School Nursing CE Course

1.0 ANCC Contact Hours AACN Category A

Syllabus

The purpose of this activity is to discuss the role of the school nurse and the benefits of having a school nurse within each school system. We will address the regulations of the school nurse position, the experience of the school nurse during the school day, and their role in promoting policy that impacts the physical and psychosocial health of the child.

According to the National Association of School Nurses (NASN, 2018), the position of the school nurse has been in existence since the early 1900s. School nursing was started to help the communicable disease plight that was affecting the United States. Many students were absent from school because of various infectious disease conditions, as well as a significant spread of illness due to poor sanitation practices. As a result of implementing nurses into the school system, the rate of illness preventing school attendance declined and children were able to attend school more regularly (NASN, 2018). The school nurse also worked in the public health setting, addressing the environmental needs of the home in which the child lived. The school nurse continues to enhance each child’s learning today by offering support in a variety of situations, such as those with acute/chronic health care needs, family crises, and psychosocial illnesses. Many families are affected by a lack of health care and the rising cost of health care interventions. Having a school nurse to assist children with healthcare concerns during the day can lessen the burden on a working family (American Academy of Pediatrics Council on School Health [COSH], 2016; Kuo, Wood, Duffee, & Paco, 2016). 

The Roles of a School Nurse

According to the NASN (2018), a school nurse is someone who works collaboratively with the child, family, teacher, and school system to enhance the quality of the child’s learning experience. School nurses can be assigned to one school or a district, dependent upon the needs of the school system and available funding. One key element of school nursing is to advocate for the child regarding social issues, both in and out of the home. Serving as an advocate for children allows the child’s voice to be augmented concerning healthcare needs and wellness initiatives. This advocacy will help the child to be self-sufficient in areas of their personal care. School nurses can be policy changers/makers, identifying situations that need policy change or the implementation of new procedures or legislation to address the many concerns facing the child in the school setting, such as bullying, nutrition, and preventive healthcare (NASN, 2018).

According to the COSH (2016), school nurses have a vast job description. School nurses continue to be primarily responsible for the decrease in the absenteeism rates of students, but the bigger picture is equally important. School nurses provide home visits for students who have physical or emotional special needs. In order for children to be their most productive selves at school, the home environment may need to be evaluated and supported. School nurses are needed for disaster preparedness. While most children spend the majority of their day in school and disasters strike at any time, the school nurse should be prepared to ensure the safety of the children. In addition, the school nurse can plan teaching sessions for children and families to discuss ways to plan for a disaster should it strike. Preparing the child for safety should be the utmost concern of the school nurse. The education that the school nurse provides to the students and staff can be one of the most important contributions that they make. Providing this information to students can save lives. Additionally, school nurses perform observations of disease incidences. This is important in times of influenza, for example. This surveillance will help the school nurse plan for illness and work on prevention strategies such as handwashing (COSH, 2016).

The school nurse also assists in the care of the chronically ill child, and those with mental health issues. It is important to allow the child with a chronic illness (physical or mental) the ability to go to school in a standard school setting despite their additional care needs. This will promote the optimal growth and development of the child (COSH, 2016).

Regulations Governing the School Nurse

School nurses are licensed under their state nursing regulatory board. The requirements of the state board of nursing may vary, so school nurses should be familiar with the Nurse Practice Act in their state. Laws governing students must be at the forefront of the school nurse’s mind. “The Privacy, Security, and Breach Notification Rules of the Health Insurance Portability and Accountability Act of 1996 (Pub L No. 104-191) and Family Educational Rights and Privacy Act (Pub L No. 93-380 [1974])” regulate the privacy of the student in regard to health information on a federal level (COSH, 2016, p. 2). Ensuring parental permission alleviates concern for these two privacy acts. School nurses are engaged in lobbying for legislation and play an active role in policy change in the government and local school systems (NASN, 2018). There is current legislative actions in development to deal with the lack of school nurses in schools that have lower-income students and child nutrition concerns. Every child has the right to good healthcare. The NASN supports the Nurses for Under-Resourced Schools Everywhere (NURSE) Act. This act is focused primarily on the need to increase the number of school nurses in areas where Title I is in effect (free and reduced lunch). Information presented to Congress illustrated that the lack of school nurses in these areas is significant. According to the NASN (2019), less than 50% of public schools have school nurses on a consistent basis. Most schools have nurses working part-time, limiting the number of hours devoted to the care of ill children. While this might not seem significant, it makes a dramatic impact when one realizes the number of uninsured children who may need interventions or assessment from a provider.  The NASN (2019) points out that without school nurses, the person responsible for administering medications and monitoring of children becomes a school staff member who is likely undertrained. Child nutrition is another area that warrants the expertise of the school nurse. Millions of children qualify for free and reduced lunches, and millions receive free breakfast. These programs are crucial, as most of the school meals are a significant contribution to the child’s nutrition. School nurses are instrumental in pushing this legislation forward to help children obtain nutritious meals in schools. These two efforts are examples of the various potential legislation that school nurses support and endorse both nationally and locally (NASN, 2019). 

Benefits of a School Nurse

The benefits of a school nurse can be multifaceted. Children spend many hours at school, with some attending before and after school programs. The school nurse can evaluate the student’s health, which influences the student academically, physically, and emotionally. Community assessments can be conducted to improve the environment in which children learn. School nurses can provide primary, secondary, and tertiary prevention programs (NASN, 2018). Immunization clinics and education programs on healthy food choices and the significance of physical activity are ways the school nurse can provide primary prevention. Secondary prevention programs could be screening for blood pressure abnormalities, hearing and vision concerns, and weight screenings. In addition, screening for respiratory conditions prevalent in childhood such as asthma can be part of secondary preventions. Tertiary prevention could be accomplished by working with children who have a physical or emotional difference to increase the child’s independence (Bergren, 2017).

An essential aspect of the school nurse’s role is the care of the chronically ill child. When children with chronic health conditions (asthma, diabetes mellitus, or musculoskeletal conditions as examples) attend school, they are accompanied by significant medical and psychological needs due to their condition. According to Leroy, Wallin, and Lee (2017), chronically ill children will have decreased school performance and limited opportunities for engagement without the interventions of the school nurse. Through their systematic review, they identified that the influence of a school nurse lessens the rate of absenteeism. This is a result of having access to clinical services throughout the day. Children with chronic illnesses may require medications and treatments during the school day. Without the school nurse, those requirements might not be met, resulting in days out of school. Learning in school can be impacted by chronic or acute illness. This same systematic review found that students who received health care at school had an improvement in academic performance. Several studies addressing asthma care indicate improved school performance. School nurses are key players in the collaboration between children with asthma and healthcare providers. Asthma management and education can positively influence the classroom experience of children with this prevalent chronic condition (Leroy et al., 2017). 

The school nurse is a unique role that focuses on wellness and patient education. The school nurse utilizes both tools to promote healthy outcomes for students. Students can benefit from the experience and interventions of the school nurse regardless of the child’s health status. While chronically ill children benefit from the nursing expertise of the school nurse, other children benefit from the prevention strategies that the school nurse will employ (NASN, 2018). Examples for school nurse interventions that will help the child live a healthier life could be hand hygiene, sexual education, abstinence from drugs and smoking, or oral hygiene (Bergren, 2017).

School Nurse Experience

COSH (2016) illustrates the experience of school nursing with both individuals and communities. One aspect of the school nurse’s experience is to be familiar with the social determinants of health. According to Healthy People 2020 (US Department of Health and Human Services, 2019), social determinants of health are situations that impact one’s ability to live, work and play. An example that pertains to the school age child would be a lack of adequate housing, or access to healthy foods. Additionally, social determinants can be related to educational access. The school nurse experience is one that looks at immediate problems as well as future issues. Having the knowledge to plan primary, secondary, and tertiary prevention programs helps to ease the illness burden on the child, family, and healthcare system. The school nurse is part of a collaborative team that is focused on the health promotion and illness prevention of the child. The school nurse experience is not solely focused on the child in school. Community initiatives such as immunization clinics, healthy food programs, and home safety are all programs that the school nurse can coordinate for the families of the student (COSH, 2016).

Perhaps the best illustration of the school nurse experience is in the article by Quinn and McAuliffe (2019). This article depicts the life of the school nurse through the lens of a nursing student. Students in a pre-licensure program attended a clinical rotation in a school setting. With the movement of patients out of the hospital, as well as the advances in medicine that allow chronically ill children to attend regular schools, this experience can be valuable. Nursing students in the study by Quinn and McAuliffe (2019) saw a very different pediatric experience while working with the school nurse. The school nurse experience consisted of medication administration, skilled interventions, and assessments.

Additionally, the school nurse provides psychosocial assistance to students, primarily adolescents who may be facing many obstacles. Student nurses found that the school nurse had a heavy caseload of students who needed nursing interventions. One nursing student observed that the school nurse had duties outside of the nursing discipline, such as social services and education. A lack of resources adversely influences the school nurse experience and causes great concern. The physical space is small, the equipment is in short supply, and monetary resources are sparse. The lack of trained support staff can also cause the school nurse experience to be challenging (Quinn & McAuliffe, 2019).

Conclusion

School nurses have long been an important part of the child’s school day. Without the interventions of the school nurse, chronically ill children would not be able to attend traditional mainstream schools as effectively or easily. The school nurse is instrumental in the transition of students from primary to secondary school settings, and from the secondary school setting to adult life (NASN, 2019). It may be a school nurse that helps a child develop and deal with upcoming changes as they grow older. Through coordination of care, the school nurse can help make this transition less traumatic. The school nurse impacts the public health of children in the community by collecting surveillance data as part of their role (NASN, 2018). Despite all of these crucial functions of school nurses, more research is needed to adequately define the importance of the role of the nurse in the school system.

References

American Academy of Pediatrics Council on School Health. (2016). Role of the School Nurse in Providing School Health Services. Pediatrics, 137(6) doi:10.1542/peds.2016-0852

Bergren, M.D., (2017). School Nursing and Population Health: Past, Present, and Future. The Online Journal of Issues in Nursing, 22(3). doi: 10.3912/OJIN.Vol22No03Man03

US Department of Health and Human Services, Office of Disease Prevention and Health Promotion (2019) Healthy People 2020. Retrieved from https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-of-health

Kuo, A., Wood, D. L., Duffee, J.H., & Pasco, J. M. (2016). Poverty and Child Health in the United States. Pediatrics, 137(4). e20160339. doi:10.1542/peds.2016-0339 

Leroy, Z. C., Wallin, R., & Lee, S. (2017). The role of school health services in addressing the needs of students with chronic health conditions: A systematic review. The Journal of School Nursing, 33(1), 64-72, doi:10.1177/1059840516678909

National Association of School Nurses. (2018). The role of the 21st century school nurse [Position Statement]. Retrieved from https://www.nasn.org/advocacy/professional-practice-documents/position-statements/ps-role

National Association of School Nurses. (2019). Transition Planning for Students with Healthcare Needs [Position Statement]. Retrieved from https://www.nasn.org/advocacy/professional-practice-documents/position-statements/ps-transition 

Quinn, B. L., & McAuliffe, D. (2019). “There was only one nurse for everyone”: Student reflections of a school nursing clinical experience. Journal of Pediatric Nursing, 48, 72-76. doi: 10.1016/j.pedn.2019.07.007