In the middle of National Nurses Week, a day is designated to honor the school nurses who work in schools nationwide and address issues that range from splinters to seizures. This year’s School Nurse Day on May 11 helps recognize and celebrate this career.
School nurses take care of children who attend school and with that familiarity they build close relationships with the children they see and often their families. Like a puzzle to piece together, school nurses work with the larger school community to understand and help treat the health needs of schoolchildren.
The pandemic has put increased pressure on school nurses, who already frequently are short staffed in their school districts. As much as school nurses are expected to advocate for the children they care for, they also need to advocate for themselves and their profession to ensure the best conditions for them to do their jobs.
For 2022, NASN targets areas that have a powerful impact on the children they work with, and their families, and issues that influence how a school nurse can operate within a school. Topmost is that each child should have access to a school nurse with the passage of the Nurses for Under-Resourced Schools Everywhere (Nurse) Act. Passage of this act would make it easier for schools to fund school nurses and would have the intention of alleviating some of the financial cost to districts. With grants, schools would be more able to provide a nurse who is sometimes the only medical professional a child might see.
In a forward-looking advocacy, NASN also encourages nurses to work for passage of the Tobacco Tax Equity Act, which will impart a tax on more tobacco products, including e-cigarettes. By raising taxes, nurses would hope to address the health disparities that are linked to youth tobacco use–and that in the wider community.
Because nurses know that health equity is so essential, the passage of the Improving the Social Determinants of Health Act is another identified priority. Children can’t learn as effectively if they don’t have secure housing or a nourishing and stable food supply. These and other social factors that provide a foundation from which children can have better lives are essential.
Advocacy can take as much time as a nurse has to offer. From writing to a legislator to getting more involved with work on the local, state, or federal level, there is always something that can be done to help make the jobs of school nurses and the schoolchildren they work with better.
A school nurse is a health practitioner in the educational field and so straddles two distinct professional worlds. Their work, focused on the students and their families, must encompass health and also the wider community they may see. Despite the tensions that can sometimes arise between the two areas, school nurses find incredibly meaningful, challenging, and rewarding work in their field.
School nursing today is nothing like it was a generation ago, and today’s National School Nurse Day is a time to recognize all the contributions school nurses make to their communities. Some things are a school nurse’s constant—there are always scrapes to be cared for, nervous tummies to settle, and accidents that can happen on the playground or in the hallways. But no one would argue that the landscape of a school’s environment has evolved to mirror the growing unrest in the larger society.
With so much going on, it’s no wonder that school nurses can never expect to have a typical day.
As a school nurse, you offer physical and emotional care, education, stability, and guidance to the kids you serve and to their families as well. School nurses today see children of all ages who cope with greater anxiety and depression. Greater numbers of children are exposed to trauma than they were 30 or 40 years ago. They are coping with social media and all the struggles to understand the open and unspoken social rules that surround the technology that is available at their fingertips. And the increasing episodes of school violence, from terrifying school shootings to dating violence to tensions between students within a school, are becoming more prevalent than ever before.
How can a school nurse be prepared?
Honor your knowledge
As a school nurse, you know your student population. You know what they are dealing with and what the predominant struggles are within your school and district. Keep in close contact with the other nurses in your school and your district if possible. That open communication can help you keep current with issues that may begin to bubble up in your own school.
Stay connected
As much as you can, stay in touch with town leaders, especially the emergency responders and police. Monitor social media to learn what is trending among the age population you serve. Vaping is a big problem among even younger students right now. Try to learn about what kids are doing.
Continue your education
Attend seminars, watch online tutorials, gain certification through the National Board for Certification of School Nurses and any other areas that may help you care for students. If you are seeing high rates of anxiety and stress, learn about how kids can cope and even how technology can help them. Are you seeing more diabetes or cancer in your school population. Learn how to best help and educate them and even what barriers they may have to remaining healthy. Check resources through the National Association of School Nurses to continue learning.
Care for yourself
School nursing is challenging, rewarding, and extremely tough. The needs of the students and the hard times they may be faced with can sometimes overwhelm even the strongest nurse. You have to help without being pulled under, so take the time to find a way to relieve your own stress. Find a hobby that captures your attention enough that you can really focus. Incorporate purposefully stress reducing activities into your life—yoga, exercise, meditation, dance, cooking, spiritual gatherings, gardening, roller derby—whatever activity helps you get away from your thoughts for a bit.
Stereotypes of school nurses primarily dispensing aspirin, taking temperatures, and offering hugs are rooted in nostalgia.
These days, school nurses increasingly handle a growing number of students with chronic or serious health issues, provide emergency care, and connect with community partners to provide additional health services.
Despite the vital role that these health professionals fulfill for students, there is a lack of full-time public school nurses to help meet the well-being of students, especially in urban school districts. Only 30% of public schools have a full-time school nurse, according to a 2007 study by the National Association of School Nurses (NASN).
Additionally, only half of schools have a registered nurse 30 or more hours each week, according to a 2014 School Health Policies and Practices Study by the Centers for Disease Control and Prevention.
Informing the public about the expanded role of school nurses and the consequences of their absence benefits students, their families, and communities, nursing experts say.
“Because school nurses practice independently as the only health care provider in the education setting, they need the critical-thinking skills that bachelor-prepared nurses develop,” says Beth Mattey, MSN, RN, NCSN, president of NASN. To this end, NASN recommends a bachelor’s degree in nursing as the minimum preparation for a school nurse.
“Many states require ongoing education to maintain an RN license and/or a school nurse certification,” Mattey continues. “NASN provides ongoing education through resources, clinical guidelines, webinars, and other online education courses. We also sponsor hands-on learning and conferences to keep school nurses abreast of current practice.”
Evolving Role of Nurses
“When schools don’t have a school nurse, there is not a health professional to help students manage acute illness and chronic conditions in the school setting,” says Mattey. “Students don’t leave their health issues at the door, and many chronic conditions must be managed during the school day. This includes students with diabetes, asthma, life-threatening allergies, epilepsy, and sickle cell disease. Children who live in poverty are at greater risk of having a chronic condition and unmet health needs.”
The average adult thinks about his or her own education decades ago and assumes every school has a nurse and the health needs are the same, says Nina Fekaris, MS, BSN, RN, NCSN, president-elect of NASN.
“Unless you are a parent of a child with a chronic illness or a life-threatening disease, you just don’t think these things are in schools,” says Fekaris, the only nurse assigned to four schools serving 4,200 students in her suburban school district in Oregon. “They don’t understand what school nurses do and they don’t understand that kids are more fragile that are attending schools now. There’s a lot more care coordination that needs to happen in school buildings to keep kids safe.”
Fekaris, who has been a nurse for 40 years and has 30 years of experience as a school nurse, says the growing number of students with type 1 diabetes is a major health change. When she first started, there were none; now, there are about 150 diabetic students, including kindergarteners, in her school district.
Advances in medical treatment and technology have also altered the practice of school nursing. For example, one treatment device for children with seizure disorders is an implanted device under their skin that delivers an electrical pulse to a nerve in their neck. “At the sign of seizure, what we want to do is activate that device to fire an impulse to try and stop the seizure, and the way you activate that is by swiping a pretty powerful magnet across that device in their chest. Thirty years ago we didn’t have that technology,” explains Fekaris.
Greater Needs at Urban Schools
Students in high-poverty urban areas are especially vulnerable when schools lack an adequate number of nurses, says Maura McInerney, a senior attorney at the Education Law Center, an education advocacy group that champions the hiring of more nurses.
“The consequences can be devastating, and I don’t think that the average citizen recognizes the critical role school nurses play in the health, safety, and education of school children,” McInerney says.
Without access to full-time nurses, students may not receive urgent or accurate and timely treatment at prescribed intervals. And, children with special education needs may not be identified or receive nursing care, McInerney adds.
“Perhaps what is most striking is the number of children with qualifying disabilities such as diabetes and asthma, who fail to receive Section 504 Plans that are critical to supporting them to attend and be successful in school. Finally, school nurses are important teachers and counselors and are often the first people to identify a child’s need for health interventions and counseling services,” says McInerney.
There are 180 nurses for 332 Philadelphia public schools serving 200,000 students. In 2011, the district had 289 school nurses. By the 2013-14 school year, that number had dwindled to 179. In March, the district announced the number of school nurses would be increased with the goal of a nurse at every school. “At that time, 123 schools had no full-time nurse and 17 schools had a nurse one day a week or less,” McInerney says. “We hope this happens, and ELC is fighting for more funding to under-resourced schools in Philadelphia and elsewhere to make this a reality.”
Unfortunately, sometimes it takes a crisis to spotlight the need for school nurses and drive changes, says Robin Cogan, who has worked 15 years as a school nurse in Camden, New Jersey. “In Flint, there was one school nurse. They now have nine school nurses. It shouldn’t take a tragedy to get a school nurse in every building,” she argues, referring to the 2015 water crisis in Flint, Michigan, that involved lead contamination.
Mattey recalled a Philadelphia student, 12, who died from an exacerbation of her asthma two years ago. “The severity of her asthma was unrecognized on that day because the school nurse was not scheduled to be in the school. The School District of Philadelphia had been having financial difficulty and school nursing services were cut,” Mattey says.
For working parents, the presence of a nurse can help them decide to enroll their child if he or she has a chronic condition, says Cherisse Howell, RN, supervisor of staff education, school health nursing, at the Montefiore Health System, one of the largest school health programs in the nation. A school nurse “gives a parent a sense of security that I can go to work and provide for my family and still feel safe that my child is OK because there is a nurse at school,” says Howell, a nurse since 2005.
Having a nurse or school clinic gets children into the building because parents share the positive experiences of the health services, Howell says. The Montefiore Health System has clinics inside elementary, middle, and high schools and provides primary, dental, mental, and community health services to over 30,000 students at 85 schools on 23 campuses.
“We transitioned from what many thought of as the school nurse… when nurses were doing ice for injuries and Band-Aids for boo boos,” says Howell. “We’ve moved to an era where, specifically in the Bronx, we have thousands of children suffering from asthma and our diabetes cases are rising. We have children with health disparities that would otherwise keep them from school. We now have these health professionals in the educational building, and children can get the treatment they need and the instruction they need simultaneously.”
Outreach and Partnerships
The volume of students treated and the complexity of their medical care require school nurses to form health care partnerships, says Lynn Meadows, RN, MS, coordinator of student health services for the Fulton County School System in Georgia.
“We can’t just do the job in a clinic. You have to partner with a local physician or a health organization in the community because it’s a team approach now of how we take care of kids,” says Meadows, a nurse for 30 years and a school nurse for 15 years. “It’s not just a school nurse trying to manage the health care needs of kids while they are in school. Yes, they are in school…but they also go home. So that collaboration and networking with health care providers outside our clinic obviously keeps that continuity of care better for kids.”
Many school nurses seek professional development to keep up with the changing care dynamic that students require, which is why partnerships are important. School districts are looking to school nurses to be caught up on health issues that can impact the community, Meadows says.
“For instance, regarding the Zika virus, my superintendent will look at me and ask, ‘Well, what should our school district’s response be to a community health issue like Zika virus?’ So I have to be up to snuff. I have to find partners that I can work with to say, ‘What is the latest, how does this impact the community, and ultimately, how might it impact the school?’ Whatever is the hottest topic or health care issue going on in the community, school nurses have to be aware of it,” says Meadows.
School nurses arrange for mobile dental clinics to visit schools and mobile vision vans to visit and provide eye exams and glasses for students who may not have those services available, says Mattey.
School nurses also work in schools and the community to promote tobacco education and cessation programs, educate students about prescription drug abuse and other substance abuse, provide immunization services for students, encourage exercise programs, and educate about healthy eating.
Measurable Results
School nurses not only play a key role for helping students learn, their presence assists educators. One study found teachers spend less than 20 minutes each day dealing with student health issues when a nurse was assigned to their school.
Data also showed students with asthma have improved attendance and better health outcomes when a school nurse managed asthma, says Mattey. Furthermore, immunization rates also improve when a school nurse is present.
“What administrators and school districts need to know is that not only do school nurses keep students in school by addressing health issues so they can stay in school, school nurses save money,” says Mattey. “A recent JAMA study demonstrated that for every $1.00 spent on school nurse service and resources, $2.20 was saved in societal costs. The study did not take into account reduced emergency room visits due to early intervention by the school nurse,” she adds.
“Consider the case of a child with a severe peanut allergy, and every day when your child goes off to school you hope that your child is not exposed to peanuts. A school nurse recognizes the potential emergency, works to make the environment safe for the child, and ensures that emergency plans are in place in the event of an exposure to peanuts. The school nurse will educate the staff on the signs and symptoms of an exposure and how to prevent the exposure in the first place,” says Mattey. “There are many health conditions children bring to school. The professional school nurse has the expertise to educate and work to prevent an emergency, but if an emergency occurs, the school nurse will recognize the emergent condition and take action.”
Raising Awareness
School nurses juggle an array of demands despite their salaries being among the lowest for RNs. However, in some areas, school nurses are paid on the teacher salary scale, which also includes benefits. For school nurses on the lower end of the salary scale, lack of understanding about all they do is a factor, nurses say.
“Traditionally, the profession of school nursing has been looked at as someone in the clinic just handling little boo boos,” explains Meadows. “There isn’t widespread public knowledge of what it takes to be a school nurse, or the volume of kids with chronic illness or medical issues. There is not enough information in the community or across the nation on how school nursing has evolved. Many people don’t get that.
“School nursing has changed. It’s a profession on its own. For many of our children, the first health provider many of them see is the school nurse. I tell many of my nurses, ‘You can be the person who finds out what is going on with that child and make a difference in that child’s life for the rest of his or her life,’” Meadows says.
Although school nurses affect educational settings, taxing working conditions can compromise their effectiveness in treating students. If the school lacks a nurse, or if the school nurse “has a workload that makes it difficult to adequately educate all staff and follow up with parents, there may not be adequate protection for students,” argues Mattey.
“The ANA has a saying, ‘Nurses are an investment in the future, not a cost center.’ I say the same about school nurses. School nurses are an investment in the future of our children, linking health and education. We are not a cost center,” Mattey adds.
Parents and guardians must address the importance of school nursing with administrators, Mattey says.
“Parents should ask, ‘Who is meeting the health needs of my child while in school?’ The answer should be a professional registered school nurse,” argues Mattey. “Parents assume that a nurse will be taking care of their children, but that is not always the case and parents need to ask the question. If not a school nurse then they need to find out, ‘Why not?’ Parents in Charlotte, North Carolina, advocated to make sure their children had access to a full-time school nurse, successfully increasing the number of school nurses in the schools.”
See Our Champions of Nursing Diversity
Sign up now to get your free digital subscription to Minority Nurse
