School Nurses: We Have Been Here All Along

In honor of National School Nurse Day, guest author Dr. Thomas Stinson, a school nurse and AFT member, talks about the vital role of school nurses which has been amplified during the COVID-19 pandemic.

How many people actually know what school nurses do? Probably not many. This is undoubtedly why, as National School Nurse Day approached, one of my mentors asked if I was willing to write a blog. As a practicing school nurse in an urban public school since November of 1997, I thought this was a great opportunity to share my perspective on the important role school nurses play within society which has been amplified during the COVID-19 pandemic. 

First, I would like to provide some history. Health concerns in schools were noted in the early to mid- 1800s in Europe. In 1837, France led the way by mandating the supervision of students by enforcing sanitary conditions in an effort to control illness. Brussels, Belgium was the first city to establish a system where doctors began providing health services in school settings. The main goal was to identify students with serious diseases such as mumps and pertussis (Wold,1981). It was not long before nurses were looked at as a solution to assisting with school health issues.

In 1892, London schools became concerned with the high number of student absences and believed these absences had to do with minor injuries and illness. The London School Board’s plan was to hire one school nurse, Amy Hughes. Amy was placed in London schools to determine nutritional status and treat minor ailments to see if the school nurse would be able to handle health issues before they became serious (Pavey, 1953). The results were very positive and over the next five years, five nurses were serving students in 500 elementary schools in London.

In 1900, the United States adopted a model originally created by France where doctors identified students with communicable diseases. The New York City Department of Health hired 150 doctors to spend 1 hour a day examining children. It was not until 1902 (Kennedy, 2003), that a passionate nurse named Lillian Wald, convinced the New York City Board of Education to allow her to place one of her Henry Street Settlement nurses in four New York City Public Schools. She claimed children would be absent from school fewer days if there was a nurse present. Hired by the Board of Education in 1902, Lina Rogers became the first school nurse in the United States (NASN, 1995, 2003, 2010). During this era, it was customary for children to be excluded from school when ill with little or no referral or follow-up. The program was such a success that the New York City Board of Education hired 12 more nurses by the end of the third month. A year later, the rate of absenteeism in schools was reduced by 90 percent, and school health was born (Harvey, 2003).

Today, the nation’s estimated 56,000 school nurses provide services to approximately 55 million students (Fleming, 2011). National, political, and economic elements exist that elevate the important role of school nurses in improving the nation’s health. School nurses serve in a unique position to address the needs of students amid a growing interest in public health spurred on by National health reform, an increased number of ethnic minority students populating public schools (Fix & Passel, 2003; Hernandez, 2004; Schmidley, 2001), growth and severity in chronic physical and mental health conditions present in schoolchildren (Akinbami, 2006; Brown & Bzosteck, 2003), and continued disproportionate rates of poverty and health problems experienced by children of color (Bloom & Cohen, 2006; Boudreaux, Emond, Clark, & Camargo, 2003; Children’s Defense Fund, 2006; DeNavus-Walt, Proctor, & Lee, 2006; Heslin, Casey, Shaheen, Cardenas, & Baker, 2006; Huang, Yu, & Ledsky, 2006).

Fast forward to in-person learning during the 2021/2022 school year, and the role of the school nurse has shifted a bit. Throughout the pandemic, the role of the school nurse expanded dramatically. School nurses became policy leaders and interpreters of ever-evolving local, state, and federal guidance. The CDC emphasizes that school nurses have a vital role in keeping schools safe and open for in-person learning while protecting the health and safety of students and staff. In addition to providing school health services for students, both in-person and remotely, school nurses are responsible for evaluating students for COVID-19 symptoms and exposure and educating staff, students, parents, and community partners on COVID-19 prevention strategies. Contract tracing alone is a challenge. For example, in my building it was common to have 5-10 positive cases of COVID-19 a day. The amount of time to contact trace, review seating charts, and connect with staff, families, and students was next to impossible. In my particular school, the collaboration with interpreters is critical. Many students and families speak a language other than English at home. This barrier alone is an issue if nurses are not supported to communicate with school families. Second, the phone was constantly ringing with students and family members who tested positive with COVID-19. Parents were extremely frustrated with the number of times students needed to quarantine and the amount of educational time their children lost. Educating families on the reasons behind health protocols was at an all-time high. As a reminder, the school nurse still needs to do all the other things needed to be taken care of throughout the day. These may include helping students manage chronic health conditions like diabetes or asthma, stocking and supplying menstrual products, addressing unexpected student health concerns from a stomach bug to a broken arm, distributing approved medications, working with teachers and administrators on individual and school-wide health issues, and more.

According to The American Academy of Pediatrics, the school nurse has a crucial role in the seamless provision of comprehensive health services to children and youth. This has become increasingly challenging as more and more students enter schools with chronic health conditions that require management during the school day (AAP, 2008; Akinbami, 2006; Brown & Bzosteck, 2003). Furthermore, nurses working in low-economic, underserved schools are often the unofficial primary care providers for the entire family. They provide triage and referral services and find resources for families with limited means (Fix & Passel, 2003; Hernandez, 2004; Libbus et al., 2003).

The school nurse’s role has expanded greatly from its original focus. However, the essence and goals of the practice remain the same (Vessey & McGowan, 2006). According to the National Association of School Nurses (NASN) (2010), a non-profit specialty nursing organization that represents school nurses and is dedicated to improving the health and educational success of children: “School nursing is a specialized practice of professional nursing that advances the well-being, academic success, and life-long achievement of students. 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” (p.3).

During the pandemic, the school nurse position has been highly visible, and it is common to hear from many, how important the role has been for students and families. However, school nurses have consistently been supporting the needs of their students, thus filling this position in every school building should have always been a priority. I am wondering why it took a worldwide pandemic to elevate the importance of students having access to school nurses. We have been here all along.