School Nurses: Where Health and Education Intersect

Do you remember where school nurses fit into your K-12 education? If you went to elementary school in the 1950s, you probably remember the part school nurses played in getting polio vaccines, eye tests, iodine on small wounds, and head lice inspections. High school in the 1960s? Unless you were in sports, you probably never saw the school nurse except if you were sick and had to be sent home to recover. As a result of these early experiences with school nursing, you may not have any knowledge of how important school nurses were in the past and are now to student success.
​
A Little History
The need for nurses in schools arose in the late 1800s when urbanization, immigration, and poverty lead to major public health issues, such as communicable infectious and parasitic diseases. The first school health services were implemented in Boston in 1894. Physicians, assisted by nurses, were hired to inspect school children, and empowered to send home any infected children with suggested treatment plans. Many of these children never returned to school because their parents could not read the plans or could not afford the remedies. A better school health program employing school nurses was developed.1
 
Side Note
Traditionally, public education has been funded primarily by state income and local property taxes.

State Revenue Estimates FY25_4.18.pdf | Powered by Box

Funding from the state legislature is allocated to the state’s schools based on a number of factors, the most important being student attendance.1 From the 1890s on, school health programs and school nursing employment were strategies implemented to maintain the highest student attendance rates possible. However, since the early 1900s, the responsibilities and contributions of school nurses have evolved and expanded greatly.
 
A Little More History
In 1902, the New York Board of Education authorized an experiment to place “a public health nurse in four schools, with a total of ten thousand students on an experimental basis to increase school attendance by educating students and families regarding health care needs related to the spread of communicable diseases among children.”1


Lina Rogers Struthers, a Canadian nurse, was chosen to lead this experiment for one month. During that month, Rogers made home visits to assess living conditions and assist families in management of diseases and other health issues. At the end of the month, the results were significant: “Rogers treated 893 students, made 137 home visits, and helped 25 children who had received no previous medical attention recover and return to school.”1


As a result of these findings, Rogers was appointed Superintendent of School Nurses and within two months had a staff of 27 nurses. During the first year, health-related absenteeism declined 90%. Rogers’ innovations included: advocacy for wellness and illness prevention programs; assistance with hygiene, nutrition, and physical development curricula; introduction of paper towels for hand-drying; promotion of dental screenings; and beginning the shift in health care priorities from inspections to prevention and education.1


During the World War II era, the school nurse’s role began to evolve. Care-giving continued to be an essential component of health service, and the nurse’s role as health educator, focusing on family, home visits, dental health education, and, of course, communicable disease control, became a greater priority.2


School Nursing in the 21st Century
For over one hundred years, school nursing programs have been instrumental in improving student attendance, health, and academic success. Today the school nurse “has a crucial role in the seamless provision of comprehensive health services to children and youth.”3 The National Association of School Nurses (NASN) defines school nursing as:


A specialized practice of professional nursing that
advances the well-being, academic success, and
lifelong achievement of students. To that end, school
nurses facilitate positive student responses to normal
development; promote health and safety; intervene with
actual and potential health problems; provide case
management services; and actively collaborate with
others to build student and family capacity for
adaptation, self-management, self-advocacy, and
learning. 3


The NASN has delineated seven core functions for school nurses:

1. Providing direct care to students – Care for injuries and acute illness for all
   students and long-term care for students with special health care needs. As
   leader of the Health Team, the school nurse contributes to the development
   of individual health care plans (IHCPs) and individual education plans
   (IEPs) when appropriate.
2. Leadership for the provision of health services – Responsibilities include
   development of plans for responding to emergencies and disasters and
   confidential communication and documentation of student health
   information.
3. Screening and referral for health conditions – Screening includes but is not
   limited to vision, hearing, and BMI assessments.
4. Promoting a healthy school environment – Monitoring immunizations,
   ensuring appropriate exclusion for infectious illnesses, and reporting
   communicable diseases as required by law. In addition, the nurse
   participates in environmental safety monitoring and development of plans
   developed to deal with campus violence, bullying, terrorism, or disasters.
5. Promoting health – Providing health education to individual students or
   groups of students and working with faculty in developing health-related
   curricula. Health education topics may include nutrition, exercise, smoking,
   oral health, substance use and abuse, and appropriate sex-related issues.
6. Leadership for health policies and programs – Within the school system, the
   school nurse is a leader in the development and evaluation of a wide range
   of school health policies.
7. Coordinating health-related communications – The school nurse is a liaison
   between school personnel, families, health care professionals, physicians,
   and community resources.
   
   (Much of this list was taken verbatim from “Role of the School Nurse in Providing School Health Services” published by the American Academy of Pediatrics. 4 )

In June 2016, the American Academy of Pediatrics recommended that schools have at least one full-time register nurse available for student health needs.4 In 2015, 52% of public schools had a full-time nurse; 30% had at least one part-time nurse; 18% had no full-time or part-time nurses. The responsibilities, duties, and qualifications for school nurses are determined on state and local regulations, Also, local funding allocations for health services staff in public schools is based on a number of factors including but not limited to number of students, health needs of individual students, health needs of the community, and availability of qualified nurses.


The Missouri Kids Count program published School Nurses: A long History of Caring for Our Children in November 2015. The article closes with the following paragraph.
 
Many of us have memories of the school nurse caring for our scrapes and bruises, providing that gentle healing touch. But nursing in schools has changed radically in the last few decades because of the complexity of medical conditions of children in school, the diversity of children, and the number of children living in poverty. It is not an uncommon sight to find children with cancer, diabetes, serious asthma, ADHD in class with children with ear infections, upset stomachs, hearing disorders—all of which would find their way to the school nurse. Children coming to school with complex medications to be administered during the school day are also an increasing challenge for the school nurse. And layered on these health conditions are the non-medical vital signs of hunger, homelessness, abuse, and neglect. School nurses are indeed on the front lines of child health like no other healthcare provider.5


Prepared and Submitted by
Cheryl Stewart, MS
MOTAL Board member and Recording Secretary


Sources
1 A Historical Perspective. Online: Nurses In Schools
2 School Nursing Past and Present: A Photographic Timeline. Wisconsin Association of School Nurses. Online: School Nursing Past and Present - Wisconsin Association of School Nurses (wischoolnurses.org)
3 Role of the School Nurse in Providing School Health Services. American Academy of Pediatrics. Online:https://publications.aap.org/pediatrics/article/137/6/e20160852/52405/Role-of-the-School-Nurse-in-Providing-School
4 School Nurses in U.S. Public Schools. Institute of Education Sciences. Online:​ https://nces.ed.gov/pubs2020/2020086.pdf
5 School Nurses: A Long History of Caring for our Children. Missouri Kids Count.