School nurses: Keeping school children, families, and communities healthy
This specialty provides many challenges—and rewards.
Takeaways:
- School nurses play an integral role in the health of children and youth, by increasing access to healthcare, addressing social determinants of health, and providing essential care coordination.
- School nursing specialty practice is frequently overlooked, but it’s been shown to be cost-effective and to improve health outcomes.
- Challenges of funding, variation in how school nursing is practiced across the country, and a decreasing pipeline threaten this rewarding profession.
The COVID-19 pandemic has highlighted the work of school nurses, who play a critical role in maintaining the health and well-being of children, families, and communities. They’re particularly integral to healthcare access for children whose health is impacted by social determinants. In fact, many consider school nurses the hidden healthcare system for vulnerable youth. Widespread understanding of the breadth and depth of professional school nursing is needed to ensure the growth of this critically important nursing specialty and to protect children’s health.
School nursing defined
The National Association of School Nurses (NASN) defines school nursing as a specialized practice that “protects and promotes student health, facilitates optimal development, and advances academic success.” The NASN goes on to explain that school nurses are grounded in ethical and evidence-based practice and work as leaders to bridge healthcare and education. They coordinate care, advocate for quality student-centered care, and work with others to design systems that allow individuals and communities to develop to their fullest potential. Functioning within local educational systems, school nurses help to ensure children have access to education by providing and managing complex care across multiple healthcare sectors, including public health, community agencies, hospitals, and insurance systems.
School nursing practice is guided by the NASN’s Framework for 21st Century School Nursing Practice, which articulates the key principles of evidence-based school nursing practice: care coordination, leadership, quality improvement, and community/public health. (See Practice framework.) Upholding these principles requires collaboration across disciplines and settings that includes teachers, school staff and administrators, community providers, insurance providers, and parents and guardians. For example, a student may visit the school nurse on a Monday describing a weekend visit to the emergency department for asthma exacerbation. Immediately, the nurse begins coordinating the care this student might need—health teaching for the student and family, communicating with the student’s classroom and physical education teachers to determine any necessary accommodations, reviewing the student’s health record to ensure flu shots are up-to-date, and, as needed, helping with health insurance applications and follow-up appointments with a healthcare provider. The nurse also may work with the building and grounds keepers to help eliminate triggers. These collaborations are critical in school nurses’ work.
School nursing practice is regulated by state nurse practice acts and standards of practice and ethics. What makes school nursing unique from other specialties, however, is that school nurses work within local or state educational systems. Therefore, school nursing practice must adhere to the legal mandates of the nursing profession and conform with education-specific state statutes (for example, those related to sexual health education and automated external defibrillator training) and federal law (for example, Title IX). In this way, school nurses have specialized knowledge that straddles both the health and education systems.
An NASN Workforce Study reports that approximately 132,000 practicing school nurses (95,000 full-time equivalents) care for the nation’s 56 million children. About half (53%) of public school nurses are baccalaureate-prepared RNs.
On the job
Once stereotyped as a slow-paced, low-skill position, school nurses today care for students with complex conditions that require higher-level acute care nursing proficiency. In addition to direct care, school nurses must have exceptional advocacy, public health, and leadership skills. These efforts to positively impact health and improve student attendance rates are critical to extending children’s educational opportunities.
Direct care
School nurses make treatment decisions that may be as simple as applying an ice pack but as complex as an emergency intervention with epinephrine, albuterol, or glucagon. Similarly, the care they provide can range from taking a temperature to tracheostomy care, catheterization, and gastrostomy tube feedings. School nurses also work with families and interprofessional teams to coordinate care for children with chronic conditions such as asthma and diabetes. As primary health educators, school nurses teach students about disease management and help them provide their own developmentally appropriate self-care.
Kessler notes that about half of mental health conditions develop before age 14, which means that school nurses frequently are the first to notice early warning signs and can provide initial assessment and support. School nurses foster an inclusive environment by creating a safe space in the health room for those struggling with bullying or other issues such as anxiety, depression or gender identity development.
If a student has been hospitalized for a physical or mental health condition, the school nurse works with hospital teams, in collaboration with the student and family, to develop successful school re-entry plans.
The school nurses’ work isn’t limited to students. Teacher and staff health and wellness and disaster preparedness also fit within the scope of school nursing practice.
Advocacy
School nurses advocate for healthier environments by identifying and developing health and wellness policies. Examples include self-carry rules for rescue inhalers, breast-feeding guidelines for students and staff, bus idling policies to mitigate air pollution, and standards on food in the classroom.
School nurses are trained to identify risk factors and detect illness at the population level, making them crucial to public health and surveillance efforts. Surveillance activities include reporting disease outbreaks (for example, measles or mumps) to public health departments. School nurses are playing an important role in the current COVID-19 crisis by coordinating health and nutrition needs while students are out of school and ensuring that schools are ready when students return. The role of the school nurse is vast, highly specialized, and immensely rewarding.
Looking forward: Challenges and opportunities
School nursing faces many challenges, but these challenges also present opportunities to effect positive change.
Funding challenge
Limited and varied funding remains one of the primary challenges to delivering comprehensive, evidence-based school nursing services. Although schools can bill for specific services through Medicaid and partially fund a small portion of nursing services, according to an NASN Workforce Study, most school nursing services (74.1%) are funded through local education dollars, with additional funding coming from states, health departments, and hospitals. Local education funding means that school nursing services must compete with teachers, support staff, and education-related expenses, such as textbooks and tablets. And because school nurses function within the education sector, health services frequently are managed by administrators who may not understand what’s needed to effectively care for a diverse student population. With limited funds allocated to education, administrators look to make cuts “outside” of the classroom, which frequently results in reducing or eliminating school nurses and other professional support staff.
Opportunity. The need to ensure educational access by keeping children healthy and ready to learn presents policy makers and school districts with an opportunity to strategize on stable funding streams that support school nursing. For example, to provide a more reliable funding source for school nurses, some school districts have developed partnerships with health systems, including hospitals. In these partnerships, school districts contract out for school nursing services, which allows nurses to operate within a health infrastructure and ensures they have access to various resources (such as continuing education and mentorship) that otherwise might not be available to them. In addition, school and health system partnerships make health records more interoperable, which facilitates efficient care coordination.
Preparation and allocation challenges
The preparation and allocation of school nurses vary across the 50 states because of several factors, including state nurse practice acts, licensure and certification requirements, and local school district regulations. Although professional organizations recommend that school nurses be, at a minimum, baccalaureate-prepared, some states employ associate-prepared nurses or licensed practical nurses (LPNs). In addition, school nurse educational and certification requirements differ across states, which influences the type and level of care that can be provided. How school nurses are deployed and used frequently are pragmatic decisions—the limited number of school nurses relative to need impacts school district staffing decisions. As a result of these factors, schools may have RNs, LPNs, and/or health room aides who cover one to three schools of varying sizes.
Opportunity. Maughan states that caseloads among school nurses can range from 300 to 6,000 students per nurse. Generally, NASN recommends one nurse per 750 students, but more recent research by Jameson and colleagues indicates that a multi-faceted formula is needed to guide workload and staffing considerations. Comprehensive metrics to guide staffing could include the number of students on free or reduced lunch, number of children with medically complex needs, types of interventions needed, experience level of the school nurse, school academic performance, and number of and distance between school buildings.
Workforce challenge
An NASN Workforce Study reported that almost half of the school nurse workforce is over age 50 and only 5.4% are under age 30, indicating that the school nursing workforce is aging. Unfortunately, little attention is being paid to increasing the pipeline. Compounding this challenge is the fact that school nurse salaries aren’t uniformly commensurate with nurses in other specialties.
Opportunity. These data point to the critical need to intensify efforts to recruit, retain, compensate, and diversify the school nursing workforce. Nurses who transition to the school nursing specialty have a range of work experiences, such as in emergency care, pediatrics, and mental health. The specialty provides an opportunity to make a difference not only through practice, but also in the areas of education, policy, and practice.
Reliable leadership
School nurses are on the frontline addressing children’s healthcare needs and keeping them healthy for academic success. School nursing builds on the breadth and depth of professional nursing practice with new challenges each day, which require knowledge of emergency care, public health, occupational health, disaster management, surveillance, tracking, direct care, population health, case management, and behavioral health. As the only health experts in schools, school nurses are relied on for their leadership, critical thinking, and communication skills. School nursing represents an important opportunity not only to practice at the full scope of professional nursing, but also to demonstrate a profound impact on nursing-sensitive outcomes and community health. AN
To view a list of references, visit myamericannurse.com/?p=72018.
This article is shared from the American Nurse
New BSN Info Sessions – Register
The on-campus Information Session aims to offer valuable insights to individuals considering a Bachelor of Science in Nursing degree. Reserve a Spot…
Share at FacebookShare at TwitterShare at PinterestShare at LinkedIn
RNs ready to pursue more?
Are you a Registered Nurse wondering what the next step is in your career? Considered your BSN? Sumner College's RN to BSN program can get…
Share at FacebookShare at TwitterShare at PinterestShare at LinkedIn
Nurses Influence the Health and Wellbeing of Patients Every Day
As individuals, nurses directly influence the health and wellbeing of patients every day. Through frequent contact, nurses are best placed to encourage lifestyle changes in…
Share at FacebookShare at TwitterShare at PinterestShare at LinkedIn
Changes in Nursing
Changes in nursing involve a major shift in higher education standards, requiring more nurses to hold a 4-year bachelor of science in nursing (BSN). The…
Share at FacebookShare at TwitterShare at PinterestShare at LinkedIn
Trades make a comeback with Gen Z Workers
America’s skilled trades — from nursing and plumbing to welding to construction — need more workers as boomers retire. Gen Z-ers are stepping up to fill…
Share at FacebookShare at TwitterShare at PinterestShare at LinkedIn
Congratulations, Sumner College Graduates: Embracing New Beginnings
Congratulations to the new Sumner College nursing graduates. As the tassels are flipped and mortarboards soar into the sky, a chapter closes, and another begins.…
Share at FacebookShare at TwitterShare at PinterestShare at LinkedIn
April BSN Info Sessions
Have you considered being a nurse and working in the healthcare industry? Attend an information meeting with Sumner College to learn more about the BSN…
Share at FacebookShare at TwitterShare at PinterestShare at LinkedIn
The State of Wellness: Everything You Need to Know About the Oregon State Board of Nursing
You have likely heard about the Oregon State Board of Nursing (OSBN), but how does the organization interact with and support Oregon nurses? Join us…
Share at FacebookShare at TwitterShare at PinterestShare at LinkedIn
OCN Explores Nursing Wages in New Research
Article & Photo Shared from Oregon Center for Nursing How much do Oregon nurses really make? The well-being of Oregon’s nursing workforce is a guiding initiative for…
Share at FacebookShare at TwitterShare at PinterestShare at LinkedIn
New Classes Start Today!
March classes start today! Welcome to our new BSN, PN and RN-BSN students.…
Share at FacebookShare at TwitterShare at PinterestShare at LinkedIn
Meet Alex – Sumner College Graduate
Alex, congratulations on your graduation! As you’ve embarked on your nursing journey, remember: ‘Nursing is not just a profession, it’s a calling to serve, heal,…
Share at FacebookShare at TwitterShare at PinterestShare at LinkedIn
Meet Alexandra – Sumner College RN to BSN Graduate
Alexandra, congratulations on your graduation! As you’ve embarked on your nursing journey, remember: ‘Nursing is not just a profession, it’s a calling to serve, heal,…
Share at FacebookShare at TwitterShare at PinterestShare at LinkedIn
Meet Renee – Sumner College Graduate
Renee, congratulations on your graduation! As you’ve embarked on your nursing journey, remember: ‘Nursing is not just a profession, it’s a calling to serve, heal,…
Share at FacebookShare at TwitterShare at PinterestShare at LinkedIn
Meet Serena – Sumner College Graduate
Serena congratulations on your graduation! As you’ve embarked on your nursing journey, remember: ‘Nursing is not just a profession, it’s a calling to serve, heal,…
Share at FacebookShare at TwitterShare at PinterestShare at LinkedIn
Meet Amanda – Sumner College Graduate
Amanda, congratulations on your graduation! As you’ve embarked on your nursing journey, remember: ‘Nursing is not just a profession, it’s a calling to serve, heal,…
Share at FacebookShare at TwitterShare at PinterestShare at LinkedIn
Meet Natalie – Sumner College Graduate
Natalie, congratulations on your graduation! As you’ve embarked on your nursing journey, remember: ‘Nursing is not just a profession, it’s a calling to serve, heal,…
Share at FacebookShare at TwitterShare at PinterestShare at LinkedIn
Now Hiring
Are you a healthcare educator? Sumner College is looking for our next Nursing Educator to join our team. This is a part time position. Read…
Share at FacebookShare at TwitterShare at PinterestShare at LinkedIn
Meet Erin – Sumner College Graduate
Erin, congratulations on your graduation! As you’ve embarked on your nursing journey, remember: ‘Nursing is not just a profession, it’s a calling to serve, heal,…
Share at FacebookShare at TwitterShare at PinterestShare at LinkedIn
Exploring the Vital Role of Nurses in Heart Health
Article Shared from DiversityNursing.com February is American Heart Month. It's important to promote cardiovascular health and explore the many ways Nurses are engaged in these…
Share at FacebookShare at TwitterShare at PinterestShare at LinkedIn
Meet Anne Marie – Sumner College Graduate
Anne Marie, congratulations on your graduation! As you've embarked on your nursing journey, remember: 'Nursing is not just a profession, it's a calling to serve,…
Share at FacebookShare at TwitterShare at PinterestShare at LinkedIn
Nursing Ranked Most Trusted Profession for 22nd Year
Article Shared from DiversityNursing.com In Gallup's 2023 Honesty and Ethics poll, Americans' evaluations of almost all 23 professions have experienced a decline compared to previous years.…
Share at FacebookShare at TwitterShare at PinterestShare at LinkedIn
Helpful Apps Every Nurse Should Have
Article shared from DiversityNursing.com Mobile apps have transformed how Nurses provide care to their patients. Smartphones allow Nurses easy access to applications designed to assist…
Share at FacebookShare at TwitterShare at PinterestShare at LinkedIn
DiversityNursing.com – Helpful Resources
Helpful Resources DiversityNursing.com is a Career Job Board, Community and Information Resource for all Nurses regardless of age, race, gender identity, religion, education, national origin,…
Share at FacebookShare at TwitterShare at PinterestShare at LinkedIn
How to Prepare for College – Oregon Goes to School
Article shared from Oregon Goes to College It’s a plan! No matter what grade you’re in, you can get ready for your future. Getting ready…
Share at FacebookShare at TwitterShare at PinterestShare at LinkedIn
Sumner College Clinical Partners
Sumner College clinical partnerships play a crucial role in advancing medical education and training. By offering opportunities for hands-on experience and mentorship, these collaborations help…
Share at FacebookShare at TwitterShare at PinterestShare at LinkedIn
Commencement Ceremony
Save the date - April 6, 2024 for Sumner College's Commencement Ceremony. Celebrating cohorts: PN54, PN55, ADN23, RN-BSN10 and RN-BSN11 Congratulations to you all!! Tickets…
Share at FacebookShare at TwitterShare at PinterestShare at LinkedIn
Healthcare Hero
Are you aspiring to be a healthcare hero? A common question from our nursing students at Sumner College is about the role of ER nurses…
Share at FacebookShare at TwitterShare at PinterestShare at LinkedIn
Dynamic – Interactive – Rich with Real-world Relevance
RNs are you ready to take your nursing career to the next level with a BSN? Guess what - at Sumner College, you can achieve…
Share at FacebookShare at TwitterShare at PinterestShare at LinkedIn
ER Nursing
Have you been thinking, “How can I start my nursing career in an ER?" Begin by obtaining a solid understanding of nursing through an approved…
Share at FacebookShare at TwitterShare at PinterestShare at LinkedIn
LPN
At Sumner College, we understand the importance of every role in the nursing field, including the dedicated work of Licensed Practical Nurses (LPNs). LPNs are…
Share at FacebookShare at TwitterShare at PinterestShare at LinkedIn