School Health Services in Maryland

Since 1991, the Code of Maryland Regulations COMAR 13A.05.05.05–.15 mandated health coverage in schools by a school health services professional. The school health services professional is defined in COMAR as a physician, certified nurse practitioner, or registered nurse, with experience and/or training in working with children or school health programs. Local education agencies, with the assistance of local health departments, are responsible for providing school health services to all public schools. The regulations do not specify a ratio of school nurses to students.

Local jurisdictions in Maryland meet the mandate in various ways. Some have a registered nurse in every school; others employ licensed practical nurses or registered nurses in each school. In some schools, trained unlicensed health staff are in each school working under the supervision of a registered nurse who may be responsible for one to three schools. Either local education agencies or local health departments manage school health services programs. School nurses work with students, families, healthcare providers, and school staff to support student success.

School nurses support student success. They are an integral part of school multi-disciplinary teams, bridging the gap between health and wellness and learning. School nurses identify student health-related concerns and make accommodations and/or interventions to support learning. They also focus on early detection and correction of health problems. School nurses promote and protect the optimal health of students. They work with families and students to develop individualized healthcare plans for students with special health needs. They provide health counseling to students and their families, as well as school staff. They identify and report school environmental concerns. They determine which nursing services can be delegated, and provide supervision for the one to whom he or she delegates.

The Annotated Code of Maryland Education Law §7-403 mandates an immunization program for children entering schools.

The Annotated Code of Maryland Education Article §7-402 requires physical examinations for children entering the Maryland public school system for the first time. The examination must be completed in the nine-month period before entering the public school system or in the six-month period after entering the school system.

The Annotated Code of Maryland Education Article §7-404 (hearing and vision) mandates screening tests for students in public schools. The hearing and vision screenings are required in the year that a student enters a school system, enters the first grade, and enters the eighth or ninth grade.

When there is a need for a student to receive medication in school, safe and proper administration is essential. The Maryland Department of Education, the Maryland Department of Health and Mental Hygiene, and the Maryland State School Health Council have developed guidelines to assist local education agencies and local health departments in the development of their medication administration policies. An authorized prescriber must order all prescription medication and over-the-counter medications to be given in school. Consult with the local school health services program for information on the medication administration policy.

Each local education agency has procedures for controlling head lice. Consult with the school health services staff regarding the local policies for head lice.