State of North Dakota, Department of Health

Report date
February 2019

What has been most instrumental to your progress?

Hiring a Registered Nurse to educate and implement telehealth nursing services into the schools has been instrumental in making progress throughout the first year. Liz Tofteland, RN has implemented policies, procedures and strategies to improve access to care in critical access areas throughout North Dakota. Her expertise and leadership has been an integral part in developing the North Dakota eCare School Health Program and connecting schools to services. Liz has been able to provide quality improvements by continuous outreach to schools within North Dakota in partnership with Avera eCare. Assessing the school's needs, identifying key issues, developing a plan of action, and evaluation been imperative for integrating telehealth into the schools throughout rural North Dakota.
As the need for nurses increase in the school setting, the North Dakota Department of Health, Mid-Dakota Education Cooperative and Avera eCare have worked together to make this possible. Schools with very little resources including personnel, financial funds, and healthcare availability have greatly benefited from these organizations. Together, they have and are providing access to care within the school setting. The unique partnership is truly what is needed for student health in schools across North Dakota to thrive and be successful. The partnerships are key in providing important leadership in schools to ensure the school environment is safe and healthy. Together, these organization have worked hard to develop a relationship with schools across North Dakota to improve child and adolescent health and well-being. The partnerships have created an ideal purpose for enhancing collaborative work across the state.
Hiring a Community Coordinator to organize Community Cafes within the communities was an instrumental part over the last year to bridge the communication gap between teachers, school officials, students, caregivers, and community stakeholders. The goals for year one were: 1) Educating the community on the importance of a nurse in the school setting. 2) Soliciting stakeholders input regarding the provision of services as well as gaps in services provided within rural communities. This role has increased collaboration between not only communities but also primary care providers, caregivers, and school officials, which allow for greater communication and engagement.

Key lessons learned

A key lesson from this year was assisting and supporting families of students with chronic conditions. Engaging families, students, caregivers, and school officials to better understand the role of the school nurse is an ongoing, comprehensive collaboration between all parties. It is imperative that the school nurse advocates for students and families to access needed resources to not only support student's health needs but also support the academic achievements of the students. Working with families of students with chronic conditions to increase the understanding of what care is required in the school setting is something that is necessary, however should not be assumed. Improving the student's health, safety, and learning in an academic setting is something that needs to be strived for and should not be taken for granted. Keeping education at the forefront is a high priority, but understanding that health needs must be met for high quality learning is something that cannot be over looked.
Telehealth is a valuable tool used in the school setting by providing access to healthcare for students that may be impacted by lack of services. Partner, Avera eCare has provided amazing support , education, and resources to students with diabetes , among other chronic and acute conditions across the state of North Dakota. However, some push back from parents is evident as they have been hesitant to care, stating they don't their child singled out or think that care for their child can be provided by the school's secretary or teacher. as we go through our first year we have realized that it is key to have open communication with the parents'caregivers. We need to ensure that relationship building is ongoing and is the key to the problem solving approach to meet the needs of the students and the schools in an effective, efficient manner.

Reflections on inclusive, collaborative or resourceful problem-solving

The element that has been the most important throughout the year in making progress has been collaborative. Collaborating with communities, schools, school officials, caregivers, parents, students, the North Dakota Department of Health, and the eCare staff has been key to success over this past year. The collaboration has facilitated a more seamless process in providing services to rural communities that without telehealth would have no access to a school nurse. Bridging the gap in schools by having access to a nurse is an amazing collaboration. Providing students with healthy, safe and effective care throughout the school day, had lead to a decrease in absences and increase of overall learning. All the working parts are taking shape to an innovative approach to well-being, healthy, excelling students.

Other key elements of Community Innovation

As year one ends, the one work that comes to mind is flexibility. As we move forward with innovative ways to ensure that schools in North Dakota have access to services we must by flexible and open moving forward and trying new things to assist schools by identifying key issues schools and students are facing. School nursing is not black and white and each community and school has unique needs that need to be addressed. We want to safeguard our schools with tools to not only address chronic conditions but to also protect and promote student health. By creating a partnership with eCare and MDEC we have been able to provide schools the power to promote healthier communities and build a culture of holistic care. The flexibility over the year has brought not only positive changes in the schools but also throughout communities.

Understanding the problem

After a year into the grant application there are more potential innovations to address through our work. One that really stands out is the lack of knowledge out communities, school officials, parents/caregivers, and students have when it comes to the role of the school nurse. We have identified that education and open communication are key to ensuring that everyone understands the vital impact a school nurse can have. Through community outreach we have found that our rural towns need services but there has been some push back to creating change. Some road blocks that have impacted the push back are staff expenses, quality service providers, and access to care. Through the Bush Grant we have been able to bridge the gap in these road blocks by providing effective nursing services to children and adolescents and provide efficient and effective communication with eCare.

If you could do it all over again...

If we could go back to the start of the grant and give ourselves one piece of advice it would have been to hire a Community Coordinator right away. The Community Coordinator is an integral and key person for engagement. We relied too much on the schools to get families, students, and school officials engaged and involved. We quickly realized that in order to engage the schools and surrounding communities, we need to take a difference approach with the help of the Community Coordinator to conduct and coordinate the community cafes.

One last thought

Through the Bush Foundation, we can give students the opportunity to access healthcare in their schools that would not be possible without this grant. We are beyond grateful for the opportunity to collaborate with the Bush Foundation to serve the undeserved. Through your support we can provide care through telehealth with boots on the ground. With evidence based practiced we are bridging the gap in health care and education, providing high quality care to students and advocating to design a system that allows individuals to receive the individualized care they deserve. It is a perfect marriage between education and health care.