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The Changing Role of School Nurses
In a recent edition of the monthly newsletter I receive in the mail from my family's HMO, a letter from a reader asked, "Do we even have school nurses anymore? And, what do they do?"
School nursing has evolved from the temperature-taking, bandage-applying friendly face we remember from our childhoods, and not all for the positive. While the responsibilities of school nurses have expanded to include things like nutrition counseling, crisis intervention and developing special education programs, nurses are now often very limited, due to liability, on how much hands-on care they can provide to injured or ill students. School nurses are pressed for time as the nursing shortage combines with dwindling education budgets to affect staffing. Schools may have only part-time coverage as one nurse rotates among many schools in a district, leaving office staff or paraprofessionals to handle routine and emergency care.
Most states have Nurse Practice Acts which govern the scope of nursing practice and spell out the services school nurses can provide. These may be basic, such as applying ice packs and administering prescribed medications to students, or they may include training school staff in CPR, developing and implementing Individualized Health Plans (IHPs) for students who require them and working with the city or town Board of Health to address health issues such as communicable diseases.
School nurses can be RNs or LPNs, but the most important qualities in a school nurse – besides the obvious love of working with children and teens – are time-management skills and the ability to set priorities. School nurses mainly work alone (or with a very small staff) and are responsible to not only the students, but to parents, school staff and the community at large. School nurses are a liaison between home and school regarding health concerns, and often interpret medical data from a student's parent to his or her pediatrician and vice versa. The increasing numbers of children who require medication or assistance with devices during the school day, and ever-growing concerns about food allergies and childhood obesity add to the realm of situations under the school nurse's umbrella. They often work with teachers, contributing to the health and science curriculum; may have input into the physical education program and are the first line of defense in addressing issues ranging from head lice to child abuse. It's important that a school nurse is well-organized and able to wear many different hats while switching from patient care provider to administrator to consultant often in the course of several minutes.
Much like the teachers with whom they work, school nurses are not in the job for the money. Unfortunately, school nurses salaries are lower than their hospital counterparts. The job of a school nurse presents unique challenges but also the reward of knowing that every day is an opportunity to better the quality of children's health care directly. Qualified school nurses are a necessity, not an option; and school nurses do make a difference.
