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.
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.
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.
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.”
The COVID-19 crisis brought an abrupt and swift end to the in-person school year for most schools across the nation. But on May 6, as the nation honors National School Nurse Day, school nurses around the country say their roles are hardly idle, even if they aren’t in a school building.
“School nurses are the only healthcare providers some school children have access to on an ongoing basis,” says Laurie Combe, MN, RN, NCSN, and president of the National Association of School Nurses (NASN). “They are really a hidden healthcare system.” As school closings remove that immediate access, school nurses currently face many unknowns about the future and the steps they can take to help keep their students as healthy as possible until they see them again.
School nurses have been thinking about the return to school virtually since the schools began closing, says Combe, so they are going to be an essential voice for next steps. “It is essential that school nurses are included on school reopening planning teams,” she says, “as they are the health experts on their campus and can ensure that evidence-based processes and protocols are established.”
While students work virtually, school nurses watch for students who may show they are struggling by not logging into class and those who become, or continue their history of being, chronically absent. They are checking in on students who have chronic conditions, returning medication and equipment, and dispensing educational materials on everything from nutrition to keeping healthy habits.
One of the things Combe says is of particular concern to school nurses right now is the uptick in the need for mental health services that could impact the entire school population. “How are schools going to support that,” she says. “This is just a difficult situation. We will need to increase capacities for that in the schools.”
Luckily, she says, school nurses aren’t the only professionals talking about mental health needs in the educational systems, and Combe advises current school nurses to reach out to the school staff they can collaborate with including school counselors, social workers, and psychologists. Each specialist brings a different professional skill to the table to help school children manage this upheaval.
And the students aren’t the only ones who will be trying to navigate a new reality while they are trying to recover from the disruption in their lives including potential loss of loved ones, job loss in families, or an unstable living situation that was made worse by the crisis. “If what we’ve talked about is true,” she says, “the stress on school nurses, teachers, and school administrators is going to be immense.”
Combe says school nurses often work quietly and behind the scenes and so many people don’t realize the enormous scope of their job duties. For the work they do, she gives them kudos, saying, “I am grateful for the school nurses who step into this space to support students, families, and staff and the larger school community.”
Today’s celebration of National School Nurse Day is recognition that school nurses are an integral and essential part of any school community. And while a school nurse’s mission has remained steady over the years, the job responsibilities and job duties have not.
“School nursing is a special role that involves managing the health and wellness needs of school-aged children,” she says. “Many children attending school have chronic and acute health conditions. It’s my job to insure these students are receiving necessary support to be in school, safe and ready to learn.”
Children and teens require support to have a good day at school and that can mean a school nurse is there to oversee all kinds of care. “It involves providing care coordination, leadership, standards of practice, quality improvement, and community/public health,” says Crowe, who has been in her role for 16 years. “The ultimate goal is connecting school health with academic success.”
When each day is different, Crowe says planning and time management become both crucial and one of the biggest challenges. “You never know what each day will bring,” she says. “During a typical day, the school nurse can be seen multi-tasking. One minute, she’s assessing a student for illness complaints. Then she’s seeing a student with a scraped knee from recess, followed by a student who recently lost a parent to substance use.”
And the landscape of who is bringing up kids is changing. “It’s also becoming more typical for grandparents to be raising their grandchildren,” she says. Dealing with multiple caregivers and different generations of caregivers becomes a masterpiece of coordination and communication. And when a school nurse is informed of and sensitive to any changes or challenges in a home environment, he or she can help the child with proper resources and support.
School nurses today are more likely to have access to data to determine the types of care they are providing, the number of children who go home early, or how many children with mental health diagnosis is changing. Using this kind of solid information can inform their practices, but can also offer the district administration insight into what a school nurse is dealing with on a regular basis.
And while roles change and responsibilities become more complex, school nurses come to school ready to offer care, comfort, medical services and guidance, and even a spare set of clothes when needed. “The school nurse is always ready for an emergency,” says Crowe, “and is prepared for multiple scenarios.”
Whether it’s a child who fell on the playground or a teen who is undergoing cancer treatment, school nurses see it all. As children are able to attend school with more and increasingly complex medical conditions, school nurses are on the front lines of monitoring, assisting, and advocating for schoolchildren across the nation.
So on May 10, National School Nurse Day, take a few moments to thank a school nurse in your life or in your community. The theme this year is “Healthy Nurse, Healthy Students” to highlight how much school nurses do to improve the health within their communities and how they are excellent and inspiring role models for the students and families who rely on their care.
“The needs of our students are increasing daily and school nurses want to meet those needs so that students have the opportunity to succeed in the classroom to prepare for a healthy and successful future,” says Beth Mattey, MSN, RN, NCSN, and president of the National Association of School Nurses (NASN) which created National School Nurse Day in 1972. “School nurses are on the front lines of population health.”
It’s no secret that kids who are healthy in body and mind will perform better in school and have more engaging and satisfying school experiences. “Schools have an energy and vitality about them where children and teens bring untapped potential,” says Mattey. A school nurse is there to offer medical care, but is often a comfort, a cheerleader, a family advocate, and a health care provider experienced with complex and diverse healthcare conditions and needs.
“School nurses have long provided a hidden health care, often working as the only health care provider in the education setting,” says Mattey. “As the needs of our students are growing, the contribution school nurses bring to health AND education of students as a member of the health care team and the education team is increasingly being recognized and valued.”
According to Mattey, the American Academy of Pediatrics notes that the incidence of children with chronic health conditions are increasing. The Data Resource Center for Child and Adolescent Health says 27.3 percent of children ages 6 to 11 and 30.8 percent of teens age 12 to 17 have a chronic health condition. And for many children, their health struggles are compounded by additional factors. “Across the nation, fifteen million children live in poverty,” she says, “and almost 46 million children receive supplemental nutrition assistance. “
And with so many shifting factors, school nurses are seeing steep increases in issues like anxiety than did school nurses of a couple of generations ago. Mattey explains how almost 23 percent of children have been exposed to two or more adverse childhood events which can affect one’s physical and mental health. “School nurses report they spend at least 32 percent of their time addressing mental health needs of students,” says Mattey.
And as laying a foundation for a healthy life begins during the school years, Mattey says this is a great time to help influence healthy choices and behaviors. “For 14 years I worked with teens in our high school to reduce the use of tobacco,” she says. “We developed posters and shared the message across the state through music. We reduced tobacco use by 51 percent in our high school.” Other school nurses work with students in physical activity programs and programs to promote healthy eating.
“It is incredibly fulfilling when we help a child and family manage a chronic health condition such as asthma, diabetes, or allergies and remain in school,” says Mattey. “School nurses want students healthy, safe, and ready to learn.”
And with school nurses in so many communities, their membership has a powerful base. NASN has 16,000 members in 50 affiliates and overseas who advocate for school children, their communities, and the national health of children.
On National School Nurse Day, acknowledging the complex and essential role school nurses play in both an educational and a community setting is important. “On May 10, school nurses will continue to care for students as they always do,” says Mattey. “This day perhaps, we will walk with an extra spring in our step knowing that the knowledge and expertise we bring to our students and community makes a difference in the lives of our students every day.”
See Our Champions of Nursing Diversity
Sign up now to get your free digital subscription to Minority Nurse
