A School Nurse in the 21st-Century: Your Partner in Supporting Student Success

By Erin D. Maughan

A 21st Century School Nurse: Supporting Educators and Students Alike

I was recently talking to a friend who is a teacher. She, like many of you, has had a rough year. She taught remotely for much of the year. And when students returned to the classroom, she saw a difference. Many were behind academically, but even more concerning were their countenances. Students appeared stressed and preoccupied with many other concerns. My friend’s bandwidth and that of her students were stretched pretty thin. She was thrilled when the year ended but expressed angst about what will happen next year. In addition to her teaching responsibilities, my friend wondered how she could help her students address their stress and anxiety, as well as other needs they are facing. She had her own children and family concerns, as well. How can she do it all?

If you are asking the same question, the answer is: You don’t have to do it all alone. School nurses (and other specialized instructional support personnel) are your allies and a great resource for helping you and your students.

School nurses have critical thinking skills and nursing knowledge that focus on addressing the needs of the whole child and their family. This past year you may have seen school nurses step into roles that are different from those in the past. The COVID-19 pandemic drastically changed the way school health looked this past year. (Click here to see some of their activities for the 2020-21 school year.) Next year will be different as well, not just because of COVID-19 but due to additional emerging student health needs. Understanding and utilizing your school nurse will be critical in creating a healthy and safe school environment and meeting the known and emerging needs of your students.

Most pre-licensure education programs do not discuss what school nurses (and specialized instructional support personnel) can do to help students be healthy and ready to learn. So, you may not realize that a school nurse does much more than react to playground injuries or help students who have asthma or diabetes.

You may not realize school nurses are often the first to identify students who are suffering from stress or anxiety. About one-third of the visits to a school nurse are for mental health concerns. They may first appear as stomachaches or headaches; but by using competent assessment skills, the nurse can determine the root cause is often stress or anxiety. School nurses can provide basic care to address stress or anxiety, and also know when to refer students who need more specialized care from a mental health professional.¹

Many school nurses are also involved with screening activities to proactively identify mental health or social needs for an entire school. Just like with other screenings such as vision or hearing, school nurses don’t simply identify the issue but also offer support and connect students with community resources and partners who can assist in addressing the concern. This could be anything from eyeglasses to connections to food pantries to medical care. School nurses may be the only healthcare provider some students see, and so the nurses also address inequities in accessing healthcare. School nurses also advocate to address other students needs that impact their health such as mold in their living conditions, or other community issues that impact student health.

School nurses do much more than meet the needs of individual students. School nurses have training in population-based care, prevention and health promotion. They use data and their observational skills to identify needs of the entire school; then they implement evidence-based programs for the entire school. For example, school nurses have been instrumental in implementing trauma-informed school strategies and improving the nutritional content of school meals. They also advocate for the health of teachers and staff. After this past year, it is critical that teachers and staff address their own health needs and work in an environment that promotes health and safety.

In addition, school nurses help ensure there are policies and procedures in the school building that address health concerns. This can include anything from idling buses to medication given in schools to proper cleaning products. Bottom line: Researchers have also found that having a school nurse saves principals and teachers time that they can then devote to the educational needs of students.²

Yes, it is true that some of these roles can be performed by others. For example, clinics can do episodic care, and other school personnel can assist families with social needs. Yet, school nurses have the continuity of care and overall holistic health vision for the school that others who only focus on one component of coordinated health may miss. Part of nursing education is to look at the whole person and coordinate efforts to meet the identified needs. When school nurses call to talk to families for one issue, they are assessing and identifying other needs that families may not be forthright in expressing. School nurses look at all that is happening with students to address underlying issues at the root of the situation.

School nurses are also part of the school community and have a trusted relationship with families and outside partners who also have a vested interest in supporting student health and academic success.  Having access to a school nurse bridges the gap of health, student well-being and academics. They create a culture of health in the building that proactively addresses issues early.

The National Association of School Nurses has developed a Framework for 21st Century School Nursing Practice that helps articulate the various roles of a school nurse. The framework is made up of five principles: care coordination, community/public health, quality improvement, standards of practice, and leadership. Within each principle are practice components that help describe the types of responsibilities of a school nurse in the 21st century.³ This graphic may help educators understand the full scope of practice of school nurses. The framework can also be a guide for educators when:

• Writing job descriptions for hiring new school nurses;
• Determining the type of professional development opportunities to offer; or even
• Framing job performance evaluations for the school nurse.

The sky is the limit of how the framework can be used!

If you haven’t talked to your school nurse lately, please reach out. Ask about what they can do to help you address the concerns you may have for the upcoming school year. COVID-19 may not be as big of a threat as last year, but its impact and the complexity of student health will remain this year. Your school nurse can be your partner in supporting the whole child, so that you can focus on teaching. Together, you can support student success.