School Nurses' New Role in Children's Health

Amid a steady rise in the number of children with complex health problems, a push is on to establish more full-fledged medical clinics within public schools and make the school nurse a more active participant in children's medicine. In the past few years, school budget cuts have left students with a growing range of physical and mental health problems in the care of a shrinking number of nurses in many states. According to the National Association of School Nurses, just 45% of public schools have a full-time nurse; 25% have no nurse at all. Schools, facing funding shortfalls for nurses as well as rising health issues among their students, are trying a new model: school-based health centers. More school-based health centers are opening in rural and urban communities where poverty levels are higher and medical care harder to come by. Clinics usually are inside or adjacent to school buildings, with a medical staff including pediatricians and nurse practitioners who can bill services to Medicaid and private insurance. With parents' consent, they can diagnose illness, prescribe medications and give preventive care. A growing number provide dental care. The clinics don't negate the need for school nurses, says John Schlitt, vice president for policy and government affairs at the National Assembly on School-Based Health Care. School nurses help" triage" students, so clinics don't become clogged taking care of minor cuts and scrapes or administering medication issues the school nurse can handle.

SCHOOL NURSES ENTER THE COMPUTER AGE

Computer literacy also figures on the growing list of skills that school nurses must have. Computers can help school nurses deal with the extensive paperwork of their job, particularly if school districts also provide clerical help so nurses don't have to enter all the data themselves. Computers also provide school nurses with two other necessities: support and information. Lacking the medical libraries available to nurses working in hospitals, school nurses also use the computer to obtain information. If a new student with an unusual medical condition enrolls, the nurse can use Internet resources to learn about the condition. She or he may also use the computer to locate community resources for families. It's likely that the school nurse's responsibilities will continue to increase. Bergren told Education World that some school districts are beginning to ask their nurses to handle third-party billing for services such as hearing and vision screening tests. In the world of tightening budgets, school districts, which have traditionally conducted these screenings for free, are starting to seek reimbursement for services to children whose family health plans will cover the procedures. And additional questions, such as whether school nurses should be involved in drug testing, loom ahead.

Lack of School Nurses Impacts Students Health, Academics

At a time when schools have more students with serious medical conditions, many schools cannot expand nursing coverage or are reducing it. School nurses say educators must recognize their vital role in keeping students safe and able to learn, and make hiring nurses a priority. Included: Examples of how school nurses affect student safety, learning. At a time when more children with chronic medical conditions are enrolled in public schools than ever before, many districts are eliminating or not expanding nursing positions because of budget cuts and fierce competition in the job market for nurses -- forcing many schools to fall back on school personnel to provide medical services. The lack of nurses not only impacts chronically-ill students, but overall student performance by keeping more children healthy. And some fear cutbacks and outsourcing care to non-medical personnel could have lifethreatening consequences. "I'd like to have a nurse in every school [nationally] so we can go back to nursing and teachers can go back to teaching and kids are safe and healthy," Apa-Hall said. "Districts nationwide look at classroom personnel as the top priority -- and I agree -- but kids who don't feel well can't concentrate and don't learn as well if they feel sick."

HELPING ALL KIDS LEARN

In terms of the general school population, school nurses' influence in enhancing student performance often is underestimated by educators, some of the nurses said. Nurses are there to help students be healthy and ready to learn, Garcia noted. "Nurses are a benefit to teachers; teachers have enough to do without worrying about health issues." "Nurses do need to do a better job of explaining their role in the education setting, and stress that they are a valuable asset when it comes to learning outcomes," said Kosiorowski. "It's partly nurses' own fault that educators don't realize the effect of nurses on learning," she said. "By having a nurse in the building, it helps support kids and helps return them to classrooms faster. Sometimes educators don't understand what we're doing. We have to keep repeating the message that health and learning go together, and make sure children's health care needs are met so they can achieve what they need to do in classrooms." And the more time nurses spend in schools observing and interacting with students and parents, the better chance they have of spotting and solving problems early, added Apa-Hall. Currently, her job demands don't leave her time to do health screenings or check students' blood pressure, hearing, sight, and weight. "If I'm in the schools, I get to know kids, get to know the issues. I can see kids who are hungry, overtired, have allergies, or appear abused," she told Education World. "I can see potential health issues that teachers are not trained to recognize. I talk to parents more when I'm in the building. There are kids with eating disorders or who have wheelchairs -- and there are a lot of kids with health needs most people are not aware of."

Bullies and Bullied Frequently See School Nurse

Children who are bullies and children who are victims of bullying both tend to visit the school nurse more often, according to a new study. "Kids who either are relatively frequent targets of other peers' victimization or who act aggressively themselves toward their peers both are at risk for having more visits to the school nurse and more health complaints," researcher Eric Vernberg, PhD, a professor of psychology and applied behavior science at the University of Kansas in Lawrence, tells WebMD. While it is expected that the victims would visit the school nurse's office often, the surprise finding was that the aggressive kids did, too. The visits involved illness, injury, and somatic complaints -- physical complaints without objective medical findings. Nearly one in five students may be affected by bullying, according to the Olweus Bullying Prevention Program, a preventive program. This includes bullies, the bullied, onlookers, followers, and defenders.

SCHOOL NURSING ARTICLES

SUBMITTED BY: Jenika Louisse Duran BSN IV

SUBMITTED TO: Rowena T. Quintos, RN, MSN