School Nurse Information
The Role of 21st Century School Nurses
- Community / Public Health
- Care Coordination
- Quality Improvement
It is the position of the National Association of School Nurses (NASN) that every child has access all day, every day to a full time registered professional school nurse (hereinafter referred to as school nurse). The school nurse serves in a pivotal role that bridges health care and education. Grounded by standards of practice, services provided by the school nurse include leadership, community/public health, care coordination, and quality improvement (NASN, 2016a).
The practice of school nursing began in the United States on October 1, 1902, when Lina Rogers, the first school nurse, was hired to reduce absenteeism by intervening with students and families regarding healthcare needs related to communicable diseases. After one month of successful nursing interventions in the New York City schools, she led the implementation of evidence-based nursing care across the city (Struthers, 1917). Since that time, school nurses continue to provide communicable disease management, but their role has expanded and is increasingly diverse.
A student’s health is directly related to his or her ability to learn. Children with unmet health needs have a difficult time engaging in the educational process. The school nurse supports student success by providing health care through assessment, intervention, and follow-up for all children within the school setting. The school nurse addresses the physical, mental, emotional, and social health needs of students and supports their achievement in the learning process.
Students who are medically fragile or who deal with chronic health issues are coming to school in increasing numbers and with increasingly complex medical problems that require complicated treatments commonly provided by the school nurse (Lineberry & Ikes, 2015). Chronic conditions such as asthma, anaphylaxis, type 1 and type 2 diabetes, epilepsy, obesity, and mental health concerns may affect the student’s ability to be in school and ready to learn.
The National Survey of Children with Special Healthcare Needs has determined that 11.2 million U.S. children are at risk for chronic physical, developmental, behavioral, or emotional conditions. These students may require health related services in schools (U.S. Department of Health and Human Services, Maternal and Child Health Bureau, 2013).School nurses address the social determinants of health, such as income, housing, transportation, employment, access to health insurance, and environmental health. Social determinants are identified to be the cause of 80% of health concerns (Booske, Athens, Kindig, Park, & Remington, 2010). In the United States, nearly one quarter of children attending school live in households below the federal poverty level (United States Census Bureau, 2014). Children from lower income families have a more difficult time accessing medical treatment for chronic diseases (Perrin, 2014).
School nursing is a specialized practice of nursing that advances the well-being, academic success, and lifelong achievement and health of students. Keeping children healthy, safe, in school, and ready to learn should be a top priority for both healthcare and educational systems. With approximately 50.1 million students in public elementary and secondary schools, educational institutions are excellent locations to promote health in children (National Center for Education Statistics, n.d.) and the school nurse is uniquely positioned to meet student health needs.
School nurses lead in the development of policies, programs, and procedures for the provision of school health services at an individual or district level (NASN, 2016a), relying on student-centered, evidence-based practice and performance data to inform care (Robert Wood Johnson Foundation, 2009). Integrating ethical provisions into all areas of practice, the school nurse leads in delivery of care that preserves and protects student and family autonomy, dignity, privacy, and other rights sensitive to diversity in the school setting (American Nurses Association [ANA] & NASN, 2011).
As an advocate for the individual student, the school nurse provides skills and education that encourage self-empowerment, problem solving, effective communication, and collaboration with others (ANA, 2015a). Promoting the concept of self-management is an important aspect of the school nurse role and enables the student to manage his/her condition and to make life decisions (Tengland, 2012). The school nurse advocates for safety by participating in the development of school safety plans to address bullying, school violence, and the full range of emergency incidents that may occur at school (Wolfe, 2013).At the policy development and implementation level, school nurses provide system‐level leadership and act as change agents, promoting education and healthcare reform. According to the ANA (2015b), registered nurses believe that it is their obligation to help improve issues related to health care, consumer care, health, and wellness. Educational preparation for the school nurse should be at the baccalaureate level (NASN, 2016b), and school nurses should continue to pursue professional development and continuing nursing education throughout their careers (Wolfe, 2013).
Community / Public Health
School nursing is grounded in community/public health (Schaffer, Anderson, & Rising, 2015). The goal of community/public health moves beyond the individual to focus on community health promotion and disease prevention and is one of the primary roles of the school nurse (Wold & Selekman, 2013). School nurses employ cultural competency in delivering effective care in culturally diverse communities (Office of Minority Health, 2013).
The school nurse employs primary prevention by providing health education that promotes physical and mental health and informs healthcare decisions, prevents disease, and enhances school performance. Addressing such topics as healthy lifestyles, risk‐reducing behaviors, developmental needs, activities of daily living, and preventive self‐care, and the school nurse uses teaching methods that are appropriate to the student’s developmental level, learning needs, readiness, and ability to learn. Screenings, referrals, and follow‐up are secondary prevention strategies that school nurses utilize to detect and treat health-related issues in their early stage (NASN, 2016a). School nurses provide tertiary prevention by addressing diagnosed health conditions and concerns.
Student absences due to infectious disease cause the loss of millions of school days each year (Centers for Disease Control and Prevention, 2011). Based on standards of practice and community health perspective, the school nurse provides a safe and healthy school environment through control of infectious disease, which includes promotion of vaccines, utilization of school-wide infection control measures, and disease surveillance and reporting. Immunization compliance is much greater in schools with school nurses (Baisch, Lundeen, & Murphy, 2011).The school nurse strives to promote health equity, assisting students and families in connecting with healthcare services, financial resources, shelter, food, and health promotion. This role encompasses responsibility for all students within the school community, and the school nurse is often the only healthcare professional aware of all the services and agencies involved in a student’s care.
School nurses are members of two divergent communities (educational and medical/nursing), and as such are able to communicate fluently and actively collaborate with practitioners from both fields (Wolfe, 2013). As a case manager, the school nurse coordinates student health care between the medical home, family, and school. The school nurse is an essential member of interdisciplinary teams, bringing the health expertise necessary to develop a student’s Individualized Education Plan or Section 504 plan designed to reduce health related barriers to learning (Zimmerman, 2013). Creating, updating, and implementing Individualized Healthcare Plans are fundamental to the school nurse role (McClanahan & Weismuller, 2015).
School nurses deliver quality health care and nursing intervention for actual and potential health problems. They provide for the direct care needs of the student, including medication administration and routine treatments and procedures (Lineberry & Ickes, 2015). Education of school staff by the school nurse is imperative to the successful management of a child with a chronic condition or special healthcare need and is codified as a role of the school nurse in the Every Student Succeeds Act (2015).Current school health practice models and school nurse workloads may require school nurses to delegate healthcare tasks to unlicensed assistive personnel in order to support the health and safety needs of students (Shannon & Kubelka, 2013). However, the availability of school nurses to work directly with students to assess symptoms and provide treatment increases students’ time in the classroom and parents’ time at work (Lineberry & Ickes, 2015).
Quality improvement is a continuous and systematic process that leads to measurable improvements and outcomes (Health Resources and Services Administration, 2011) and is integral to healthcare reform and standards of practice (Agency for Healthcare Research and Quality, 2011). Continuous quality improvement is the nursing process in action: assessment, identification of the issue, development of a plan of action, implementation of the plan, and evaluation of the outcome. Data collection through this process is a necessary role of the school nurse.
Formal school nursing research is needed to ensure that delivery of care to students and school communities by the school nurse is based on current evidence. School nurses utilize research data as they advocate and illustrate the impact of their role on meaningful health and academic outcomes (NASN, 2016a).
It is the position of NASN that school nurses play an essential role in keeping children healthy, safe, and ready to learn. The school nurse is a member of a unique discipline of professional nursing and is often the sole healthcare provider in an academic setting. Twenty‐first century school nursing practice is student‐centered, occurring within the context of the student’s family and school community (NASN, 2016a). It is essential that all students have access to a full time school nurse all day, every day (American Academy of Pediatrics, 2016).
SKSD Policies & Procedures
Seattle Children's Hospital Adolescent Medicine Resources
This page offers information and resources on a broad list of topics, ranging from healthy eating to safety practices.
Adolescent and School Health
This site, run by the the Centers for Disease Control and Prevention, offers adolescent-focused health information.
The HealthyChildren.org website is run by the American Academy of Pediatrics. The site offers a broad range of health-related information for parents and families.
Community Service Opportunities
Mental Health-Bainbridge Youth Services
This site offers access to counselor's or health care providers. You can ask questions anonymously and receive free answers and guidance. Additionally, the site is packed with great mental health resources for teens and families.
Kitsap Community Resources
Kitsap Community Resources offers a broad range of services to needy families on the Kitsap Peninsula. Please visit their Website for program information, calendars of upcoming events, and additional resource information.
The SK Helpline provides community members with food and emergency resources. Please visit their site for more information.
Port Orchard Lions Club
The Port Orchard Lions Club offers community member free vision and hearing care. Please visit their site for additional information about this program, including contact information.
Washington Department of Health
This site offers a broad range of resources. You can find information about immunization requirements, health living, oral health, and food safety.
Frequently Used Forms
SKSD Emergency Guidelines
This is a copy of our district emergency guidelines for life threatening student health issues.
- 634 Emergency Guidelines for School Personnel
Health History Form
Please update the school when your student has any changes to their health history.336 Health History
Physical Activity Limitation Form
This form is used when your student has an illness or injury that impacts his or her ability to participate in physical education.112 Physical Activity Limitation Form
Mutual Release of Information
This form allows school nurses and healthcare providers to share information about a student's health conditions.63 Request for Mutual Release or Exchange of Info
Medication at School Form
This form must be completed for a student to take medication at school. This form is required for both prescription and over-the-counter medications.157 Medication at school