Nurses have been serving in schools since 1902. As a leader and health advocate, the role of the school nurse has expanded to include health assessment, immunization, chronic and acute health management, counseling, and clinician duties to not only the students, but the school staff as well. Unfortunately, as cutbacks are made to school districts, the immediate availability of the school nurse is also diminishing.

The original intent of the nurse in a school system was to create access to children, often immigrants, who were either already ill or to prevent infectious diseases from spreading, therefore improving the absenteeism rate. This experimental project proved that, when nurses can interact directly with children, and while working closely with an infectious disease medical director, health outcomes improved not only in the schools but in the surrounding communities. Within 6 months of the program, absenteeism improved by 90% in the schools with a nurse on staff.

RELATED: Can a Nurse Serve on a Board?

As the overall health of the communities improved, the focus of the school nurse turned toward health promotion and illness prevention. Nurses conducted health screenings such as eye and hearing exams. This allowed family practice physicians to focus on the acutely ill while relying on the skills of the school nurse to refer children with complex health problems as necessary.

By the 1970s, however, the school-based health services became more institutionalized into the bureaucracy of education and no longer fell under the public health domain. Decisions for health programs were made by those in academia rather than medicine. The field of nursing had been impacted greatly by two wars where health aides were used in schools for nurses who were called into the service. Additionally, experienced nurses were retiring, and the overall nursing shortage was rising. It was during this phase where the National Association of School Nurses (NASN) was formed as a separate entity from the National Education Association to standardize the practice of school nursing.

RELATED: Hospital Nursing vs Clinical Nursing

Nurses in schools have dropped significantly in the past 30 years. Most states require that nurses be employed by school districts, yet it is the number of schools and students to oversee that grows as education budgets are cut. The NASN recommends one registered nurse for every 750 students; less if there are high numbers of complex students. Most school nurses are responsible to oversee between 920-1200 students. This is a tremendous challenge considering the increase in complicated chronic conditions such as asthma and diabetes. Nurses who are stretched too thin are unable to perform community health services such as assisting families with applying for resources like Medicaid.

While most schools in the U.S. have access to a school nurse, most schools employ a health aide in their medical bay who can contact a nurse as needed. School nurses are responsible to oversee more students at multiple schools, sometimes many miles apart and only at part-time hours. Only 45% of public schools have full-time school nurses. School nurses must work in tandem with school officials to address the health and safety concerns of their communities. Through this partnership, school nurses will continue to make a positive impact on students and their families.

Amanda Bucceri Androus RN, BSN
Latest posts by Amanda Bucceri Androus RN, BSN

Our Visitors Found These Nursing Topics Useful

Nursing Residencies and Internships

The entire process of nursing school is both exciting and challenging. From the prerequisite courses to the admissions process to the first clinical experience, the physical and emotional toll is exhausting. As one nears the end of their nursing student…

Young business woman holding keycard to get into

Looking for a Non-Traditional Career? Let Your Nursing Degree Lead the Way

There are many reasons that nurses look for extra income or a new job. Layoffs (I'm looking at you, COVID-19), high-stress work environments (COVID-19 once again), heavy workloads, and workplace injuries can all motivate a nurse to look for alternative…

What Does it Mean for a Nurse to Sign a Consent for Surgery Form?

The duties of the preoperative or perianesthesia nurse include many specific tasks that may affect outcomes for the surgical patient. Initially, registered nurses conduct a preoperative (pre-op) phone or in-person assessment and triage to ensure all the appropriate lab work,…

Improving Cultural Competence in Nurses

In a world moving toward globalization more than ever before, nurses must strive to connect to not only patients of differing cultural beliefs, but to colleagues as well. Culturally competent care is the cornerstone of nursing care to best reduce…

What is the Difference Between a Scope of Practice and a Scope of Employment?

Each state is responsible for creating legislation regarding laws related to the practice of nursing. These laws are defined as the Nurse Practice Act (NPA). Each state's Board of Nursing (BON) is charged with further clarifying and defining the NPA…