Nurses have been a part of the school setting since the late 1800ís when they provided student inspections to identify those with communicable diseases needing treatment. With the widespread use of antibiotics and vaccines to prevent common childhood diseases the role of the school nurse has evolved to a new level.
Students with chronic diseases, mental health issues and high-risk behaviors have driven school nurses to gain expertise not only in public health but also in pediatric and mental health nursing. Additionally, the need for nursing services in the school setting increased with the passage of Public Health Law 94-142 in 1975, requiring the mainstreaming of physically and mentally challenged students into the general student population
A later version of P.L. 94-142, known also as the Individuals with Disabilities Act (IDEA), did not specifically fund school nurses, but a ruling by the Supreme Court in 1999 confirmed that nursing services were to be provided by the school district for students needing nursing care. Under IDEA regulations, school nurses provide nursing assessments for students in special education programs as well as deliver nursing services for students in need of procedures such as gastrostomy tube feedings, clean intermittent catheterizations, tracheostomy care, and others.
The primary role of the school nurse is to support student learning. The nurse accomplishes this by implementing strategies that promote student and staff health and safety. The nurse takes a leadership role in serving as the coordinator of all school health programs in the following manner:
- Health Services -- serves as the coordinator of the health services program and provides nursing care
- Health Education -- provides health education to students, staff and parents
- Healthy Environment -- identifies health and safety concerns in the school environment and promotes a nurturing social environment
- Nutritional Services -- supports healthy food services programs
- Physical Education/Activity -- promotes healthy physical education, sports policies and practices
- Counseling -- provides health counseling, assesses mental health needs, provides interventions and refers students to appropriate school staff or community agencies
- Parent/Community Involvement -- promotes community involvement in assuring a healthy school, serves as school liaison to a health advisory committee.
- Staff Wellness -- provides health education and counseling, promote healthy activities and environment for school staff
As the health services expert, the school nurse serves as the health professional for the school community. Some of the services provided include: illness and injury assessments and interventions; health assessments and participation in development of Individualized Education Plan for students with special needs; pediatric nursing procedures such as gastrostomy tube feedings, tracheostomy care, and catheterization; screening for health factors impacting student learning; activities to promote health and prevent teen pregnancy, sexually transmitted diseases, tobacco, alcohol and substance use and abuse; chronic disease management and education, administering medications; crisis team participation; recommending health curricula and guidelines for school district health policies; and serving as a health care provider liaison between the school and community.
School nursing is recognized as a specialty nursing area and has become more clearly defined with the development of standards of practice. Additionally, school nurses might further specialize their practice with a focus on children with special needs, early childhood programs, elementary or secondary age children, adolescents, or students with high-risk behaviors. Many states require school nurse certification either through the Department of Education or Health. National certification is available through a national board.
School nurses practice in schools throughout the United States and overseas military bases in settings that include:
- Elementary schools
- Middle schools
- Junior High schools
- High schools, Alternative schools
- Private schools
- Parochial schools
- Vocational schools
The National Association of School Nurses recommends that all school nurses have a minimum of a baccalaureate degree and achieve School Nurse Certification.
The school nurse needs expertise in pediatric, public health and mental health nursing and must possess strong health promotion, assessment, and referral skills. School nurses also need to have knowledge of laws in education and health care that impact children in the school setting.
The school nurse works independently in the school setting to provide health care and education primarily to students and needs strong skills in critical thinking, decision-making, communication, individual and classroom education, and child advocacy.
Many educators responsible for hiring nurses are not aware of the various levels of nursing preparation. Consequently nurses in the school setting range from LPNs to PhDs, many with practitioner training and/or licensing. The National Association of School Nurses recommends a minimum of baccalaureate preparation for school nurses.
In the1999-2000 school year, school nurses nationally earned salaries ranging between $20,000 and more than $70,000 across a range of job assignments. The majority of school nurses earn salaries between $28,000 and $49,000 based on a nine- month contract.
National Association of School Nurses
111 Cantril Street
Castle Rock, CO 80104
FAX: (303) 663-0403
Web site: www.nasn.org
American Public Health Association: School Nurse Section
800 I Street, NW
Washington, DC 20001-3710
FAX: (202) 777-2534
American School Health Association: School Nurse Section
7263 State Route 43
P.O. Box 708
Kent, OH 44240
FAX: (330) 678-4526
National Association of Pediatric Nurse Associates and Practitioners
1101 Kings Highway, North, Suite 206
Cherry Hill, NJ 08034-1912
FAX: (856) 667-7187
Web site: www.napnap.org