TUESDAY TALLIES

Diabetes Legislation 10/21/2025

Has your district posted diabetes information as directed by new legislation?

Background: In response to SB102, the Department of Education has created a toolkit to provide informational materials to school districts regarding Type 1 Diabetes.

SB 102-FN - VERSION ADOPTED BY BOTH BODIES

Results: 30 Nurses Responded

Has your district made this information available to parents?

11 - No
11 - Yes
8 - I don't know

How did they make it available?
10 - After inquiring, I found out that that the information was not disseminated to parents. I've sent the information to the appropriate person to act on it.
1 - District wellness page
3 - I'm not sure / Haven't seen it
6 - It is posted on my Health Office webpage.
2 - It is posted on a webpage other than my health office page
1- It was sent out via email or parent portal
7 - These nurses discovered that it hadn't been disseminated, and they have forwarded it to appropriate people.

How many Concussions have you seen so far this year?

# of Concussions Reported - Elementary=9, Middle=12, High=124
Does your district have a policy on concussion protocol? NOTE: Not all nurses answered.

Elementary: 1 No | 5 Yes

Middle: 1 No | 12 Yes

High: 1 not sure | 20 Yes

Comments

Did have several last school year during football season
We send home the CDC's TBI fact sheet on the first day of school annually
2 are from soccer and 1 is a non-sport injury
Last year 1 had 11 by Oct 8th, so less this year with 5, or I'm just not being notified which is real!
We are also seeing a high number, and a lot with lingering symptoms.
Last year I had probably 5 students diagnosed with and on a protocol for a concussion, in a small school of a little less than 200 students. So far this year so good!
I am an elementary school nurse. I have seen some head bumps from playground injuries, but none with concussion signs or symptoms.
I do not see a lot at the elementary level at my school. Maybe a handful a year but non so far this year.
So far nothing from gym class or outdoor recess.
We are lucky enough to participate in a pilot program with Return To Learn, it has been hugely helpful in safe return to learning for our post-concussion students.
Unknown sports students in MS as the coaches do not communicate concerns to the nurse. Parents do not always follow up.

Medicaid Billing 09/30/2025

Do you bill for Medicaid?

66 Nurses Responded
56 reported No, they do not bill
9 reported they do bill

Of the 9 that do bill, the program used
3 - Maxcapture: All three in same school district
3 - MSB X-Logs
2 - Relay
1 - SNAP "Easy Medicaid" Add-On Module

Comments

only paras do the billing
I do not personally bill for Medicaid but my SPED dept does as necessary for services.
some nurses in our district do bill through software
I personally do not bill for medicaid. If our school district does, I am not aware of it. Our school uses Powerschool as our information system, we use the health component.
Have asked the district about this and they stated they use Alma for special education for this. We do not bill for nursing at this time. Would like more information about that though as I am new to school nursing.
I honestly don’t know what is “billable” other than maybe like a tube feed, and if I needed to bill, I wouldn’t know how. I guess I would ask SPED in my building how they do it
The district RNs do not. What SpEd does however is a different story and SpEd department would have to be asked.
I don't have eligible students
I do not bill this year, however, in previous years our district had me use MSB School Services (Xlogs)
I personally do not bill for Medicaid however those staff that do bill for Medicaid use a program called X Logs
The Paras and I use MSB/X Logs - which is a horrible program, NH and TX use it - but it is tailored for TX. Creates more work for me in the end.

Stock Naloxone 09/09/2025

Does your school stock naloxone?

101 Nurses Answered:
81 Schools do stock Naloxone, none use OPVEE
20 Schools do not stock Naloxone.

		Yes	No
5	Elementary/Middle/High	5
38	Elementary: 5th grade or under	29	9
19	Elementary: 5th grade or under Middle	13	6
20	High School	20	0
12	Middle Schools	11	1
6	Middle/High	3	3
1	Pre-school	0	1

Comments

We have the ability to stock naloxone in our district. At this time only the middle school and high school have it in stock but we do plan to look at the elementary schools in the future.
It is very hard to get a free box. When I am unable to procure one, we will likely no longer stock it.
All Derry schools have Naloxone.
We work with The Doorway program at Concord hospital Laconia to stock this and have our school medical provider include a Naloxone use order in our school standing orders.
Our entire school district stocks Naloxone and have been for the last several years.
My district does not have a policy about stocking naloxone. I have a personal supply that I keep in my desk
I get it through ConvenientMD's School Nurse program
Haven't had the need to use it so far.
Housed with our AED, available to public.
Plan on working with admin to obtain. This is my first year here and have been told the school board has been against this in the past. It would be beneficial to have some reliable data to present as well as testimonials from schools stocking naloxone.
I'll be honest, I'm hesitant to use it especially on an adult without other support (like EMT etc} with me. People can be extremely combative when coming out of it. I would provide rescue breaths with bag/mask while awaiting assistance. If a concern was an accidental exposure in a child, I wouldn't hesitate to use it.

Nurse Sub Pay and Shortage 4-01-2025

Let's drill down on the substitute shortage in NH Schools. As you can see by the report, more schools in some counties would be helpful. We would hope that this could be used to negotiate/suggest higher pay for substitutes. Survey will remain open.

Nurse Sub Pay and Shortage

RESULTS: 43 responses with at least one from every county.

VIEW RESULTS

School Nurse Evaluations March 25, 2025

School Nurse Evaluations (Two simple questions)

We would like to add sample evaluations to our members only page. Once received, we will remove all identifying information before posting. Our first sample is attached.

Download sample evaluation.

RESULTS: 28 Nurses Responded

Who did your last evaluation?

19 Principal
4 Asst. Principal
3 No one, I did not receive an evaluation
1 Guidance Director
1 I am contracted from a hospital, my boss at the hospital does the evaluation.

No sample forms were submitted

Continuing Education March 18th, 2025

Help us improve our continuing education offerings.

Results as of 3/25/2025
40 nurses responded

Have you ever attended any NHSNA sponsored continuing education?

3- Not Sure
7- No
30 - Yes

Are you certified by the National Board of School Nurse Certification? (NCSN). We ask because those nurses are required to have ANCC accredited continuing education.

32 No
8 Yes

Most of our webinars are $25 for members. We arrange for an expert in the field in NH to present them. Do you think this price is:

23 Just Right
12 Too Much
5 Other

Many of our webinars are recorded and posted for your purchase. Very few members have utilized them. Why have you not used them?

4 I can find what I want elsewhere for free
25 I didn't know it was there
4 Price is too high
1 I have received training in the topics offered
1 I receive enough CEU from sources that are sent to me
1 I like in-person conferences but would only be able to attend one per school year.
1 I prefer free webinars so I don't have to request a PO.
1 Avail to me
1 Haven't made the time to do so
1 I don't know

If you could choose just one topic, what topic would you like to see as a webinar in the future?

advocating for profession with administrations
any and all
anxiety
Assessing for orthopedic injuries
Behavior management
Best practices for forming Medical Emergency Response Teams in the school setting, POTS, Leading Wellness Initiatives in Schools
body image
community health and how it affects school health
Concussion Management in Elementary School
Connecting with Adolescents
diabetes
Emergency management- We are often alone with few people who can assist when an emergency occurs. I'd love some tips on how to successfully manage.
Enzymes
Food allergies
g tubes
Guidance on requirements/expectations for special education health assessments/evaluations. With information specific to NH.
Handling emergencies in the school setting.
head injury at school - playground bumps vs possible concussions
Hearing and vision screenings
Managing Type I diabetes in the school setting.
More about legal issues
orthopedic
orthopedic injury stabilization
pediatric skin conditions/rashes
Planning field trips, day and overnight
Prada Willi Syndrome
Review of insulin pumps for type 1 DM
school nurse specifics like complex care plans, nurses role in IEP, or 504's
seizure management
Seizures
Self Advocacy for School Nurses
simple assessments
stock med laws and best way to obtain meds and orders
teaching parents how to be parents r/t edu and healthcare
Updated legislature on NH School nursing /legal issues
What resources do local public health offices offer?
What services are available in the state for assist families in need

Concerning our next in-person conference, Changing Climate >> Changes Health, what is the reason you are not attending? Check all that apply

10 I am attending
2 I am going to sign up
4 Schedule Conflict
3 I do not want to attend on a weekend
5 I prefer online, not in-person
6 The topic of Climate Change is too politicized"
5 The topic of Environmental Health issues does not interest me
7 Too Expensive
I struggle giving up a weekend day in the spring
timing of the offerings are not convenient for me.
I have maxed out my training funds for the school year; topic interests me, but it is less of a priority in my day to day work
They should all be free

Asthma Control Program March 11, 2025

Demographics: 35 Nurses Responded

How often do you see the following scenarios?

	Not a problem	Not a problem, AFTER I have made a lot of phone calls	Still a small problem AFTER making phone calls	A big problem despite making phone calls
Students not bringing their rescue inhalers to school	13	5	16	1
Obtaining asthma action plans from parents	5	10	13	7

Has your district purchased a stock inhaler for you to keep in your office for the students who have asthma action plans on file?
Yes 12
No: 23

Please identify your biggest challenges in working with your students with asthma by ordering the following from 1 (most challenging) to 3 (least challenging).	1-Most Challenging	2	3 - Least Challenging
Obtaining Asthma Action Plans from Parents	19	5	11
Students not knowing how to use the rescue inhaler properly	9	13	13
Students not having access to their rescue inhaler	7	17	11

If there is anything additional you would like the NH Asthma Control Program to know about, or if there are resources you would like them to supply, please write it here:

Is a weekly puff prior to gym/PE acceptable or should the student be weaned off?

Just a comment. It would be so helpful if doctor's offices used a standardized asthma Care plan AND if they just automatically completed it for every school age child they are prescribing an inhaler for. It's so frustrating.

We haven't purchased an inhaler for the district because it has been a challenge to get a provider to write an RX for a school and not a specific student, then a challenge to get the pharmacy to fill it and it is expensive. Plus, since it requires having an action plan on file, we don't have much opportunity to use it.

Overuse of rescue inhaler, does it prevent it from not working well when he does need it? and what harmful effects might happen.

at middle school and high school level the parents think their students are responsible, but then we find out they are not coming to us in a complete exacerbation episode. MD offices are giving inhalers out without instruction. more education is needed at the medical MD level or urgent care.

MDs do not routinely (per the parents) recommend or prescribe spacers

Age appropriate educational materials such as books or video shorts to give out to families and review with students

Convenience Care has written a prescription for an inhaler for school. I am going to reach out to them today and request another prescription.

I have only a few asthma Action plans for my students with asthma. I send them home in the summer, have them accessible on my school's website, and send them home in the fall. I will also accept a different form from a doctor, but very few doctor's actually make an asthma action plan.

There should be a free inhaler for schools program like there is for epi-pens.

I would love to know if there is an asthma action the NH Asthma Control Program endorses. I was using the American Lung Association's for, which has orders for rescue inhalers to be used every 20 minutes for up to 4 hours, but I had a lot of providers cross out the orders and change it to 1-2 puffs every 4-6 hours. My understanding is that the ALA form is based on the most current information about rescue inhalers, but what if I am wrong?

Cystic Fibrosis Legislation

Would you approve of 2026 legislation allowing students with Cystic Fibrosis to carry their own enzymes?

Currently, there are two laws which permit the self carry of student medication for Asthma and Anaphylaxis

200:46 Possession and Self-Administration of Asthma Inhalers Permitted

A pupil may possess and use a metered dose inhaler or a dry powder inhaler to alleviate asthmatic symptoms, or before exercise to prevent the onset of asthmatic symptoms, if the following conditions are satisfied:

I. The pupil has the written approval of the pupil's physician and, if the pupil is a minor, the written approval of the parent or guardian.

200:42 Possession and Use of Epinephrine Auto-Injectors Permitted

A pupil with severe, potentially life-threatening allergies may possess and self-administer an epinephrine auto-injector if the following conditions are satisfied:

I. The pupil has the written approval of the pupil's physician and, if the pupil is a minor, the written approval of the parent or guardian. Legislation for the 2025 season is already in progress to add nasal epinephrine to this law.

RESULTS as of 3/09/2025

42 Nurses responded / 41 public schools / 1 charter school

Please indicate whether or not you approve of self-carry legislation for the following age groups.

Age Group	Yes	No
Pre-K & K	1	41
1-5 Elementary	13	29
6-8 Middle	38	4
9-12 High	42	0

Comments

I delegate to staff member for my pre K student; I would also think middle school would be ok, (even though I put no) to self carry but also really helpful to get to see the student to check in; High school yes think would be fine with following protocol

My school just went through this. Essentially my district 504 coordinator made the call allowing my 4th grade student permission to carry, despite me not being able to find any legal resources supporting it.

I would start to consider it come 3rd grade, but not in K-2.

As with any med, it would need to agreed upon by all parties that the child is responsible enough to use it appropriately.

I strongly feel it depends on the individual situation for the students' maturity and capability to self administer correct amount of enzyme capsules with their food intake since the dose varies with amount of food consumed.

I would approve middle school and high school if parent and doctor sign that student is knowledgeable and responsible to carry (same as permission to carry inhaler/epipen)

It depends on the age of the student and the maturity and responsibility of the student.

I would consider this for certain students earlier depending on knowledge of condition and maturity level for the elementary level.

Of course with stipulations: student demonstrates responsibility, RN & PCP agreement, etc.

Same process for all meds currently in the building, self-carry once they are responsible and mature enough to self-administer. Possibly as soon as 5th grade.

I answered no for Grades 1-5, but I think this should depend on the student. A 4th or 5th grader may be able to safely self-carry their enzymes, but it depends on the student. Additionally, some middle schools include grade 5.

For elementary it would depend on the students maturity - some could absolutely carry their enzymes

I'm conflicted in the elementary age- A first grader probably not but a fifth grader probably yes. At any age it depends on the maturity of the child but I think there is greater variation at the elementary level. But this is a condition the child will have their whole life and they should be encouraged to be independent.

Although I voted yes for 1-5, I would hold off until 3rd grade before self-carrying.

As long as a healthcare provider trains them and signs off that the student is fully trained and capable of managing this independently.

We permit middle to carry, but if RN, parent and Dr thought it appropriate and the child responsible, I would allow an Elementary student to carry. I think it important the child be as independent as appropriate.

This would definitely be a case by case bases with the input of all, the parent, student, teacher, and doctor and obviously the school nurse to decide whether or not the student is responsible enough but I believe it should be allowed and then the team can make the final decision.

I think students in Grades 1-5 should have the option of carrying their enzymes. Some students in early elementary may be mature enough to handle the responsibility and some may not - that would be at the discretion of the provider, parent and school nurse.

Who oversees the nurses in your district? 02/18/2025

Survey will remain open if you have not answered yet.

Results as of 2/28/2025

69 Nurses Responded
57 Districts Represented (duplicate entries from same district edited out)

Demographics:

1 Private School
1 Charter
57 Public Districts

Results per Demographic:

Private School has one nurse, no supervisor
Charter school has one nurse, no supervisor

57 Public School Districts

21: No supervisor

# of nurses in their district:

1.5
1 (6)
2 (3)
3 (4)
4 (4)
5 (2)
6

They meet with their supervisor: N/A

If they don't meet with a supervisor, how often do the nurses meet with each other?

1x a year
1-2x each year
Once a month or as needed (2)
3x a year (3)
4x a year (2)
Other (no answer) (3)
We have not met as a nursing group this school year (4)
i am the only nurse in my SAU (3)
Several times a year
I meet with nearby district nurses whenever able, so far once this school year as our PD days do not line up

Comments

I cover 4 schools
NH needs a state level school nurse liaison.
I strongly believe every district should have a designated school nurse leader at the admin level.
It is difficult to get everyone together due to the start end times differ between middle/high and elementary. everyone has some pretty challenging case loads. We do have a group chat in google that we communicate frequently through.
We have good access to each other by phone & email.
district nurses meet only for pd days
We are a group of three nurses. One acts as a head nurse and schedules meetings, makes agendas and schedules classes (CPR/First Aid) for staff but she has never been given that title.
Our principal supervises the nurses, she reports to the superintendent if we have major concerns.
My principal is my supervisor.

6 Assistant Superintendent

# of nurses in their district:

1 (2)
6
7
12 (2)

They meet with their supervisor:

4x a year (2)
We have not met as a nursing group with this supervisor this school year (2)
Once Month (2)

If they don't meet with a supervisor, how often do the nurses meet with each other?

1x Month
no answer (5)

Comments

meetings are over google chat(previously zoom) leadership of meeting has created an unfriendly/unproductive environment

4: Director of Student Services

# of nurses in the district

They meet with their supervisor:

Once Month
1x a year
We have not met as a nursing group this school year
3x a year

If they don't meet with a supervisor, how often do the nurses meet with each other?

Once Month
We try to meet every other month
We have not met as a nursing group this school year
no answer

Comments

We have monthly scheduled nursing department meetings but our supervisor often does not attend these meetings due to schedule conflicts.
The Executive Director of Student Services oversees nursing in our district. The nurses felt we lacked support last year in a staffing shortage at the district’s elementary school. It seems there is lack of understanding what is involved with licensure while being on the teacher contract.

9: Head Nurse

# of nurses in District

3 (3)
6
8
10
11(19
23

They meet with their supervisor:

Once Month (5)
4x a year (2)
3x a year (1)
Due to distance and SAU, the location for return to school group meetings, meetings are done via phone and email as needed. Monthly reports are faxed to the head nurse.

If they don't meet with a supervisor, how often do the nurses meet with each other?

We have not met as a nursing group this school year (1)
no answer (8)

Comments

School Health Coordinator (Head Nurse) is not treated with the respect other Administrators are outside of pandemic duties.
Our Nurses report directly to their School Principals. Our Head Nurse is our Nurse Leader in the District.

9: Special Education / Services Director

# of nurses in the district

2
4 (4)
7 (2)
8
10

They meet with their supervisor:

1x Month (2)
3x Year
4x Year
We have not met as a nursing group with this supervisor this school year (4)
not answered

If they don't meet with a supervisor, how often do the nurses meet with each other?

1x a year
1x Month
3x Year
4x Year
with lead nurse 10x / year
no answer (4)

Comments

The director does not have any medical training.
no answer (8)

4: Superintendent

# of nurses in the district

1
3 (2)
6

They meet with their supervisor:

4x a year
As needed
We have not met as a nursing group this school year
1x Year

If they don't meet with their supervisor, how often do the nurses meet with each other?

1x Year
4 x Year
I am the only nurse in the district
Every other month

Comments

We have 4 school districts within our SAU with different schedules so often only meet once as a whole group on the first in-service day and then maybe once for a social dinner throughout the year.
I work under the superintendent as I am no longer on the teacher contracts but I work real close with my principal and assistant principal.

2: Building Principal

2 nurses in district; building principals of two schools; they meet 3x times a year The same two nurses meet on their own 4x year
As needed

1: HR contact is our person who checks in with us and is our liaison to superintendent

# of nurses in the district: 8
They meet with their supervisor: we used to meet monthly with HR liaison but have not this year but we check in monthly

1: Nurse Practitioner

10 nurses in the district
They meet once a month

Do you have a medical director? 02/11/2025

One simple question, please answer. NOTE: It's not too late to add your data, results will be updated monthly.

Results as of 2/18/2025
75 Nurses Responded
60 Separate Districts represented

Of those 60:

52 Public Schools
5 Private Schools
1 Boarding School
2 Charter Schools

Breakdown by School Type:

Public: 52 Schools

- 9 Have a Medical Director
- 43 Do not have a Medical Director

We have a director AND...

- we do not meet with him/her
- Just found this out yesterday
- He or she is available for phone calls and writes standing orders
- She is an APRN that writes our standing orders and offers physicals for students if needed paid for by the school
- (5) He or she is available for phone calls
- meet with him/her regularly
- we do not meet with him/her
- He or she reviews all health policies

Private Schools: 5 total

- 2 Have a Medical Director
- 3 Do not have a Medical Director

Boarding School: 1
This boarding school has their Medical Director on site Monday - Friday

Charter Schools: 2
Charter Schools do not have a Medical Director

Are you currently a member of the NASN? 02/04/2025

Are you currently a member of the National Association of School Nurses (NASN)?

Every Nurse counts, please answer yes or no on this anonymous survey. AND it will remain open if you have not answered it yet.

Results: 34 Responses:

26 YES
8 NO

Of the 8 that answered no, Plus comments section:

4 answered "it's too expensive" ($125 / year)
1: I don't need their resources
1: Have had access to resources through a colleague.
1: I think it is helpful to be a member of both local and national- so many great resources in both
1: I am a Lifetime member of NASN. Have been retired since 1994.
1: I am not, but the School Nurse Manager is.
1: I feel I get all I need from the NHSNA. Thanks

Editor's note: NHSNA will be taking a vote in April whether or not we should unify with NASN, this means that you must be a member of NASN to be a member of NHSNA. NASN would collect all dues and forward it to us. It is really important that we get a number of nurses who currently belong to NASN vs. those that don't for various reasons. The survey will remain open if you have not answered it yet.