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.”
This week’s National School Nurse Day (May 12) honors the tireless and complex work of school nurses—all of whom cared for students thorough a constantly changing year that veered between in-person, remote, and a hybrid of both.
I had a wonderful community health nursing rotation within my undergraduate nursing coursework that always stuck with me. I worked on a trauma unit after earning my BSN, and often thought back to that course and the role of a public health nurse. I remember calling my high school nurse on one of my days off and asking her “what do I have to do to become a school nurse?” I made the decision to follow my passion after that phone call and haven’t looked back since.
How has your job changed in the last year and with all the ramifications from the pandemic?
School nurses have always answered the call to serve during times of crisis. What I know for sure about school nursing is that we are each demonstrating how essential the role of a school nurse is to the health, safety, and well-being of students, staff, and the communities across the state of Illinois.
School nurses were at the frontlines before stay-at-home orders went into effect last year; over the summer many of us answered the call to action and donated PPE to our colleagues, volunteered at COVID testing sites, donated blood, served on various state taskforces, and supported our students by delivering meals. We are now serving in the tremendous role as frontline healthcare providers mitigating the impact of COVID-19 in our schools by isolating, contact tracing, ensuring IDPH COVID-19 Exclusion Guidelines, and case management amongst many other things.
We continue to amplify our voices at the local, state, and national level, all the while working together to address the health inequities faced by so many of our students and families that have only magnified over these past several months.
What do you enjoy most about your job?
What I enjoy most about my career in school nursing is the continuity of care that I’m able to offer my students throughout their high school experience. I love being a school nurse, and I encourage everyone reading this to follow their passion and find your place to thrive. I also enjoy being an advocate for my profession and teaching. I’ve been teaching for over seven years now, and it fulfills my other passion of educating the next generation of nurse leaders.
School nurses’ jobs are incredibly complex and you care for kids with many health conditions. What do you wish people knew about your role?
I wish people knew how vital our role is and that we are public health experts. I have a vision that every child in the U.S. will one day have access to a full-time certified school nurse. Every child deserves that access and it should not be determined by their zip code.
Can you give us an example of your work in educating the public on issues that are relevant right now?
In partnership with the COVID Collaborative, the Ad Council launched a historic public communications effort to educate the public about the COVID-19 vaccines. I was chosen to participate in these messages for healthcare professionals nationwide! The videos featured Dr. Anthony Fauci and other healthcare experts. We explained the rollout and administration of COVID-19 vaccinations and discussed how to navigate questions and conversations with patients.
At the local level, I am leading a science-first public health campaign through IASN by calling all Illinois school nurses to share their COVID-19 vaccine photos and videos by and using the hashtag #VaxUpIL and #IASNVaxUp to show how safe and important it is to get vaccinated. This campaign will also cover topics like masking, testing, vaccinations, and will address vaccine hesitancy. I’m designing the messages with diversity and inclusion in mind to maximize their reach and effectiveness.
To ensure equitable access to COVID-19 vaccines we must consider the social determinants of health that have increased the prevalence of COVID-19 within BIPOC communities. The national vaccination effort is one of the greatest operational challenges America has ever faced, and this is with existing underfunded public health programs across the country. I’m proud to be doing my part in this effort.
Barrera serves on the legislative committee and most recently as an expert panel member of the Diversity, Equity, and Inclusion Committee of the American Nurses Association-Illinois. She holds a chair elect position within the American Public Health Association’s (APHA) Nursing Section, is an active representative of Hispanic nurses on the Nursing Collaborative on Climate Change and Health, and is an active member of the Alliance of Nurses for Healthy Environments (ANHE). Barrera has been recognized for her leadership and community work by several organizations, both locally and nationally and most recently was named a 2020 Pinnacle Nurse Leader in Illinois. She is committed to being a lifelong learner and continues her efforts in improving child health outcomes in our most vulnerable populations through her current practice, advocacy, and teaching.
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.”
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