With the May 10 celebration of School Nurse Day, school nurses around the country will recognize how the role of a school nurse has changed dramatically over the decades. This recognition day helps highlight the increasingly complex medical, social, and community needs and duties school nurses are responsible for.

Melanie K. Bales, MSN, BSN, RN, CMS, is nursing supervisor in Georgia’s Cobb County School District and a member of the Georgia Association of School Nurses (President 2019-2022) and the National Association of School Nurses (NASN). Bales has been a school nurse for more than 20 years and says the role is exciting, demanding, and extremely satisfying.

Bales spent several years in nursing before moving into this nursing specialty. “I had no idea about school nursing when I finished nursing school,” she says. After receiving her BSN from Tuskegee University, says her heart was set on pediatric nursing and that’s where she made her first foray into nursing. She spent many years working in pediatrics and in neonatal ICU units in Florida and Georgia.

But her path changed when her family settled in one area and her children’s school district had an opening for a school nurse. She was encouraged to apply, noting that her schedule would then mirror her children’s school times. “That was 21 years ago, and I am still here,” says Bales with a laugh. “I have the opportunity to marry my love of pediatrics with the school age group and grow in my leadership skills. It’s been quite a ride.” Bales herself has assumed increasing leadership roles.

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As a school nurse, Bales has taken on roles that are diverse. She has worked as an elementary school nurse, an itinerant school nurse instructor, and a consultant nurse. In her current role as a nursing supervisor, she oversees school nurses across a county school district.

Throughout her career, Bales has worked with students of elementary, middle, and high school ages and has especially enjoyed seeing them grow. And even if she might not instantly recognize a grown adult who comes up to her and says, “Mrs. Bales, it’s me!” she’s always happy to hear about their adult lives. There are many students who remember the care and comfort their school nurse gave them, and even some who are inspired to follow a nursing path because of their school nurses. Bales recalls talking with past students who have overcome health challenges and gave Bales credit for her help. “Those are very heartwarming encounters,” she says.

As with many school nurses, being able to make connections with students and their families is what keeps the profession rewarding. There are plenty of challenges school nurses face. From the increasing complexity of health conditions to the wider family and community issues that impact school children, school nurses have to be well prepared for anything.

“Some of the biggest challenges are staff shortages,” says Bales. The pandemic has compounded nursing shortages in general, and school nursing hasn’t escaped the lack of nurses to fill roles. In addition, Bales says the staffing model can look different from state to state or even within a state, and can make school nurse staffing particularly challenging. Sometimes school nurses are paid on a teacher pay scale and sometimes they are paid using a different pay scale, so it’s difficult to lure nurses, who might otherwise be offered signing bonuses and larger salaries, to the school nurse arena, says Bales.

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And school nurses must continually fight for the funding they do get. Bales says it gets tiring to have to justify the need for more funding and more school nurses to lawmakers and decision makers. A healthy school community relies on the school nurses who are able to act as a liaison between students, the community, and healthcare providers. It’s frequently said that school nurses and the school health services are the hidden health system in the country, says Bales. Helping students and staff to be engaged in the learning process, she says, requires school nurses to prioritize health and safety.

For nurses thinking of moving into a school nurse role or who may already be school nurses, Bales says she encourages them to take advantage of every single opportunity that comes to them professionally. Whether it is through mentors, preceptors, or a new opportunity for a new skill, don’t turn down a challenge, she says. Join an organization like NASN to learn from others and share your own knowledge as well.

“It warms your heart to know the significant impact you are making,” says Bales. “School nursing is truly a calling.”

Julia Quinn-Szcesuil
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