It is the position of the National Association of School Nurses that the registered professional school nurse is the leader in the school community to oversee school health policies and programs. The school nurse serves in a pivotal role to provide expertise and oversight for the provision of school health services and promotion of health education. Using clinical knowledge and judgment, the school nurse provides health care to students and staff, performs health screenings and coordinates referrals to the medical home or private healthcare provider. The school nurse serves as a liaison between school personnel, family, community and healthcare providers to advocate for health care and a healthy school environment (National Association of School Nurses / American Nurses Association [NASN / ANA], 2005).
The practice of school nursing began in the United States on October 1, 1902, when a school nurse was hired to reduce absenteeism by intervening with students and families regarding health care needs related to communicable diseases. After one month of successful nursing interventions in the New York City schools, Lina Rogers, the first school nurse, was able to provide leadership to implement evidence-based nursing care across the city. The school nurse’s role has expanded greatly from its original focus, the essence and goals of the practice remains the same (Vessey & McGowan, 2006).
DESCRIPTION OF ISSUE
A student’s health status is directly related to his or her ability to learn. Children with unmet health needs have a difficult time engaging in the educational process. The school nurse supports student success by providing health care through assessment, intervention, and follow-up for all children within the school setting. The school nurse addresses the physical, mental, emotional, and social health needs of students and supports their achievement in the learning process. The school nurse not only provides for the safety and care of students and staff but also addresses the need for integrating health solutions into the education setting.
The number of children that have a chronic condition has increased dramatically over the past four decades (Perrin, Bloom, Gortmaker, 2007). Chronic conditions such as asthma, anaphylaxis, Type 1 Diabetes, epilepsy, obesity and mental health concerns may impact the student’s ability to be in school and ready to learn.
The number of students with special health care needs has also increased dramatically over the past decade. Students are coming to school with increasingly complex medical problems, technically intricate medical equipment, and complicated treatments (Robert Wood Johnson Foundation, 2010).
The school nurse is a registered professional nurse who has a commitment to lifelong learning. Educational preparation for the school nurse should be at the baccalaureate level, and the school nurse should continue to pursue professional development and continuing nursing education. School nurses typically practice independently and are called upon to assess student health, develop and execute plans for care management, act as first responders, and engage in public health functions such as disease surveillance, immunization compliance, and health promotion. The school nurse is a vital member of the school team that leads change to advance health and collaborates with school staff members, parents and community members to keep students safe at school and healthy to learn.
School nursing has multiple components and the role of the school nurse is a broad one, dependent on many factors, including the school setting (rural, urban, suburban), health needs of the student population and the availability of specialized instructional student support services and programs.
The National Association of School Nurses defines school nursing as a specialized practice of professional nursing that advances the well-being, academic success and lifelong achievement and health of students. To that end, school nurses facilitate normal development and positive student response to interventions; promote health and safety including a healthy environment; intervene with actual and potential health problems; provide case management services; and actively collaborate with others to build student and family capacity for adaptation, self-management, self advocacy, and learning (National Association of School Nurses [NASN], 2010).
School nurses facilitate normal development and positive student response to interventions.
The school nurse serves as the health care expert in the school to meet student health needs with an understanding of normal growth and development in children and youth as well as students with special needs. The school nurse develops plans for student care based on the nursing process, which includes assessment, interventions, and identification of outcomes and evaluation of care (Wolfe, 2012).
School nurses provide leadership in promoting health and safety, including a healthy environment.
The school nurse provides health-related education to students and staff in individual and group settings and provides consultation to other school professionals, including food service personnel, physical education teachers, coaches, and counselors. Responsibilities in the provision of a safe and healthy school environment include the school nurse’s monitoring of immunizations, managing communicable diseases, assessing the school environment for safety to prevent injury and spearheading infection control measures. The school nurse is also a leader in the development of school safety plans to address bullying, school violence, and the full range of emergencies that may occur at school (Wolfe, 2012).
School nurses provide quality health care and intervene with actual and potential health problems.
Health care for chronic and acute illness, as well as injuries in the school setting, is a major focus of the role of the school nurse. The school nurse is responsible for medication administration, health care procedures, and the development of health care plans. Students often have multiple needs that should be examined in order for the student to be able to be successful in the classroom, and school nurses often engage in health screenings that include vision, hearing, body mass index, mental health index or other screening procedures (often based on local and state regulations) to address those issues (Wolfe, 2012).
School nurses use clinical judgment in providing case management services.
The school nurse receives medical orders to guide the health care needed to assist each student to be safe and successful at school. As in other clinical settings, the nurse develops Individualized Healthcare Plans (IHPs) in nursing language to direct nursing care for students as well as Emergency Care Plans (ECPs) written in lay language to guide the response of unlicensed personnel in a health-related emergency. Both plans are tailored to the individual needs of a specific student to improve expected care outcomes. The nurse makes decisions related to the appropriate delegation of healthcare tasks as directed by state laws and professional practice guidance (American Nurses Association [ANA]/National Council of State Boards of Nursing [NCSBN], 2006). As medical and information technology advance and change, it is imperative for the school nurse to pursue professional development so the school nurse is able to provide the best possible care for the student population (Wolfe, 2012).
School nurses actively collaborate with others to build student and family capacity for adaptation, self-management, self advocacy and learning.
Coordinating the linkage between the medical home, family and school is an important aspect of the role of the school nurse. The school nurse has health expertise that is essential to school educational teams, such as the Committee on Special Education, the Individualized Educational Plan (IEP) team and the Section 504 Team so that health-related barriers to learning can be reduced for each student. The school nurse can provide families with referral information along with available community resources to improve access to health care. The school nurse can also assist families in obtaining health insurance as needed and can represent the school on community coalitions to advocate for school-based health care (Wolfe, 2012).
The school nurse may take on additional roles as needed to meet the needs of the school community.
Healthy children are successful learners. The school nurse has a multi-faceted role within the school setting, one that supports the physical, mental, emotional, and social health of students and their success in the learning process. It is the breadth of nursing activities contained within the role of the school nurse and the unique non-medical setting that differentiates school nursing from other nursing specialties.
American Nurses Association / National Council of State Boards of Nursing (ANA/NCSBN). (2006). Joint statement on delegation. Retrieved from https://www.ncsbn.org/Joint_statement.pdf
National Association of School Nurses (NASN) (2010). Definition of school nursing. Retrieved from: http://www.nasn.org/Default.aspx?tabid=57
National Association of School Nurses / American Nurses Association (NASN / ANA). (2005) Scope and Standards of School Nursing Practice. (pp. 1 – 8). Silver Spring: Nursebooks.org
Perrin, J.M., Bloom, S.R., Gortmaker, S. L., (2007). The Increase of Childhood Chronic Conditions in the United States. Journal of the American Medical Association, 297 (24) 2755-2759. doi: 10.1001/jama.297.24.2755.
Robert Wood Johnson Foundation. (2010). Unlocking the potential of school nursing: keeping children healthy, in school, and ready to learn. Retrieved from http://www.rwjf.org/files/research/cnf14.pdf.
Vessey, J, and McGowan, K, (2006) A successful public health experiment: school nursing. Pediatric Nursing, 32 (3) 255 – 256.
Wolfe, L.C. (2012). The profession of school nursing. In J. Selekman, School Nursing: A Comprehensive Text. Philadelphia: F.A. Davis.
Acknowledgement of Authors:
Connie Board, BSN, RN, NCSN
Margo Bushmiaer, MNSc, RN, NCSN
Linda Davis-Alldritt, MA, BSN, PHN, RN, FNASN, FASHA
Nina Fekaris, MS, BSN, RN, NCSN
Judith Morgitan, MEd, BSN, RN
Kathleen Murphy, DNP, RN, FNP-BC
Barbara Yow, MEd, BSN, RN, CSN
Adopted: 2002 (Issue Brief)
Revised: April 2011