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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
