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.

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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.

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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.