Monday, December 10, 2012

Guest Post: The Blurred IEP Role of the School Health Nurse

by Steve Zepnick

During the IEP (Individualized Education Plan/Program) process, parents are rarely informed of the specific nature of the role of the school health nurse. There is enough vagueness to the role that MCPS can use the opinions of the nurse to counteract the recommendations of a child’s physician. 

According to the County Government Administration, School Health nurses are employees of the Montgomery County Department of Health and Human Services but acting “under the direction” of the MCPS IEP team when they participate in the IEP process. During this process, the County Government Administration states that they have no authority to direct the actions of school health staff in the IEP proceedings.

The school health assessments are designed to be narrowly focused on whether or not health care needs can be met in the school setting and what level of nursing support is available by School Health Services. The nurse is not supposed to make recommendations on program or school placements for students. Furthermore, the County Government states that the school health nurse should not be relied on to provide “expert” opinions on the student’s overall medical condition.

So, who is it that ensures that appropriate limits are maintained by the nurses during a disputed IEP process, especially when MCPS disagrees with the recommendations of a child’s physician? The use of a School Health Nurse as a MCPS expert witness in a due process procedure, guided by the MCPS attorney, seems to blur the role and causes confusion for the parents and the administrative law judge. Clarification of the role conflict is definitely needed. In my grandson’s due process hearing, the nurse, in my opinion, was inappropriately allowed to challenge the recommendations of a minimum of three, attending, pediatric specialists.


  1. Here is the link to Maryland Board of Nursing. Click on the link for "complaints and investigations."

    Here is Roles and Responsibilities of School Nurse:

    Interestingly, it says: Under COMAR 13A.05.01 some children with special health needs or who are technology
    dependent may be identified as being handicapped and in need of special education services. Decisions
    concerning eligibility, service provision, and placement are based on the child's individualized
    educational program developed by the Admission, Review and Dismissal Committee (ARD). The
    school nurse (RN) as a vital member of the ARD Committee interprets assessments, determines the
    level of personnel needed to provide care and provides other valuable information relative to the
    specific child.

    But it also says:
    The school health nurse (RN) determines the level of personnel needed to care for this child in
    the school setting. Input will be gathered from a multidisciplinary health team which should include but is
    not limited to: a representative of the primary institution providing health care; the child's primary
    physician; the child's parents; the child (when the child is able to communicate); the primary registered
    nurse coordinating the child's home care and a designated school representative.

  2. The team determines with whom they communicate. The school health nurse should be mandated to contact all pertinent medical professionals. However, the team ultimately makes decisions and, in our case, were dismissive of the recommendations of the child's specialists.

  3. In reality, several legal steps were taken and were unsuccessful. We went through mediation, due process and an appeal at the Federal District Court levels. Basically, we were unable to present a solid case as we couldn't wait until the child was so sick that his safety was compromised. A proactive strategy is difficult when the system responds mainly reactively. Easy to say file a complaint.

  4. If the child's specialists don't know what's best, who would! Silly.


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