What is School Nursing in 2022?

This is a snapshot of the modern day health office in public schools to correct the perception that School Nurses do not practice real nursing.

What is School Nursing in 2022?

The perception of school nursing, even within the nursing community, is of a retired older nurse passing out ice packs and bandaids and maybe reading magazines during down time. Truthfully, there are a lot of ice packs passed out, yet the breadth of practice is so much more. When my generation attended elementary school in the 1970’s and 80’s, there were not any medically fragile children attending my school. This changed when Free and Appropriate Education (FAPE) laws were passed as part of the Americans with Disabilities Act (ADA) in 1990.

“The ADA was modeled after the Civil Rights Act of 1964 which prohibits discrimination based on race, color, religion, sex, or national origin”1. FAPE protects the rights of people with disabilities by guaranteeing access to any program funded by the federal government. Section 504 of FAPE requires public schools to provide an appropriate learning situation to meet students with disabilities needs, including nursing care and transportation to school, “regardless of the nature or severity of the disability”2. Advances in medical care in the last 25 years have made it possible for children to survive serious traumas and survive outside of the hospital setting. The next step then was the movement to mainstream these children into the public school classroom3. The goal of most individual education programs is to place the student in the least restrictive environment with the best possible support. 

Test your knowledge. See if you can identify the responsibilities that are managed daily in the public school health office:

  • Collect proof of state-mandated health requirements, pursue families that are not compliant and enforce exclusion. 
  • Monitor diabetic students' blood sugar throughout the day and maintain prescribed range. 
  • Administer medication for ADHD, OCD, Anxiety/Depression, and other behavioral health conditions. 
  • Provided 1:1 nursing to a student with a tracheostomy. 
  • Monday morning triage for weekend accidents for students without primary care. 
  • Care for a student in hospice.
  • Manage active student with Tetralogy of Fallot wearing a Holter monitor. 
  • Provide first aid for injuries from scratches to broken limbs. 
  • Arrange medical care and transportation to receive it for McKinney-Vento students.
  • Provide CPR to an unconscious student. 
  • Manage students on concussion protocol and other medical exemptions. 
  • Work with pregnant teens to try and prolong their own education and connect with resources. Care for mother if she goes into labor at school. 
  • Provide peg tube feedings. 
  • Evaluate students suspected of being under the influence of illegal drugs. 
  • Organization of vaccination or dental clinics for students. 
  • Coordinate with behavioral health hospitals to create re-entry plan for hospitalized students. 
  • Provide vision and hearing screening. Pursue follow-up for failed screenings. 
  • Providing disease process and family living education to students and families. 
  • Supervise emergency situation and administer Narcan, Diastat, or Glucagon. 
  • Empty an ileostomy bag, catheterize a student, or change an adult diaper. 
  • Write 504 plans and participate in Special Education evaluations.
  • Working with the health dept. to report specified disease occurrence. 
  • Treat staff for emergencies: accidents, heart attacks, high blood pressure, etc. 
  • Supervise ill student who was never picked up because parent did not respond to call. 
  • Supervision of extended health office staff.

If you selected all of the above you either work in a school or are starting to get the idea. School nursing is not a fallback career. It requires continuous prioritization and diplomacy and a heart for serving children and families. Nurses providing this dedicated care are not looking for a parade in our honor, but would appreciate being recognized as the competent nurses that we are by teaching staff, administrators, parents, and nurses outside school nursing practice. 

References/Resources

1The Americans with Disabilities Act (ADA) protects people with disabilities from discrimination

2Who Is Entitled to FAPE?

3Medically Fragile Students Pose Dilemma for School Officials

What is and isn’t covered under FAPE

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LHartnett01

About LHartnett01

LHartnett01 has 9 years experience and specializes in Pediatric Nursing.

2 Articles   6 Posts

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Specializes in Pediatrics.

Excellent overview.  I don't think the average (non-nurse) person--or even school administrators--has even a whiff of a clue about what school nursing involves.  Hats off to school nurses!!

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Specializes in Med-Surg, Oncology, School Nursing, OB.

This is a very good overview. We also have to teach CPR to employees, teach classes to students on various health subjects, play “Name that bug!” (Is it lice, bedbugs, fleas, scabies, roaches, etc) and provide education and help families find the proper resources for those, write care plans and emergency care plans, organize food and clothing banks for our needy students, provide counseling when there’s no counselor around and a student is having an anxiety attack, organize paperwork for students who have to stay home for a short term problem like a broken bone or frequently need to miss school due to a chronic disability, organize wellness committees, do Medicaid billing, do monthly checks on the AED’s, be a part of the disaster team, give nebulizer treatments, help kids that have soiled their pants, etc. At least in my county in addition to all of the above.  I could go on but I’ve never had a job where I’ve been expected to do so much with such low pay and respect. I’ve had students ask me when I’m going to be a real nurse and principals ignore my clinical judgements because the parent was mad and then when they find out I was right, I don’t even get an apology. It’s OK though. I don’t do it for the glory or the money. I do it for the kids and the schedule. But I sure would like to feel appreciated a once in a while!!

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Specializes in Pediatric Nursing.

Thank you for helping to round out the image! We are also responsible for those tasks in my district. When I was writing my list I was imagining teaching community nursing to a class because new nurses are not educated at all that this can be a fulfilling job. I’d love to go and guest lecture at the local community college about the reality of school nursing. 

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Specializes in Med-Surg, Oncology, School Nursing, OB.

You’re welcome! That’s a great idea! It’s like a combination of a clinic nurse, public health and a social worker all in one. We wear many hats. It’s definitely not just a “cake job”. Those that think they’re just going to take this job to coast into retirement are very disappointed because it’s still a challenging job with a lot of weight on our shoulders with many stressors and responsibilities! 

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Specializes in Corrections and Occupational Health.

I have worked in corrections and now I work in occupational health at a large factory. Many people feel we are not real nurses either but Band-Aid and ibuprofen pushers. In school nursing and the nursing jobs I have had - we work alone a lot so you must be able to triage, treat, and release or send out with every person that needs medical attention. It makes me mad when I hear that if you work in these areas then you are less than a nurse that works in a hospital and do not have any skills. I do know when I worked in corrections we did get some nurses that were not the best and very lazy since they had the attitude too that this is a cake job - it just made more work for the rest of us and I think they would have been lazy nurses anywhere they worked. Thanks for a great article. 

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One significant thing on this list is : as school nurse, I am it! There is no back up. Countless times in the hospital I have asked another  nurse for a second opinion I.e. Vitals, ekg  are okay but something is not right , he does not look good.... there is no second opinion at school. If student is injured  in playground , is it really bad enough to go to E.R. ? Can parent go to urgent Care, which would be faster? , Why won't that parent answer their phone or call back ? Just Me.  

 

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