By Teresia Odessey of Bloomfield College
As a nursing student, I have had the privilege of observing many nurses in different units; pediatrics, maternity, the burn unit, hospice, medical surgical, ICU, CCU, wound rounds, and psychiatry. I’ve realized from these experiences that school nurses are by far the most unappreciated and de-valued. As I gathered information on the role of school nurses, and shadowed an elementary school nurse for my senior capstone project, I discovered the challenges faced by school nurses.
Contrary to popular belief, the school nurse’s role is critical to the well-being of students’ health and academic achievements. The scope of practice for the school nurse includes supervision of school health policies and procedures; promotion of health education; health services; competence of interventions; facilitation of health care screenings; making referrals to other healthcare providers; patient advocacy and maintenance of the appropriate environment to promote health. This role requires the nurse to be knowledgeable and competent in various skills and interventions. School nurses provide care, support and teaching for diabetes, asthma, allergies, seizures, obesity, mental health, and immunizations to all students (Beshears & Ermer, 2013). The role of the school nurse as defined by the National Association of School Nurses is as follows: “a specialized practice of professional nursing that advances the well-being, academic success and lifelong achievement and health of students” (Board, Bushmiaer, Davis-Alldritt, Fekaris, Morgitan, Murphy &Yow, 2011).
Clearly, it is not just about Band-Aids and ice packs but still 25% of US schools have no nurse present and 16% of students have a medical condition that warrants a skilled professional (Taliaferro, 2008). One in every 400 children under 20 years is diagnosed with diabetes; 10% of students nationwide have asthma; prevalence of school allergies have increased drastically; 45,000 students are diagnosed with seizures each year; obesity rate has tripled among children 6 to 11 years, and more than tripled for children 12 to 19; and one in five students have mental health issues (Beshears & Ermer, 2013).
Despite having laws allowing disabled children to attend school, increasing the workload on the nurses, there are no laws that mandate a nurse to student ratio. The national recommendation for nurse to student ratio is 1:750 but on average some nurses are responsible for up to 4,000 students (Resha, 2010). Nwabuzor (2007) mentioned that parents and stakeholders cannot truly advocate for more school nurses because most of them do not comprehend the role, responsibilities, and advantages of having a school nurse. The major reason for the school nurse shortage is the lack of legislation on school nursing; not enough funding, and no laws forcing schools to hire nurses. Therefore, many educational facilities have opted to hire unlicensed assistive personnel (UAP) instead.
Yes, it is likely more cost effective to hire UAP’s instead of Registered Nurses but that does not make it acceptable. It is my belief that we have different titles and scopes of practice for a reason. I find it mind boggling that some schools do not have school nurses. How is it that some parents are comfortable with sending their children to a school without a nurse? Is it that they don’t inquire about the presence of a school nurse? Or could it be that maybe they assume that every school has a full-time nurse? I wonder if some parents are aware of the nurse to student ratio at their child’s school. Yes, there are budget cuts due to many reasons but why do these schools say they don’t have enough funding to hire a school nurse but they have six assistant coaches for any one of the sports? So yet my question remains unanswered: what is the priority?
References
Beshears, V., & Ermer, P. (2013). SCHOOL NURSING: It's Not What You Think!. Arkansas
Nursing News, 9(2), 14-18.
Board, C., Bushmiaer, M., Davis-Alldritt, L., Fekaris, N., Morgitan, J., Murphy, K., &Yow, B. (2011, April). Role of the school nurse. Retrieved from http://www.nasn.org/PolicyAdvocacy/PositionPapersandReports/NASNPositionStatementsFullView/tabid/462/ArticleId/87/Role-of-the-School-Nurse-Revised-2011
Nwabuzor, O. (2007, February). Legislative: "Shortage of Nurses: The School Nursing Experience." Online Journal of Issues in Nursing Vol12 No 2. doi:10.3912/OJIN.Vol12No02LegCol01
Resha, C., (2010, May 31) "Delegation in the School Setting: Is it a Safe Practice?" OJIN: The
Online Journal of Issues in Nursing Vol. 15, No. 2, Manuscript 5. doi:
10.3912/OJIN.Vol15No02Man05