HISTORY
Determining staffing for school nurses is generally a local function (Costante, 2001). Thus, caseload assignments for school nurses vary greatly throughout the United States. Historically, the federal government and the National Association of School Nurses (NASN) have recommended a school nurse-to-student ratio of 1:750 (U.S. Department of Health and Human Services, 2000). Previous versions of this position statement have also recommended a school nurse-to-student ratio of 1:225 in mainstreamed special education populations, 1:125 in severely chronically ill or developmentally disabled populations, and based on individual needs in medically fragile populations (Harrigan, 2002). Expectations for school nursing services vary depending upon state mandates and local school district and school attitudes toward school heath services. But generally school nursing practice has been focused on a defined set of specific tasks, such as screenings, first aid, and immunization compliance. Many school nurses have been, and continue to be, evaluated by the tasks they complete and the frequency with which these tasks are performed (Selekman & Guilday, 2003).
DESCRIPTION OF ISSUE
A task-oriented role definition no longer describes the impact school nurses have on individual students and the school community (Selekman & Guilday, 2003). School nurses now need to have expertise in clinical nursing, communication, surveillance, education, advocacy, and leadership in order to ensure that all students’ health needs are addressed. Changing populations in the schools are impacting the nature and scope of nursing services required. The school nurse is the most appropriate person to oversee the coordinated school health program. As part of coordinated school health the school nurses role includes assessing student health status, identifying health problems that have an impact on health and learning, delivering emergency care, administering medications, performing health care procedures, providing wellness programs, advocating for children and families, as well as providing health counseling and health education. School nursing further involves planning, developing, managing, and evaluating health care services to children in an educational setting and encompasses working with the families of the students and the community in which the student resides (Guilday, 2000).
The school nurse-to-student ratio affects the delivery of school nursing services. Caseload assignments are influenced by multiple factors, such as:
Mandated functions
School district goals and objectives
Educational preparation of the school nurse
Geographic location and number of buildings assigned to the nurse
Social, economic and cultural status of the community
Special health problems within the student population
Mobility of the people in the community
Reimbursement opportunities
Licensed or unlicensed assistive personnel
Presence or absence of a school-based clinic
Job description, model of service delivery
Accessibility to medical care
Student populations with Individualized Educational Plans, Individualized Health Care Plans, or 504 Plans
School nurse-to-student ratios in many schools indicate that teachers cannot always depend on the school nurse to be available in case of a medical emergency (Barrett, 2001). Additionally, some students’ health needs may not be safely met by a nurse who has simultaneous responsibility for hundreds of other students (Costante, 2001) or who needs to cover schools at disparate sites.
Research has shown that nurses with a baccalaureate degree are more likely to use interventions that facilitate health promotion and disease prevention activities and are more likely to involve families and communities. These activities are vital to the establishment of a coordinated school health program. Nurses without baccalaureate degrees report using more interventions that focus on the physical needs of the students (Guilday, 2000). School nurses with advanced preparation as a nurse practitioner or in other fields bring additional skills to the school setting.
RATIONALE
All students have a right to have their health needs safely met while in the school setting. School nurse-to-student ratios need to be set to ensure that each student is afforded appropriate preventative, health promotion, early identification, and intervention services (Costante, 2001).
CONCLUSION
It is the position of the National Association of School Nurses that school districts should provide a full-time professionally prepared registered nurse all day, every day in each building (NASN, 2003). Also recommended is additional school nurse staff to accommodate other student health needs including, but not limited to, special education evaluations, nursing services included in IEPs, nursing services for students with 504 Plans, and schools with large populations and large numbers of students with mental or social concerns.
NASN recommends minimum ratios of nurses to students depending on the needs of the student populations:
1:750 for students in the general population,
1:225 in the student populations that may require daily professional school nursing services or interventions,
1:125 in student populations with complex health care needs, and
1:1 may be necessary for individual students who require daily and continuous professional nursing services.
References/Resources:
Barrett, J. C. (2001). Teaching teachers about school health emergencies. Journal of School Nursing, 17(6), 316-322.
Costante, C. C. (2001). School health nursing: Framework for the future, Parts I & II. Journal of School Nursing, 17(2), 3-11 & 64-72.
Guilday, P. (2000). School nursing practice today: Implications for the future. Journal of School Nursing, 16(5), 25-31.
Harrigan, J. (2002). Overview of school health services. Castle Rock, CO and Scarborough, ME: National Association of School Nurses.
Hootman, J. (1994). Nursing our most valuable natural resource: School-aged children. Nursing Forum, 29(3), 5-17.
National Association of School Nurses (NASN), (2003). Resolution: Access to a school nurse. Available at http://www.nasn.org/resolutionaccess.htm.
Selekman, J., & Guilday, P. (2003). Identification of desired outcomes for school nursing practice. Journal of School Nursing, 19 (6), 344-350.
U.S. Department of Health and Human Services. (2000). Healthy people 2010. Available at http://www.health.gov/healthypeople/document/html/volume1/07ed.htm#_Toc490550856.
Adopted: June 1972
Revised: June 1982, June 1995, July 2004, June 2006