Safe, Supportive, Equitable Schools
It is the position of the National Association of School Nurses (NASN) that every student should attend school in a safe, supportive, and equitable environment. Access to a registered professional nurse (hereinafter referred to as a school nurse) democratizes healthcare for the most vulnerable students and families.
BACKGROUND AND RATIONALE
Poverty, racism, homelessness, access to healthcare, food insecurity and other social determinants of health can have a significant impact on the health and well-being of students and school communities (CDC, 2021a; NASN, 2020). The Future of Nursing Report emphasizes the positive impact of school nurses on students’ clinical and social needs and highlights the urgent need to expand, strengthen, and diversify school nursing practice as a means to advance health equity for students (National Academies of Sciences, Engineering, and Medicine, 2021.) Learning is best achieved when the student’s physical, social, and emotional development are addressed in the school setting (CDC, 2018).
All students have a right to learn in a safe environment. Structural and systemic barriers, both within and outside of schools, have created environments in which students may feel disconnected and unsafe. Issues related to safety, racism, and violence impact all students; however, they may disproportionately impact racial, ethnic, and gender-sexual minority students (Brookings, 2020). Students who do not feel safe are unable to learn; therefore, they may be chronically absent, may not actively engage in learning, or may drop out of school.
Students struggling with mental health issues, including isolation, stress, anxiety, depression and the effects of bullying, may avoid school if they do not feel a sense of safety and belonging (Baek et al., 2019; Eugene et al., 2021). Thirty-six percent (36%) of U.S. high school students identified being treated unfairly or badly due to their race or ethnicity, with those who indicated poorer mental health and less school connectedness reporting the highest incidence of racism (Mpofu et al., 2022). Minority stress also places students at additional risk for depression and suicidal ideation or attempts (Kosciw et al., 2020). Furthermore, safe and supportive school environments provide opportunities for LGBTQ+ youth to socialize and build positive, identity-affirming relationships that are pivotal in improving their mental health and physical well-being (McCabe et al., 2022).
School connectedness is a protective factor that supports youth physical, mental, and emotional well-being, fosters resilience, and is a significant predictor of healthy behaviors (Steiner et al., 2019; Eugene et al., 2021; Osher et al., 2021) and academic success (Reynolds et al., 2017). School nurses promote connectedness through communication, advocacy, and by establishing trusting and caring relationships with all youth, including youth from marginalized groups (McCabe et al., 2022). A schoolwide approach to connectedness also involves the integration of trauma sensitive schools (TSS) and social emotional learning (SEL) (Osher et al., 2021).
Adverse childhood experiences (ACEs) have been linked to long-term impact on physical, social, and mental health (CDC, 2021b). This is more prevalent in black and brown communities and escalated during the COVID-19 pandemic (Martin et al., 2022). Issues of structural racism, intentional or unintentional, must be eradicated. For example, it is well known that school discipline policies related to expulsion and suspension have been unevenly applied toward ethnic minority and special education students (Steinberg & Lacoe, 2018). School nurses are well-positioned to address systemic inequities and to influence school policies and practices, working in concert with other school support personnel. These include disciplinary and other practices involved in treatment of racial, ethnic, and gender-sexual minority students (Willgerodt et al., 2021).
Youth violence is a public health concern. Half of U.S. students have experienced violence in the school setting (David-Ferdin et al., 2021). Black, Indigenous, and people of color (BIPOC) and LGBTQ+ teens are at a greater risk of experiencing violence than their peers (CDC, 2021c; 2022). A majority of U.S. children and teens worry that a school shooting may occur at their school (Cogan et al., 2019; Graf, 2020). Teens who experience violence in and out of the school environment may be at risk for:
- Missing school due to safety concerns
- Risky sexual behavior
- Low academic achievement
- Overweight or obesity
- Access to a weapon
- Feelings of sadness or hopelessness
- Suicidal thoughts or behavior
- Substance use (David-Ferdon et al., 2021)
Students who experience or fear violence, at home or at school, report that a positive school climate with supportive adults helps them to feel safer (Baek et al., 2019). Students and school communities require safe and supportive environments to flourish. A safe, trauma-sensitive school is one where teaching and learning are collectively embraced; equity is centered as a shared value; strategies to minimize disruptive behaviors and address the root causes of violence are prioritized; students' voices are included in shared governance; school community norms are clearly communicated, and restorative justice practices are implemented.
School nurses possess the skill and judgment to identify and address the structural and systemic barriers that impact the attainment of safe, supportive, and equitable school environments which contribute to students’ ability to achieve wellness and academic success.
Baek, H., Andreescu, V., & Rolfe, S. M. (2019). Bullying and fear of victimization: Do supportive adults in school make a difference in adolescents’ perceptions of safety? Journal of School Violence, 18(1), 92–106. https://doi.org/10.1080/15388220.2017.1387133
Brookings Institute (2020). Unsafe school facilities reinforce educational inequities among marginalized students. https://www.brookings.edu/blog/brown-center-chalkboard/2020/09/01/unsafe-school-facilities-reinforce-educatio nal-inequities-among-marginalized-students/
Centers for Disease Control and Prevention (2021a). About social determinants of health. https://www.cdc.gov/socialdeterminants/about.html
Centers for Disease Control and Prevention (2022). Adolescent behaviors and experiences Reports. https://www.cdc.gov/healthyyouth/data/abes/reports.htm
Centers for Disease Control and Prevention (2021b). Adverse Childhood Experiences (ACEs). https://www.cdc.gov/violenceprevention/aces/index.html
Centers for Disease Control and Prevention (2021c). Preventing Youth Violence. https://www.cdc.gov/violenceprevention/pdf/yv/YV-factsheet.pdf
Centers for Disease Control and Prevention (2018). The Whole School, Whole Community, Whole Child (WSCC) Model. https://www.cdc.gov/healthyyouth/wscc/model.htm
Cogan, R., Nickitas, D.M., Mazyck, D., & Hallowell, S.G. (2019). School nurses share their voices, trauma, and solutions by sounding the alarm on gun violence. Current Trauma Reports 5, 178–186. https://doi.org/10.1007/s40719-019-00179-1
David-Ferdon, C., Clayton, H. B., Dahlberg, L. L., Simon, T. R., Holland, K. M., Brener, N., Matjasko, J. L., D'Inverno, A. S., Robin, L., & Gervin, D. (2021). Vital signs: Prevalence of multiple forms of violence and increased health risk behaviors and conditions among youths - United States, 2019. MMWR. Morbidity and Mortality Weekly Report, 70(5), 167–173. https://doi.org/10.15585/mmwr.mm7005a4
Eugene, D. R., Crutchfield, J., & Robinson, E. D. (2021). An Examination of Peer Victimization and Internalizing Problems through a Racial Equity Lens: Does School Connectedness Matter? International Journal of Environmental Research and Public Health, 18(3), 1085. https://doi.org/10.3390/ijerph18031085
Graf, N. (2020, May 30). Majority of teens worry about school shootings, and so do most parents. Pew Research Center. Retrieved March 30, 2022, from https://www.pewresearch.org/fact-tank/2018/04/18/a-majority-of-u-s-teens-fear-a-shooting-could-happen-at-thei r-school-and-most-parents-share-their-concern/
Kosciw, J. G., Clark, C. M., Truong, N. L., & Zongrone, A. D. (2020). The 2019 National School Climate Survey: The experiences of lesbian, gay, bisexual, transgender, and queer youth in our nation’s schools. GLSEN. https://www.glsen.org/research/2019-national-school-climate-survey
Martin, R., Rajan, S., Shareef, F., Xie, K., Allen, K., Zimmerman, M., & Jay, J. (2022). Racial disparities in child exposure to firearm violence before and during covid-19. American Journal of Preventive Medicine. https://doi.org/10.1016/j.amepre.2022.02.007
McCabe, E., Davis, C., Mandy, L., & Wong, C. (2021). The Role of School Connectedness in Supporting the Health and Well-Being of Youth: Recommendations for School Nurses. NASN School Nurse, 37(1), 42-47. https://doi.org/10.1177%2F1942602X211048481
Mpofu, J.J, Cooper, A.C.,Ashley, C., Geda, S., Harding, R.L., Johns, M.M., Spinks-Franklin, A., Njai, R., Moyse, D., & Underwood, M. (2022). Perceived racism and demographic, mental health, and behavioral characteristics among high school students during the COVID-19 pandemic — Adolescent Behaviors and Experiences Survey, United States, January–June 2021. MMWR Suppl 2022;71(Suppl-3):22–27. http://dx.doi.org/10.15585/mmwr.su7103a4
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 Association of School Nurses (2020). Framework for 21st Century School Nursing Practice TM: Clarifications and updated definitions. NASN School Nurse (Print), 35(4). https://doi.org/10.1177/1942602X20928372
Osher, D., Guarino, K., Jones, W., & Schanfield, M. (2021). Trauma sensitive schools and social and emotional learning: An integration. University Park, PA: Edna Bennett Pierce Prevention Research Center, The Pennsylvania State University
Reynolds, K. J., Lee, E., Turner, I., Bromhead, D., & Subasic, E. (2017). How does school climate impact academic achievement? An examination of social identity processes. School Psychology International, 38(1), 78–97. https://doi.org/10.1177/0143034316682295
Steiner, R.J., Sheremenko, G., Lesesne, C., Dittus, P.J., Sieving, R.E., & Ethier, K.A. (2019). Adolescent connectedness and adult health outcomes. Pediatrics, 144(1):e20183766. https://doi: 10.1542/peds.2018-3766 PMID: 31235609.
Steinberg, M.P. & Lacoe, J. (2018). Reforming school discipline: School-level policy implementation and the consequences for suspended students and their peers. American Journal of Education, 125(1), 29–77. https://doi.org/10.1086/699811
Willgerodt, M.A., Maughan, E., Jameson, B., Johnson, K.H. (2021). Actions speak louder than words: Social justice Is integral to school nursing practice. The Journal of School Nursing, 37(4):226-227. https://doi:10.1177/10598405211019228
Acknowledgment of Authors:
Christine Amidon MSN, RN, FNP-C, NCSN
Robin Cogan MEd, RN, NCSN, FAAN
Lisa Kern MSN, RN, NCSN
Joan Hlinomaz MS, BSN, RN, NCSN
This document replaces the following position statement, School violence – The role of the school nurse (Adopted June 2013, Revised June 2018).
Adopted: January 2023
Suggested Citation: National Association of School Nurses. (2023). Safe, supportive, equitable schools (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.