Student Access to School Nursing Services
It is the position of the National Association of School Nurses (NASN) that all students should have access to school nursing care by a registered, professional school nurse (hereinafter referred to as school nurse) all day, every day. For students who face barriers to accessing healthcare, especially those living in predominantly low-income, rural and minority communities, a school nurse may serve as their only regular healthcare provider. School nurses provide students, staff, and school communities with quality healthcare that is critical for health promotion, disease prevention, health maintenance, and health equity (National Academy of Medicine, 2021).
BACKGROUND AND RATIONALE
About 56 million students attend school in the United States; about 6% or 3.3 million do not have health insurance coverage (NCES, 2020; US Census Bureau, 2020). School nurses provide all students equitable access to healthcare when they teach, assess, and support physical and mental health, and remove barriers to community-based healthcare through care coordination and case management (Maughan et al., 2016).
Several barriers may impact a family's ability to seek medical care or advice (Johnson, 2017). This may be related to a lack of insurance or an available healthcare provider. Other barriers, such as job or transportation constraints, can impact parents’ ability to take a child for treatment. Whatever the reason, the school nurse is often the healthcare provider who provides assessment and episodic care for the student. The school nurse also provides care coordination by helping families to enroll in public health insurance programs, finding a medical home and even arranging transportation to appointments (American Academy of Pediatrics, 2016). Support of a school nurse may be even more essential in schools where socioeconomic and geographic disparities exist (Gratz et al., 2021).
School nurses empower students to be well; they teach, treat, counsel, and support students to increase classroom seat time and decrease trips to the health office and absences from school (Best et al., 2021). School nurses support student health in a variety of ways. School nurses may teach students how to manage their own health and wellness; monitor student immunization status, conduct vision and hearing screening, and refer students for treatment; participate in 504/IEP meetings, contribute to individualized education programs and/or develop individualized health care plans (American Academy of Pediatrics, 2016). School nurses are often the first to identify and address student behavioral health concerns and serve as an early warning system for children and families in crisis or otherwise at risk of abuse and neglect. School nurses provide support and care for students with special healthcare needs/chronic conditions through care management and direct care, including medication administration and health procedures.
School nurses use their public health expertise to advocate for healthier communities by leading school wellness teams and developing health and wellness policies addressing issues such as quality air, healthier lunches, and barriers created by health disparities (Johnson, 2017). School nurses support the school community through constant surveillance of student and staff conditions to prevent and control spread of communicable disease and prepare for and respond during emergencies (Shannon et al., 2020).
School nurses provide care and support to all students using the Framework for 21st Century Practice model (NASN, 2016). The model is student-centered and includes five nonhierarchical key principles: Standards of Practice, Care Coordination, Leadership, Quality Improvement, and Community/Public Health. The principles of the Framework help to describe many of the practice activities nurses perform each day to support student health and learning. The Framework is aligned with the Whole School, Whole Community, Whole Child movement and its interdisciplinary approach to student health and learning (NASN, 2020; CDC, 2014)
School nursing plays an essential role in keeping children healthy, safe, and ready to learn so that they may grow into healthy and productive adults. The school nurse is a member of a unique, specialized discipline of professional nursing and is often the sole healthcare provider in an educational setting (NASN, 2016). It is essential that all students have access to a full-time school nurse all day, every day to level the playing field with regard to health equity and to support student physical health, mental wellness and academic readiness (Council on School Health, 2016).
American Academy of Pediatrics, Committee on School Health. (2016). The role of the school nurse in providing school health services. Pediatrics, e20160852. Retrieved from https://pediatrics.aappublications.org/content/108/5/1231
Best, N.C., Nichols, A.O., Waller, A.E., Zomorodi, M., Pierre-Louis, B., Oppewal, S., & Travers, D. (2021). Impact of school nurse ratios and health services on selected student health and education outcomes: North Carolina, 2011-2016. Journal of School Health, 91(6), 473-481. https://doi-org.proxy.cc.uic.edu/10.1111/josh.13025
Centers for Disease Control and Prevention. (2014). CDC Healthy Schools: Whole School Whole Community Whole Child (WSCC). Retrieved from https://www.cdc.gov/healthyschools/wscc/index.htm
Council on School Health. (2016). Role of the school nurse in providing school health services. Pediatrics, 137(6) e20160852. https://doi.org/10.1542/peds.2016-0852
Gratz, T., Goldhaber, D. & Willgerodt, M. (2021). The frontline health care workers in schools: Health equity, the distribution of school nurses and student access. Journal of School Nursing [epub before print]. https://doi.org/10.1177%2F10598405211024277
Johnson, K. (2017). Healthy and ready to learn: School nurses improve equity and access. OJIN: Online Journal of Issues in Nursing, 22(3). https://doi.org10.3912/OJIN.Vol22No03Man01
Maughan, E. D., Duff, C., & Wright, J. (2016). Using the framework for 21st-century school nursing practice in daily practice. NASN School Nurse, 31(5), 278–281. https://doi.org/10.1177/1942602X16661558
NASN. (2016). Framework for 21st century school nursing practice. NASN School Nurse, 31(1), 45-53.
NASN. (2020). Framework for the 21st century school nursing practice: Clarifications and updated definitions. NASN School Nurse, 35(4), 225-233. https://doi.org10.1177/1942602X20928372
National Academies of Sciences, Engineering, and Medicine. (2021). The future of nursing 2020-2030: Charting a path to achieve health equity. The National Academies Press. https://doi.org/10.17226/25982
National Center for Education Statistics. (2020). Fast facts: Back to school statistics. Retrieved from https://nces.ed.gov/fastfacts/display.asp?id=372
Shannon, R. (2020). Emergency and disaster nursing in schools. In C.J. Goodhue & N. Blake (Eds.), Nursing Management of Pediatric Disasters (pp.315-330). Springer International Publishing. https://doi.org/10.1007/978-3-030-43428-1_14
U.S. Census Bureau. (2020). American community survey: Table HI-05_ACS Health insurance coverage status and type of coverage by state and age for all persons: 2019. Retrieved from https://www.census.gov/data/tables/time-series/demo/health-insurance/acs-hi.html
Acknowledgment of Authors:
Catherine F. Yonkaitis, DNP, RN, NCSN, PHNA-BC
Amy Dark, BA, BSN, RN, CSNT
Linda Compton, MS, RN
Kathey Haynie, MSN, RN
Adopted: January 2022
Suggested citation: National Association of School Nurses. (2022). Student access to school nursing services [Position Statement]. Author.
“To optimize student health, safety, and learning, it is the position of the National Association of School Nurses that a professional registered school nurse is present in every school all day, every day.”
All position statements from the National Association of School Nurses will automatically expire five years after publication unless reaffirmed, revised, or retired at or before that time.