School Nurse



Nursing Shortage

1. Look up the description of the school nurse. Did you find anything surprising or disconcerting about their role and responsibilities?

School nursing has multiple components and the role of the school nurse is a broad one, dependent on many factors, including the school setting (rural, urban, suburban), health needs of the student population and the availability of specialized instructional student support services and programs(Vessey, 2006). While the essential role of the school nurse is constant, the responsibilities and expectations of the school nurse have changed dramatically. The skill level has increased commensurate with that occurring in inpatient care. Ventilators, catheters, feeding tubes, chest physiotherapy, glucose monitoring, and insulin pumps are just some of the daily skills required of the school nurse. One ever constant challenge is that the children in any one school are cared for by different health care providers; thus, the protocols and equipment for the same condition may be different, requiring the school nurse to be familiar with multiple technologies and protocols. Just as the hospital/staff nurse has been developing individualized care plans for years, school nurses develop Individualized Health Plans (IHP) for children with chronic conditions to assure that their health needs are being met in the school setting. These are separate from the IEP or 504 accommodations that are developed by interdisciplinary teams to meet the educational needs of the child (Wolfe, 2012). IHPs are developed primarily by the school nurse with input from the student and family. Based upon a nursing assessment and diagnosis, goals are established to address such things as self-care and increasing the child's knowledge based on their needs and abilities.

The school nurse has a multi-faceted role within the school setting, one that supports the physical, mental, emotional, and social health of students and their success in the learning process. It is the breadth of nursing activities contained within the role of the school nurse and the unique non-medical setting that differentiates school nursing from other nursing specialties.

2. If funding wasn't a concern, what do you think should be the highest priority of a school nurse role? Why?

Forty percent of school-age children miss three or more days of school per year due to illness, and it isn't just the flu -- chronic illnesses such as diabetes and asthma are more common and remain unmanaged. Mental and emotional health issues urgently need addressing as well (Robert Wood Johnson Foundation, 2010). 

Although all children have the potential to achieve in school and deserve a great education,  children who suffer from unmanaged conditions and illnesses are more likely to fall behind. School nurses should be reimbursed for their work, as they would be for working in a doctor's office. But HSC believes that a misinterpretation of the free care rule is standing in the way. The free care rule states thatMedicaid funds may not be used to pay for services that are provided for free to everyone in the community. For example, if all children in a school receive hearing evaluations, Medicaid cannot be billed for the ...