| HISTORY:
The practice of school nursing is both complex and multidimensional. School nurses come from many specialty areas and function in a number of different roles and practice settings (Christeson, 2003). One of the specialty areas found in school nursing is advanced practice.
The first expanded role for nurses was developed during the 1960s at the University of Colorado with the inception of the pediatric nurse practitioner program. Pediatric nurse practitioners were educated to provide pediatric care in ambulatory community health settings (Wold, 1981). Since that time, other nurse practitioner and clinical nurse specialties have been developed, and advanced practice registered nurses now function as nurse practitioners or clinical nurse specialists in a variety of areas and settings. In 2000 the “National Sample Survey of Registered Nurses” estimated there were 102,829 nurse practitioners with 14,643 also prepared as clinical nurse specialists (American College of Nurse Practitioners, 2003A). The advanced practice areas most appropriate for nurses working in the school setting are pediatric, school, family, and psychiatric/mental health.
DESCRIPTION OF ISSUE:
The term Advanced Practice Registered Nurse (APRN) is being increasingly used by legislative and governing bodies to describe the collection of registered nurses that practice in the extended role beyond the normal role of basic registered nursing. The APRN has education beyond the four-year baccalaureate degree in nursing. In addition to increased education, the APRN role requires extra responsibility, critical thinking, and judgment. While there are four major groups of advanced practice registered nurses: nurse practitioners, clinical nurse specialists, certified nurse midwives, and certified registered nurse anesthetists, those groups appropriate to work in schools are nurse practitioners and clinical nurse specialists. The nurse practitioner and clinical nurse specialist are differentiated by educational preparation and clinical practice (Advanced Practice Registered Nurses Council, 2003). Some states require certification from a nationally recognized body in order to be licensed as an APRN (American Nurses Association, 1996).
Clinical Nurse Specialist (CNS)
Clinical nurse specialists are advanced practice registered nurses who are educated in the disciplines of nursing and a clinical practice specialty of primary or acute care. Clinical nurse specialists may practice in the advanced role with specialized education, national certification, and official recognition from a state licensing board (Advanced Practice Registered Nurses Council, 2003).
Nurse Practitioner
Nurse practitioners are registered nurses with advanced academic and clinical experience that enables them to diagnose and manage most common and many chronic illnesses, independently or as part of a health care team. Nurse practitioners provide some care that was previously only performed by physicians. In most states nurse practitioners have the ability to prescribe medications. Nurse practitioners focus mainly on health maintenance, disease prevention, counseling, and patient education. Nurse practitioner education programs grant either a certificate or a master’s degree (American College of Nurse Practitioners, 2003B). Currently entry-level preparation for nurse practitioner practice is a master’s degree (American Academy of Nurse Practitioners, 2003). A key component to most nurse practitioner programs is an intensive preceptorship under the direct supervision of a physician or an experienced nurse practitioner. There is also instruction in nursing theory. The scope of practice for nurse practitioners varies depending on each state’s nurse practice act (American College of Nurse Practitioners, 2003B). The competencies that all nurse practitioners should be able to demonstrate regardless of specialty area are available in the document “Nurse Practitioner Primary Care Competencies in Specialty Areas” (National Organization of Nurse Practitioner Faculties, 2002).
RATIONALE:
Health services provided in school districts may include enhanced health services as an alternative to school-based or school-linked health centers. A number of school districts throughout the country offer health services beyond the basic core services. This is due in part to the fact that health care reforms have not solved the problem of students’ access to health care and health problems continue to interfere with students’ learning (Marx & Wooley, 1998). As good health is important to a child’s ability to learn and succeed in school and life, the need for quality, affordable health programs in or near schools is unavoidable (NASN, 2001). Employment of an advanced practice registered nurse enables a school district to offer more than the core health services. An enhanced school health services team may include school nurses, advanced practice registered nurses, licensed practical nurses, unlicensed assistive personnel, clerical staff, school physicians, school counselors, school psychologists, and school social workers (American Academy of Pediatrics, 2001). On an enhanced school health services team that includes both school nurses and advanced practice nurses, school nurses are able to assist in the identification of students with health problems and provide triage services for the advanced practice registered nurse (NASN, 2001)
CONCLUSION:
It is the position of the National Association of School Nurses that advanced practice registered nurses can provide unique and valuable services for students. In those communities where students do not receive consistent, appropriate medical care, advanced practice registered nurses offer a cost effective solution to this need. School districts that include both school nurses and advanced practice nurses on their staffs will be able to offer a broader range of health services. The anticipated outcome is more health needs of students being met, resulting in a positive impact on the health and educational performance of students.
References/Resources:
Advanced Practice Registered Nurses Council (2003). Information on APRNs. Retrieved May 29, 2003 from http://www.scnurses.org/A_P_Council/aprns.asp
American Academy of Nurse Practitioners (2003). Position statement on nurse practitioner curriculum. Retrieved May 26, 2003, from http://www.aanp.org
American Academy of Pediatrics (2001). The role of the school nurse in providing school health services. Retrieved May 28, 2003, from http://www.aap.org/policy/re0050.html
American College of Nurse Practitioners (2003A). Facts about nurse practitioners. Retrieved May 26, 2003, from http://www.nurse.org/acnp/facts/index.shtml
American College of Nurse Practitioners (2003B). What is a nurse practitioner? Retrieved May 26, 2003, from http://www.nurse.org/acnp/facts/whatis.html
American Nurses Association (1996). Scope and standards of advanced practice registered nursing [Brochure]. Washington, DC: Author.
Christeson, E.P. (2003). The health of the school nurse community: A framework. Journal of School Nursing, 19(2), 73-80.
Marx, E., & Wooley, S. F. Eds. (1998). Health is Academic: A Guide to Coordinated School Health Programs. New York: Teachers College Press.
National Association of School Nurses (NASN). (2001). Issue brief: Integrated service delivery. Scarborough, ME (Retired).
National Association of School Nurses (NASN). (2001). Position statement: The role of the school nurse in school based health centers. Retrieved April 26, 2006, from http://www.nasn.org/Default.aspx?tabid=245
National Organization of Nurse Practitioner Faculties. (2002). Nurse practitioner primary care competencies in specialty areas: Adult, family gerontological, pediatric, and women’s health. Retrieved May 26, 2003, from http://www.nonpf.com/finalaug2002.pdf
Wold, S. J. (1981). School nursing: A framework for practice. St. Louis: The C. V. Mosby Co.
Adopted: October 1997
Revised: June 2003 |