PROFESSIONAL PERSPECTIVES: School nursing — Caring for kids and communities
By Larisa Hubbs
"School nurses don't just do Band-Aids anymore," emphasizes Jane Tustin, RN, MSN, NCSN, president of the National Association of School Nurses, an organization that represents more than 11,000 of the 45,000 school nurses in the country.
In this interview, Tustin, coordinator of health services at the Lubbock Independent School District in Lubbock, TX, speaks about the broad scope of care that school nurses provide and the growing challenges of caring for a patient population of schoolkids.
Q. How would you describe the role of school nurses today?
A. School nursing falls more into a community health role. We not only care for students from birth to age 22, but we also promote health and wellness to the school staff and parents.
We're not only healthcare providers but also teachers — we educate students, teachers, and others in the community about the health needs of students.
Also, I think that many nurses are under the misconception that school nurses sit in the clinic alone all day waiting for students to come in. That's not the case. Although we're usually the only health professional on campus, we don't work in isolation. We coordinate with administrators, teachers, counselors, special education staff, social workers and other healthcare providers to meet the schoolchildren's health needs.
The school nurse plays a very holistic role — often the health of the student is impacted by the social, economic, environmental, emotional, and psychological circumstances in the home life. School nurses are sensitive to these issues.
Q. In what types of settings can school nurses work?
A. Nurses can work in universities, public schools, boarding schools or parochial schools. They may work as full- or part-time employees of these institutions or as independent contractors who set their own criteria.
For example, one of my friends works in a rural area and contracts with about eight school districts. She takes care of things such as ensuring immunization compliance, making sure state-mandated screenings, such as vision and hearing, are completed and referred appropriately, writing health plans, and providing training and staff supervision.
School nurses may also work for state departments of public health or education. At this level, they set policies, orient new school nurses, help implement standards of practice, and more.
Q. What are some of the most significant trends you see in school nursing?
A. We're seeing several trends such as:
- More medically complex students. For example, in our district, I have three children with tracheostomies on ventilators, several who are receiving tube feedings, and others who need catheterization. In previous years, these kinds of students wouldn't have come to school because they wouldn't have survived their infancies.
We also see more children who have asthma and diabetes. We care for an increasing number of students with attention deficit disorder and autism. We have the whole gamut of physical, mental, and emotional conditions.
My district, which has about 30,000 students and 43 RNs, has a higher-than-normal incidence of students who have some kind of kind of health condition that requires care and monitoring by a professional. Our community includes the area between Dallas and Albuquerque, and our percentage of these students is between 10% and 12%. It's more typical that this percentage is 5% to 10%. In our community, some of our medically complex students may live in group homes, nursing homes or the state school and have significant healthcare needs that require ongoing monitoring.
- Higher incidences of school violence. School nurses are involved in crisis planning and campus emergency teams. Our organization provides mental health assessment training to help school nurses deal with students' problems before they escalate out of control.
- Social issues that involve the entire family. Access to care is a big concern. Many families don't have primary care providers, or they don't have insurance. Often, the school nurse is their first healthcare contact, referring students and families to physical and mental health resources in the community. Many school nurses enroll students in the states' child health insurance programs. With kids, it's not just the kid's issue; it's a family issue.
Q. What do you like best about school nursing?
A. Every child is a unique person, and you must modify your approach for each child. I like the challenge of that.
I also enjoy how community-oriented and holistic school nursing is. Many school nurses would also mention the family-friendly schedule, a shortened work year and the hours that are the same as their childrens'.
Q. What do you see as an obstacle to doing your job as well as possible?
A. The biggest obstacle is that in some areas of the country, mostly rural areas, nurses aren't paid on the teacher pay scale; they make less. Also, even though everyone acknowledges that health is important, it's frustrating when state and district funding all goes toward education, but not necessarily including health-related matters.
Time pressures are always at issue, as well. If you're one nurse taking care of 2,000, 4,000 or 6,000 kids, you don't have enough time to do things like health teaching or developing health promotion programs — and that's a fun part of the job.
Q. What kind of salary can a school nurse expect to make?
A. Often, the salaries of school nurses are comparable to what the teachers earn. And, just to give you an idea demographically, salaries are higher on the East Coast because teachers earn more there. Also, as is the case with many professions, school nurses who practice in rural areas earn less, and those who practice in urban areas tend to earn more.
Q. What's on the horizon for school nursing?
A. NASN is in the process of gathering data to identify the average nurse-to-school ratios. In the Healthy People 2010 Objectives, the recommended ratio is one nurse to every 750 students. We'd like to develop research on appropriate ratios for student populations.
Also, our organization has just completed our scope of practice and standards of practice, and we're working towards recognition as a specialty by ANA.
First and foremost though, we're continuing to strengthen the knowledge and skills of the school nurse, and to collaborate with schools and other agencies to help the students.
Schools are communities unto themselves, and we all work together for the children's sake. Our mission is to promote the health of students through the leadership of the school nurse.
For more information about school nursing, contact the National Association of School Nurses (www.nasn.org) by calling their Scarborough, ME office at 207-883-2117, or by e-mailing them at firstname.lastname@example.org.
Larisa Hubbs has written extensively about news, trends and clinical topics in nursing and healthcare.
Photo: © 1998 Victor Mosqueda Photography (Lubbock, TX)