School Nurses - Does Their Compensation Match Their True Worth?

Sarah Matacale, BSN, RN

This article is featured in the July 2018 edition of our allnurses Magazine...

School nurses have always been one of the most diverse and unique subspecialties in nursing throughout the decades. While the specific job responsibilities and pay may have changed some, the mission and purpose of the job remain constant. The National Association of School Nurses defines school nursing as " a specialized practice of nursing, that protects and promotes student health, facilitates optimal development, and advances the academic success" of its population. First and foremost I want to stress the many areas in which school nurses serve the community, the vital roles they play with our youth today, and the challenges that come with those roles. As we dive into the 2018 allnurses.com salary survey results we can see trends in the field of school nursing such as salary comparisons, full or part-time hours, years of experience etc. Are school nurses compensated for their responsibilities appropriately? I will let you decide.

Let me start by saying that I am not a school nurse. I am a nurse that has worn many hats in my 20+ year career, but school nursing is not one of them. I will say, however, that I have ALWAYS wanted to be a school nurse. As a child, they were the nurses that I had the most exposure to on a daily basis. They seemed to always play a huge role in the school's day-to-day function. I was awed by what school nurses knew, the fact that they teach AND practice medicine to hundreds of students, staff, and visitors. They were so organized, knew who to call and when and what was a true emergency. At the end of the day, they knew that sometimes we just needed a hug, a listening ear, and some TLC.

I decided to be a nurse because of my school nurses. After nursing school, it was apparent that I needed to get experience before applying to work as a school nurse. So I did. When the "right time" in my career came to jump in, I realized that school nurses love what they do! They don't leave their jobs until they retire and I can't say I blame them. So my career and calling as a nurse went in different directions. Then, my admiration for school nurses was taken to a new level when I became a mother to three little hooligans, who, despite my best efforts grew up and started school.

I was about as much of a wreck as any other mom on our first child's first day of school. He is still to this day, at 12 years old, our clumsiest child, peanut allergy laden, and asthmatic. This added to my anxiety by sending him to school, epipen and all. No joke, on the FIRST day of school, I got a call from his teacher to tell me that my son had walked into a wall and had a large goose egg on his head. I was then asked by the teacher what did I want her to do with him. What? I said...well, if you think he needs attention, send him to the school nurse. That's when I found out that, in our school district, a school nurse visits each school only one day a week and serves up to 4 or 5 schools! During that day, the nurse's job consists of managing paperwork and teaching teachers how to give kids their medicine's, perform CPR, manage seizures, anaphylaxis etc., until emergency personnel arrives. SAY WHAT??!!

Since that day, I have become a school nurse advocate extraordinaire. I believe in my heart of hearts that school nurses serve as one of the most important members of our community. Their job is so broad, ever-changing, and wide-reaching, that it cannot be compared fairly to any other in the field of nursing. They work as health educators and medical and mental healthcare professionals. One would think that school nurses would be one of the most valued members of a school system and the community as a whole, which would then lead to appropriate compensation, respect, and funding. Boy, was I wrong.....

I was shocked with several statistics that I discovered in writing this article, but this is one of the most profound to me. According to the Centers for Disease Control 2017, 18% of schools have NO school nurse at all or serve in a part-time capacity, and over 55% of schools have nurses responsible for 2 or more schools at a time! As parents, we send our kids to school entrusting that they will be in a safe, cared for environment. If, in the worst case scenario, they need medical attention for a chronic illness or an emergency such as injury or life-threatening condition that the school would be staffed to handle the situation. Obviously, this is not true for many of us. How are teachers and school administrators expected to care for these needs? Teachers are educated in teaching. Administrators are educated in administration and education. Nurses are educated in healthcare, health education, and medicine. Simply put, teachers and administrators are not nurses and should not be responsible or accountable for that role.

According to the U.S Health Resources and Services Administration (2016), over 20% of students that are enrolled in school, enter with a chronic health condition. Such chronic diseases as diabetes (with complicated glucose management systems), seizures, asthma, and of course allergies, (the dreaded food allergies included) are just a few examples off hand. School nurses are able to trend patterns seen with these conditions and can play a major role in student's disease management through collaboration with pediatricians, specialists, parents, pharmacies, and community health staff. They can safely administer prescribed medication and assess and intervene if necessary. When/ if an emergency arises, they can communicate effectively with other medical personnel and start care immediately which can be crucial in many situations.

Let's talk about mental health in children. Many mental health disorders are not "officially" diagnosed until children are school-aged or older based on patterns in behavior, grades, and social situational responses. Collaboration with teachers, school nurses, pediatricians and mental professionals is pivotal in providing quality outcomes for these kids. School nurses participate, initiate and intervene in the treatment and management of ADD, depression, bullying, suicidal behaviors and autism, just to name a few, common mental health issues seen in schools today. Roughly â…“ of visits to the school nurses are mental health related. School nurses get to know the children and family situations they serve. From a community health perspective, think of the impact they have on children who may be abused, neglected, malnourished or lack adequate healthcare. Early intervention can prevent further mental health crisis down the road. Nurses are trained in the management of factors that come with mainstreaming children with mental health disorders. This is one area of education that is ever changing and can be very challenging for teachers and staff.

Education is a key job responsibility for school nurses. They educate staff regarding health care issues of students and other staff. They participate in producing policies and procedures for environmental safety emergencies both outside and inside the school building. They educate students about maintaining their own health and wellness, diseases, social pressures, mental health, and community health concerns. They educate parents and caregivers on issues affecting their children such as diseases, immunizations, and concerns noted by school staff.

This of course, is just a broad overview of some of the vital roles school nurses play in schools and the community at large. With the amount of responsibility placed on these nurses and the number of "patients" they serve each day, lets venture into some of the statistics from 2018 allnurses.com survey such as salary versus hourly pay rates per state/ regions, number of years as a nurse and years of experience in current job title (school nursing).

OK...shocking statistic #2 for me....according to results from the 2018 allnurses Salary Survey, the average pay for a full-time school nurse is only $37,164 for hourly employees and $51,043 for salaried employees. The hourly pay per year feels very low to me given the responsibilities of a school nurse at large. Keep in mind with the next set of values, that for some states only a handful (sometimes only 1), school nurse answered the survey representing their respective state. Some of the highest paid school nurses reside in the states along the west coast and northeast coast. For example, New Jersey hourly paid school nurses make an average salary of $50K per year and salaried nurses make an annual salary of $67K per year. The Texas nurses that responded to the survey were all annual salary based and average $50K per year. This is a sharp comparison to Montana (who only had 1 nurse take the salary survey) making $20K as an annual hourly salary and Georgia with a few more responders making an average hourly salary of $25K per year and an annual salary of $15K per year! This made my brain spin and my stomach upset!

I began to think about how much experience school nurses have and whether this plays into the average pay rates. As I suspected most of the respondents have 5 to 35+ years of career-long nursing experience. As far as the number of years in their current job, those numbers were pretty evenly spread over the span of less than one year to more than 10 years. I wonder whether this number spoke more to years as a career school nurse or years in their present job as a school nurse. Of the school nurses that responded, 99% were women. I further polled the allnurses' school nurses and asked about whether they work year-round or have the summers off. The majority of school nurses do keep their summers off to vacation or spend time with families etc. Some work part-time at their schools and other work in the hospital or as camp nurses during the summer.

In wrapping this up, I have come full circle to where I began with how much I love school nurses. I admire them now more than ever, knowing how much they balance and the grand scope of their practice. I am grateful beyond words for the people who watch over our children as though they are their own. Those who put bandages on our children's wounds both internal and external. Those who watch, listen and truly hear our children and their needs. Those who advocate for our kids individually, school-wide, statewide, and nationally. School nurses are vital to our children and the community's health and welfare. So do we compensate them fairly based on those roles and responsibilities? For those states and counties where schools either don't have nurses or have them part-time or less, we need to look for creative ways to fund full-time nurses in our schools. We need to advocate and speak up for our children. As our nation's healthcare needs evolve and change over time, we have a responsibility to provide a voice for those without one......just as school nurses have done for our children for decades!

As a side note, there are so many more aspects to the discussion of school nursing as a career in terms of roles, challenges, more pertain thought-provoking questions regarding the number of hours worked per day, degrees most commonly held, whether CNAs or LPNs can fill some of the gaps, continuing education requirements etc. Please add more to the conversation!

by Sarah Matacale RN, BSN, CCS

School Nurses - Does Their Compensation Match Their True Worth?

About Sarah Matacale, BSN, RN

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