Registed Nurses' Association of Ontario

Call for Increased Public Health Nurses in Schools and Transition of Nurses Currently in Community Care Access Centres (CCAC)

Call for Increased Public Health Nurses in Schools and Transition of Nurses Currently in Community Care Access Centres (CCAC)

Dear Eric,

Congratulations on pursuing legislative changes through Bill 210, Patients First Act, 2016 that have the potential to introduce greatly needed improvements to Ontario’s health system. We know that the current focus is on building a solid legislative framework and RNAO is pleased to be contributing to this discussion. However, we are also looking forward to the future policy development that is needed to ensure the success of the Patients First movement.

Many children and youth are not achieving optimal development and health. Access to services is often fragmented, and the level of service is inconsistent across the province. As nurses, we know there is a strong link between optimal child development and long-term health and educational outcomes. We also know that school is where children and youth learn and play, and where families and communities engage. Thus, schools have the potential to be significant venues to engage in health promotion and illness prevention. Given their preparation and expertise, public health nurses (PHN) are ideally situated to make a difference in the lives of children and families.

A PHN has -- by legislation -- at least a baccalaureate degree, and combines knowledge from nursing science, public health science, primary health care and the social/environmental sciences. PHNs focus on promoting, protecting and preserving the health of populations, and link health and illness of individuals, families, and communities to population health promotion practices. There is a growing body of evidence from other jurisdictions, including the US, UK, and Australia, demonstrating that school nurses are key contributors to the development and well-being of children and youth, and to the creation of healthy school environments that promote student attendance and academic achievement. There is also an international movement to better integrate the health and education sectors, with a focus on the growth and development of the whole child. This is consistent with the Ontario government’s "Achieving Excellence" vision for education and promoting student well-being.

PHNs working to their full scope of practice can partner with students, families, educators, community agencies, and other health professionals to develop strategies that address the health of children and youth using a holistic approach. School-based PHNs are also able to work with individuals and families to provide direct services for children at higher risk of not achieving optimal growth and development, as well as those with identified needs. Thus, increasing the number of PHNs in schools would provide synergy with identified government priorities, such as mental health, Fetal Alcohol Spectrum Disorder (FASD), Immunization 2020, sex education and the Healthy Kids Strategy. School-based PHNs working to their full and expanded scope of practice (including independent RN prescribing) could also provide students with comprehensive reproductive and sexual health services in an environment that is safe, comfortable and easy to access. Along with health promotion strategies, school-based PHNs with independent prescribing authority can help youth make informed sexual health decisions, decrease the rate of adolescent pregnancy and enable healthy sexuality.

Ontario has a long history of PHNs in schools, but restructuring and budget cuts in the 1990s led to a significant reduction of PHN presence in the province's schools. Today, a PHN may be assigned to up to 35 schools (as many as 14,000 students), and high caseloads can limit their effectiveness. Evidence shows that both health and educational outcomes improve when one full-time PHN works with just one school of 500 to 1,500 students.

Minister, we know you will agree with us that it is easier to help develop healthy children than to try to repair broken adults. We are asking you to devote resources now to school-based public health nurses as an investment in the health of our province's children. We understand that the Ministry will be reviewing the Ontario Public Health Standards, and this presents an ideal opportunity to discuss how we can increase the presence of PHNs in schools. Supportive funding and mechanisms to collect data on the processes and outcomes associated with this role are needed. We request an opportunity to meet with the Ministry at the earliest convenience to discuss how we can move this opportunity forward.

Meanwhile, an immediate first step we already discussed with Nancy Naylor, Associate Deputy Minister, on May 26th – is to ensure that the CCAC mental health nurses that work in schools, be relocated to public health units if they meet the legislated requirement to become a PHN. If not, we are calling for them to be relocated into the mental health sector. In addition, we are asking for the relocation of other nurses who are currently practising within CCACs as per the attached appendix A.

Warmest regards,

Doris Grinspun, RN, MSN, PhD, LLD(hon), O.ONT.
Chief Executive Officer
Registered Nurses' Association of Ontario

Cc. Hon. Mitzie Hunter, Minister of Education
Hon. Michael Coteau, Minister of Children and Youth Services
Jeff Yurek, Health Critic, Progressive Conservative Party of Ontario
France Gélinas, Health Critic, New Democratic Party of Ontario
Patrick Brown, Education Critic, Progressive Conservative Party of Ontario
Lisa Gretzky, Education Critic, New Democratic Party of Ontario
Sylvia Jones, Child & Youth Services Critic, Progressive Conservative Party of Ontario
Monique Taylor, Child & Youth Services Critic, New Democratic Party of Ontario
Nancy Naylor, Associate Deputy Minister, Delivery and Implementation

See the full letter with references and appendix below.

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