School Nurses Advocate for Inclusion in Oregon’s New Health System

April 08, 2014 | Written By:

School nurses are making the case that they’re critical to students’ health.

“School nurses are with students six hours a day and know what health issues are impacting their students. They can improve student health and make sure a student’s health providers get the information they need to provide quality care.” – Nina Fekaris, school nurse with Beaverton School District

This is the argument a group of school nurses is putting forth to make sure the transformation of Oregon’s health care system takes full advantage of the tremendous contributions school nurses can make to coordinated care of children’s health.

Beginning in 2012, Oregon began delivering health services to its Medicaid population through Coordinated Care Organizations (CCOs), networks that include physicians, mental health providers, dentists and other health care providers who work together in their local communities. There are currently 15 CCOs across the state. Through this model, Oregon aims to increase the coordination of patients’ care and promote exchange of health information among providers so each part of this team can do their job most effectively. Another significant goal is to reduce preventable hospital admissions in order to decrease costs.

Research demonstrates that school nurses can play a key role in meeting all of these goals. However, school nurses are not currently included in the delivery and financing models of these new CCOs.

A group of nurse advocates, including Nina Fekaris from Beaverton School District, Beth Baynes from Multnomah Service Education District and Paula Hall from West Linn/ Wilsonville School District, is working to change that.

Ms. Baynes, Ms. Fekaris and Ms. Hall identified the CCOs serving their communities and knew how important it was to meet with the CCOs to discuss how school nurses are naturally positioned to work collaboratively with the CCOs to help coordinate the care of school-age members. Through checking meeting announcements on the CCOs’ websites and reaching out to staff and partner organizations, Ms. Baynes, Ms. Fekaris and Ms. Hall found out that key staff from Health Share of Oregon (one of the two CCOs serving their community) would be attending a meeting of the Healthy Students Learn Better Coalition (a coalition the school nurse advocates were part of). The school nurse advocates came to the meeting prepared to make their case: school nurses could help the CCO meet the goals of improving quality and access to care while reducing costs.

Their argument caught the attention of the right people. Ms. Baynes, Ms. Fekaris and Ms. Hall now have monthly standing meetings with the key staff who are creating the CCOs that will be serving their communities. These meetings provide the school nurses with the opportunity to continue to make the case for why school nurses should be recognized within the CCOs.

One of the key ways in which the school nurses are making this case is through a coordinated care pilot project they have launched in coordination with a local pediatric clinic that is part of the largest CCO in the state. Ms. Baynes, Ms. Fekaris and Ms. Hall will be working with five schools in Portland Public School District (a district Ms. Baynes serves) and physicians from the clinic to demonstrate how school nurses can help the pediatricians meet the health goals that have been set for them by the CCO, specifically related to ADHD and asthma.

School nurses in the five pilot schools will be communicating regularly with the physicians in the pediatric clinic to share information regarding student health and help coordinate the care students receive. Through this information-sharing and coordination, the school nurses believe both they and the physicians will be able to provide more effective care and students will have better health outcomes at a lower cost to the state. They hope to not only gather data documenting the benefits of this approach but also to help the physicians they’re working with recognize the valuable role school nurses can play in coordinated care for children’s health.

“If we can convince a handful of physicians that school nurses are providing valuable health information that will help physicians do their jobs better and provide better care to their patients, it would be a huge win,” said Ms. Fekaris.

The physicians are already beginning to show support for this project and will be obtaining consent from their patients’ parents to give school nurses access to students’ electronic health records. This will not only allow school nurses to see physicians’ notes and develop a better understanding of the care students are receiving outside of school but will also allow school nurses to communicate directly with the physicians by adding additional notes to students’ charts.

“If a school nurse notices a student with asthma is using their inhaler more frequently, we can make a note in the student’s health record so that the doctor will see it and know they need to consider increasing the student’s medication next time they visit,” explained Ms. Fekaris.

The goal is to expand this project to Ms. Fekaris’ district and Ms. Hall’s district in the coming years and continue to collect and share data documenting the powerful role school nurses could play as providers within the state’s new CCOs. If Oregon’s CCOs include school nurses in their financing and delivery models, this could mean better care for students and more effective use of health dollars. It could also mean increased resources to fund school nursing.

We commend Ms. Baynes, Ms. Fekaris, Ms. Hall and the school nurses they’re working with in the Portland metro area for leading this innovative effort. We look forward to learning more as the project progresses.

At HSC, we believe that the Affordable Care Act presents important opportunities for redesigning the health system to better support students’ health at school. Through our work with the National Collaborative on Education and Health, we will be working to better understand these opportunities and support innovative efforts such as those taking place in the Portland metro area. To learn more, visit


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