School nursing, a specialized practice of public health nursing, protects and promotes student health, facilitates normal development, and advances academic success. School nurses, grounded in ethical and evidence-based practice, bridge the gap between health care and education, provide care coordination, advocate for quality student-centered care, and collaborate to design systems that allow individuals and communities to develop their full potentials.[1] A school nurse works with school-aged children in the educational setting. Students experiencing illness or injury during the school day often report to the school nurse for assessment. Administering routine medications, caring for a child with a virus, or stabilizing a child until emergency services arrive after a more serious injury may all be a part of the job requirements.[2] School nurses are well positioned to take the lead for the school system in partnering with school physicians, community physicians, and community organizations. They facilitate access to Medicaid and the State Children's Health Insurance Program to help families and students enroll in state health insurance programs and may assist in finding a medical home for each student who needs one.[3]
According to the National Association of School Nurses, there are approximately 61,232–73,697 registered nurses (RNs) working in elementary and secondary schools (K-12) in the United States depending on the survey sample (- need these references: HRSA, 2010; ACS, 2013), which represents between 2.1 and 2.8% of registered nurses in the United States.[4] According to the American Federation of Teachers, there are approximately 45,000 school nurses employed in the United States.[5] About 63% of public school districts employ a full-time school nurse, while a further 19% have a part-time nurse and 18% have no nurse.[6] School nurses are often the only health professional serving students in an educational setting.[citation needed] As such they have a great responsibility in promoting important health initiatives in schools across America such as making sure that there are AEDs on school campuses and that staff are taught on how to use them. Sudden cardiac arrest is common amongst school aged children and adolescents resulting in <1 to 10 deaths/100,000 population per year.[7] This is thought to be in part due to the fact that inherited and acquired cardiomyopathies, arrhythmia syndromes, structural congenital heart defects, myocarditis, and coronary abnormalities that may be present in this age group may not be detected during routine sports physicals.[7] "Since strenuous exercise can trigger deadly arrhythmias in these students, the first and potentially last symptom [of undiagnosed cardiac abnormalities] is sudden cardiac arrest".[8]
School nurses must use evidence-based practice, implement prevention programs, and properly manage student medical issues in order to improve student health.[9] For students with acute and chronic health problems, the school nurse will collaborate with the student's physicians and parents to create a health plan that accommodates the student while at school.[10] The school nurse must be competent in management of pediatric health issues such as seizures, asthma, diabetes, and allergies.[11] In addition to nursing skills, the school nurse must possess excellent organizational and communication skills in order to succeed.[11] School nurses play a vital role in the reduction of absenteeism by promoting healthy practices among students and staff.[10]
School nurses have the potential to have a positive effect on their young students. Previous studies have addressed their role as helping families address health needs, decrease the amount of absent days from school, and helping them advance academically (Yoder, 2019).[12] Across the United States, the school nurse's role and workload varies, so that has an effect on whether or they are able to properly address their student's needs (National Association or School Nurses, 2016; Yoder 2019).[12] The presence of a school nurse varies among regions in the United States. According to Willgerodt et al., most schools on the west coast work part-time and have a higher load of students to care for versus some regions that don't have a nurse in the school (2018).[13]
Notable school nurses
Annie McKay, first school nurse in Massachusetts, 1905[14]
Lina Rogers Struthers, first school nurse in the United States, in New York City, 1902[15]
United Kingdom
A school nurse measuring the heights of students in Hertfordshire
In 1892 Amy Hughes was working in Bloomsbury Square as the Superintendent of Queen's Nurses. She was asked to visit a local elementary school to advise about nutrition, and was surprised to find that the students were suffering with minor ailments that were contributing to school days lost to sickness. Hughes eventually arranged for Queen's nurses to visit schools; she is considered to be the first school nurse in the United Kingdom.[16]
The statutory provision of school nursing in all schools in the United Kingdom arose out of the Boer War. A large proportion of army volunteers - between 40% and 60% - had been found to be medically unfit for service, so in 1903, the government set up the Interdepartmental Committee on Physical Deterioration to study the causes. In 1904 the committee reported back, saying that there was no general health problem, but treatable conditions had been left untreated, meaning that the conditions had worsened to the extent that they became debilitating. The committee recommended that:
children have medical inspections in schools
free school meals be provided to children from extremely poor families
The government reacted first by passing the 1906 Provision of School Meals Act, which allowed (but did not compel) local authorities to provide school meals, at no cost to the poor, and to raise a tax to pay for this. Then the 1907 Education Act was passed, which established a team of school nurses at every local authority. This was accompanied by the 1907 Medical Inspections Act, which required local authorities to ensure that each child received a total of at least three medical inspections during their time at school. The act established clinics within schools to treat anything discovered, but parents had to pay for treatment; after 1912 the government made small contributions towards the cost.
In modern times, school nurses are comparable to health visitors, but specialise in a school setting, rather than a domestic one. As such they normally take over public health responsibilities for children, from health visitors, once the children are over 5 and start attending school. Like health visitors, they monitor child development, and deliver certain vaccination programmes, as well as instigating the child safeguarding process when they suspect a child is being abused or neglected. Given their physical setting, they are also often called upon to provide first aid, and it is for this that they are most familiar to children.
In the mid to late 20th century, school nurses were often familiar to children as the nit nurse - a specialist nurse who inspects children's head hair for lice, and lice-eggs (colloquially known as nits). In 1947, 8% of school children had lice infections, but the use of nit nurses had managed to reduce that to 3% within a decade. Skin infections of any kind, which were once common, had become a rare phenomena by the end of the century, except those which affect the soles of the feet. Under the Blair ministry, nit nursing came to be seen as not being clinically cost-effective, and nit nursing was gradually withdrawn from schools.
Following the Cameron ministry's reorganisation of the National Health Service, school nurses fall under the general aegis of Public Health England, but are locally commissioned by local authorities, who now hold local responsibility for public health. To become qualified registered school nurses, ordinary nurses undertake additional training as specialist community public health practitioners. They are regulated by the Nursing and Midwifery Council.
Impact of school nursing on student achievement
Children who have chronic illnesses or live below the poverty line are more likely to end up dropping out of school.[17] Two separate studies performed in 2017 looked at the way asthma medications were being managed in schools and found that nurses who assisted in daily corticosteroid usage resulted in fewer absences by children with asthma.[18] Nurses in schools have the unique ability to create relationships with patients who they get to see frequently. Children spend nearly 40 hours a week in a school setting and need their health needs met just the same as if they are at home. If a child is able to receive their appropriate medications and services at school then they will be less likely to stay home and therefore achieve more academically than if their school lacks nursing services.[19]
The future of school nursing
School nursing in the future is challenged to accept leadership responsibilities in shaping, developing, and implementing policies that affect schools and communities. Becoming part of school boards, public health departments, and community organizations, school nursing can affect change and highlight the impact of social determinants on health because school nursing is where the effects of environments, school funding, and chronic health conditions on the health and education of children can be seen.[20] According to the National Center for Education Statistics (2016),[21] 98% of all school-aged children attend school each day. Therefore, health policies and health systems that affect these children, families, and communities must be changed on the school nursing and community nursing level.[20] School nursing is an area of community health nursing where health initiatives can be implemented and policy change can happen on local, state, and national levels.[20]
↑ Harrington, C.B; Langhans, E; Shelef, D.Q; Savitz, M; Whitmore, C; Teach, S.J (2018). "A pilot randomized trial of school-based administration of inhaled corticosteroids for at-risk children with asthma". Journal of Asthma. 55 (2): 145–151. doi:10.1080/02770903.2017.1323915. PMID28594249. S2CID39152945.
↑ "Digest of Education Statistics, 2015". National Center for Education Statistics. Washington, D.C.: U.S. Department of Education. December 2016. NCES 2016-014. Retrieved 31 October 2020.
Further reading
School Nursing: Scope and Standards of Practice (2011). American Nurses Association and National Association of School Nurses. Silver Springs, MD: nursesbooks.org, the publishing program of ANA.
Richard A. Meckel, Classroom and Clinics: Urban Schools and the Protection and Promotion of Child Health, 1870–1930. New Brunswick, NJ: Rutgers University Press, 2013.
A registered nurse (RN) is a nurse who has graduated or successfully passed a nursing program from a recognized nursing school and met the requirements outlined by a country, state, province or similar government-authorized licensing body to obtain a nursing license. An RN's scope of practice is determined by legislation, and is regulated by a professional body or council.
Occupational therapy (OT) is a healthcare profession. It involves the use of assessment and intervention to develop, recover, or maintain the meaningful activities, or occupations, of individuals, groups, or communities. The field of OT consists of health care practitioners trained and educated to improve mental and physical performance. Occupational therapists specialize in teaching, educating, and supporting participation in any activity that occupies an individual's time. It is an independent health profession sometimes categorized as an allied health profession and consists of occupational therapists (OTs) and occupational therapy assistants (OTAs). While OTs and OTAs have different roles, they both work with people who want to improve their mental and or physical health, disabilities, injuries, or impairments.
Pediatric nursing is part of the nursing profession, specifically revolving around the care of neonates and children up to adolescence. The word, pediatrics, comes from the Greek words 'paedia' (child) and 'iatrike' (physician). 'Paediatrics' is the British/Australian spelling, while 'pediatrics' is the American spelling.
Nurse education consists of the theoretical and practical training provided to nurses with the purpose to prepare them for their duties as nursing care professionals. This education is provided to student nurses by experienced nurses and other medical professionals who have qualified or experienced for educational tasks, traditionally in a type of professional school known as a Nursing school. Most countries offer nurse education courses that can be relevant to general nursing or to specialized areas including mental health nursing, pediatric nursing and post-operatory nursing. Courses leading to autonomous registration as a nurse typically last four years. Nurse education also provides post-qualification courses in specialist subjects within nursing.
The treatment of human lice is the removal of head lice parasites from human hair. It has been debated and studied for centuries. However, the number of cases of human louse infestations has increased worldwide since the mid-1960s, reaching hundreds of millions annually. There is no product or method that assures 100% destruction of the eggs and hatched lice after a single treatment. However, there are a number of treatment modalities that can be employed with varying degrees of success. These methods include chemical treatments, natural products, combs, shaving, hot air, and silicone-based lotions.
Health visitors are professional individuals engaged in public health work within the domestic setting, predominantly found in countries with state-funded health systems. They are distinct from district nurses, who provide clinical healthcare, domestically.
A chronic condition is a health condition or disease that is persistent or otherwise long-lasting in its effects or a disease that comes with time. The term "chronic" is often applied when the course of the disease lasts for more than three months. Common chronic diseases include diabetes, functional gastrointestinal disorder, eczema, arthritis, asthma, chronic obstructive pulmonary disease, autoimmune diseases, genetic disorders and some viral diseases such as hepatitis C and acquired immunodeficiency syndrome. An illness which is lifelong because it ends in death is a terminal illness. It is possible and not unexpected for an illness to change in definition from terminal to chronic. Diabetes and HIV for example were once terminal yet are now considered chronic due to the availability of insulin for diabetics and daily drug treatment for individuals with HIV which allow these individuals to live while managing symptoms.
Nursing is a profession within the healthcare sector focused on the care of individuals, families, and communities so they may attain, maintain, or recover optimal health and quality of life. Nurses may be differentiated from other healthcare providers by their approach to patient care, training, and scope of practice. Nurses practice in many specialties with differing levels of prescription authority. Nurses comprise the largest component of most healthcare environments; but there is evidence of international shortages of qualified nurses. Nurses collaborate with other healthcare providers such as physicians, nurse practitioners, physical therapists, and psychologists. Unlike nurse practitioners, nurses typically cannot prescribe medications in the US. Nurse practitioners are nurses with a graduate degree in advanced practice nursing. They practice independently in a variety of settings in more than half of the United States. Since the postwar period, nurse education has undergone a process of diversification towards advanced and specialized credentials, and many of the traditional regulations and provider roles are changing.
Head lice infestation, also known as pediculosis capitis, is the infection of the head hair and scalp by the head louse. Itching from lice bites is common. During a person's first infection, the itch may not develop for up to six weeks. If a person is infected again, symptoms may begin much more quickly. The itch may cause problems with sleeping. Generally, however, it is not a serious condition. While head lice appear to spread some other diseases in Africa, they do not appear to do so in Europe or North America.
No nit policy is a public health policy implemented by some education authorities to prevent the transmission of head lice infestation. The "no nit" policy requires the sending home and barring of all children who have nits on their hair from controlled settings such as school, summer camp or day care facilities. The CDC, American Academy of Pediatrics (AAP) and the National Association of School Nurses (NASN) advocate that "no-nit" policies should be discontinued, due in part because nits, the eggs or empty egg shells, are not transmissible and the burden of unnecessary absenteeism to the students, families and communities far outweighs the risks associated with head lice. Proponents of the no-nit policy counter that only a consistently nit-free child can be reliably shown to be infestation-free. That is, the presence of nits serves as a proxy for infestation status. Proponents argue that such a proxy is necessary because lice screening is prone to false negative conclusions.
Nurses in Canada practise in a wide variety of settings, with various levels of training and experience. They provide evidence-based care and educate their patients about health and disease.
Occupational health nursing is a specialty nursing practice that provides for and delivers health and safety programs and services to workers, worker populations, and community groups. The practice focuses on promotion, maintenance and restoration of health, prevention of illness and injury, and protection from work‐related and environmental hazards. Occupational health nurses (OHNs) aim to combine knowledge of health and business to balance safe and healthful work environments and a "healthy" bottom line.
School-based health centers (SBHCs) are primary care clinics based on primary and secondary school campuses in the United States. Most SBHCs provide a combination of primary care, mental health care, substance abuse counseling, case management, dental health, nutrition education, health education and health promotion. An emphasis is placed on prevention and early intervention. School-based health centers generally operate as a partnership between the school district and a community health organization, such as a community health center, hospital, or the local health department. Most SBHCs report that the majority of their student population is eligible for the National School Lunch program, a common indicator of low socioeconomic status.
Loretta C. Ford is an American nurse and the co-founder of the first nurse practitioner program. Along with pediatrician Henry Silver, Ford started the pediatric nurse practitioner program at the University of Colorado in 1965. In 1972, Ford joined the University of Rochester as founding dean of the nursing school.
Correctional nursing or forensic nursing is nursing as it relates to prisoners. Nurses are required in prisons, jails and detention centers; their job is to provide physical and mental healthcare for detainees and inmates. In these correctional settings, nurses are the primary healthcare providers. These nurses also work with victims and assist in expert witness testimonies and are involved in a variety of legal cases including paternity disputes and workplace injuries.
Charlotte Laura Clarke is the Professor of Health in Social Science at the University of Edinburgh. Her research centres on the experiences of living with dementia.
Pam Smith is a Professor of Nursing in the School of Health in Social Science at the University of Edinburgh. Her research relates to emotions and care within the nursing profession.
The National Association of School Nurses (NASN) is an American organization that releases guidance on the role of school nursing and recommends minimum standards for the profession. It develops education programs for its members, publishes position statements and issue briefs on relevant subjects, and uses advocacy to increase support for school nursing.
Virtual reality is the creation of a three-dimensional, interactive environment. With this technology, users are able to move through this developed simulation, as if it is real.
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