruction regarding opioid addiction and abuse and methods of administering an opioid antagonist.
Who should the members of a SHAC be?
- classroom teachers employed by the district;
- school counselors employed by the district;
- school administrators employed by the district;
- district students;
- health care professionals licensed or certified to practice in this state, including medical or mental health professionals;
- the business community;
- law enforcement;
- senior citizens;
- the clergy;
- nonprofit health organizations; and
- local domestic violence programs.
Are there any required subcommittees for the SHAC?
How often are SHACs required to meet?
What topics are typically discussed at SHAC meetings?
SHAC annual report to Board
- any SHAC recommendation concerning the school district's health education curriculum and instruction;
- any suggested modification to a SHAC recommendation previously submitted to the board;
- a detailed explanation of the SHAC's activities during the period between the date of the current report and the date of the last prior written report; and
- any recommendations made by the physical activity and fitness planning subcommittee of the SHAC.
Are public charter schools required to have a SHAC?
Are districts of innovation required to have a SHAC?
Where can I get more information on SHACs?
Is a LEA required to have a Wellness Policy?
What is the Wellness Policy?
What is the Wellness Plan?
Is a LEA required to have a Wellness Plan?
Who should create a LEA’s Wellness Policy/Plan?
Does the Wellness Policy require approval of the School Board?
How often does the Wellness Policy have to be evaluated?
Where can I access more information on the Wellness Policy/Plan?
What should a LEA do if they find a bat on a school campus?
- Remove the bat and bat colony (if present)
- Make repairs so bats are excluded in the future
- Disinfect the areas where bats roosted or a dead bat was found
What is considered a potential exposure to rabies?
Does a potential exposure to rabies need to be reported?
Where doe a LEA report a potential rabies exposure?
Where can additional information be found on responding to bat incidents in schools?
School Nursing Peer Review
What is nursing peer review?
- the evaluation of the accuracy of a nursing assessment and observation and the appropriateness and quality of the care rendered by a nurse;
- a report made to a nursing peer review committee concerning an activity under the committee's review authority;
- a report made by a nursing peer review committee to another committee or to the board as permitted or required by law;
- implementation of a duty of a nursing peer review committee by a member, an agent, or an employee of the committee; and
- the provision of information, advice, and assistance to nurses and other persons relating to:
- the rights and obligations of and protections for nurses who raise care concerns or report under Chapter 301 of the Texas Occupations Code or other state or federal law;
- the rights and obligations of and protections for nurses who request nursing peer review under this chapter;
- nursing practice and patient care concerns; and
- the resolution of workplace and practice questions relating to nursing and patient care.
Is a LEA required to have a nursing peer review committee?
May a LEA contract with another entity to provide the nursing peer review process?
What is Safe Harbor?
What is Incident Based Peer Review?
Does ESC Region 20 offer a nursing peer review committee for LEAs?
Where can a LEA find more information on the Peer Review Process?
Are schools required to report students that have communicable diseases?
Where do I access the current Communicable Disease Chart for schools?
Where do I report Communicable Diseases to?
What guidelines related to COVID-19 should a LEA follow?
Where can a LEA find information and best practices related to COVID-19 prevention in school settings?
Where can a LEA find information related to COVID-19 that is specific to the state of Texas?
Where can a LEA find information related to COVID-19 that is specific to San Antonio?
Where is a LEA required to report a positive COVID-19 case to?
**NOTE: Reporting information may change at the start of the 2021-2022 school year.
Is the COVID-19 vaccination required for students enrolled in school?
What are the current quarantine guidelines related to COVID-19?
What is considered being “fully vaccinated” against COVID-19?
Were can I find more information about international travel during COVID-19?
Miscellaneous School Health Related Questions
Is a LEA required to have a policy on teen dating violence?
- The dating violence policy must include a definition of dating violence that includes the intentional use of physical, sexual, verbal, or emotional abuse by a person to harm, threaten, intimidate, or control another person in a dating relationship.
- The policy must address safety planning, enforcement of protective orders, school-based alternatives to protective orders, training for teachers and administrators, counseling for affected students, and awareness education for students and parents.
Is smoking or the use of e-cigarettes allowed on school property?