School Health Services

Why School Health Matters

United States Surgeon General, Dr. Joycelyn Elders said it best, "...we can't educate children who are not healthy and we cannot keep them healthy if they are not educated. There has to be a marriage between health and education."

School health services are incredibly valuable tools to join health and education to build healthy, successful futures for Utah's children and families. When schools have a school nurse, it is a safety net to assess, plan and coordinate for student care. When students' physical and mental health needs are met, they are able to be mentally and physically present to learn. Research consistently supports that academic measures are improved when health needs are met.

Definition of School Nursing

“School nurse” means a registered nurse who is licensed under (Section 58-31b-302 of Title 58, Chapter 31b, Nurse Practice Act;), or who holds a multistate registered nursing license as defined in (58-31e-102), and whose primary role is the care of defined group of students enrolled in public or private schools (UCA 53E-1-102 from 2022).

School nursing, a specialized practice of registered nursing, protects and promotes student health, facilitates optimal development, and advances academic success. School nurses, grounded in ethical and evidence-based practice, are the leaders who bridge health care and education, provide care coordination, advocate for quality student-centered care, and collaborate to design systems that allow individuals and communities to develop their full potential (adopted by the National Association of School Nurses [NASN] Board of Directors February 2017).

Education & Professional Qualifications

Required Qualifications

• Registered nurse (RN) licensed by the state board of nursing (BSN or higher preferred)
• Accountable to practice within current state laws, rules and regulations
• Expertise in several areas, including: pediatric, public health and mental health nursing; education and health laws impacting children
• Ability to work independently
• BLS/CPR certification

Recommended Qualifications

• School Nurse Certification through the National Board of Certification of School Nurses (recommended)

Primary Responsibilities

To strive to advance the well-being of students and staff within the school environment.  The school nurse promotes healthcare and safety by handling the daily health issues that arise by providing the following services:

• Ensure compliance with national and state laws
• Illness and injury assessments
• Identification, assessment, planning, intervention and evaluation of student health concerns
• Activities and education to promote health
• Chronic disease management and education
• Participation in Individualized Education Plan and Section 504 Plan development for students with health needs that interfere with learning
• Implementing healthcare plans (Individualized Healthcare Plans and Emergency Action Plans) for students with specific health needs that interfere with learning
• Work with parent/guardian to obtain medication orders and procedure orders
• Pediatric nursing procedures: ventilators, gastrostomy feedings, tracheostomy care, catheterization
• Delegation to lay staff based on student’s needs, including supervision and evaluation of delegatee
• Medication administration
• Monitor student immunization records
• Screening for health factors impacting student education (i.e. vision, oral health)
• Assessment and interventions for students with mental health needs
• Crisis team participation

Other School Health Staff

Licensed Practical Nurse

The principle role of the school Licensed Practical Nurse (LPN) is to assist the licensed school nurse with the implementation of the school health program by providing practical nursing care for students in the health room and by meeting the complex needs of medically fragile/severely disabled students. The LPN must be supervised by the RN school nurse or the school physician.

School Health Assistant

The School Health Assistant (SHA) is a paraprofessional a district or school may employ to assist and support the school nurse so the school nurse may have more time and opportunities to utilize professional nursing skills in the school health program. The SHA, supervised by the school nurse, provides health-related services as assigned by the school nurse.

How Do I Find My School Nurse?

Each Local Education Agency  assigns their school nurses at the school or district level.  Many schools and districts will have personnel listed on their website.  The state does not keep a list of which schools each nurse is assigned to.

Framework for the 21st Century School Nursing Practice

Based on the Framework for the 21st Century School Nursing Practice, the following are some things a school nurse can do for children in Utah:

• Care Coordination – this involves case management, chronic disease management, direct care, nursing delegation, and student-centered care. The school nurse develops individualized healthcare plans (IHP) and emergency action plans (EAP) for those students with chronic health conditions and ensures the staff in the schools are trained on how to care for those students.
• Leadership – school nurses are advocates for the students and the health of the communities they serve. They should be involved in policy development and implementation at the district and school level. They should participate on interdisciplinary teams, sharing their knowledge on how to address the individual needs of the students.
• Quality Improvement – with the annual School Health Workload Census, the school nurse can see through documentation and data collection what services are provided to students in Utah. This also allows them to see where improvements can be made. Evaluation is an important part of the nursing process and a standard of school nursing practice.
• Community and Public Health – School nurses are often the only healthcare professional in the school, so they must be knowledgeable on how to expand their focus to the entire school community, not just the students. They should be culturally competent and help their community understand the levels of disease prevention in order to reduce risks. These include vision, dental, and hearing screenings (in some districts), as well as follow-up activities in the event a problem is detected. School nurses also support healthy food services programs and promote healthy physical education, safe sports policies, and practices.
• Standards of Practice – The school nurse provides the specialized knowledge, skills, decision making, and standards for school nursing practice. These include clinical competence, clinical guidelines, critical thinking, evidence-based practice, and practice in an ethical way. All of these are guided by the Utah Nurse Practice Act and accompanying rules.

The center of this framework is the student, their families, and the community. By working within the Framework of the 21st Century School Nursing Practice, school nurses can ensure that students are healthy, safe, and ready to learn.

Reference:

National Association of School Nurses (2016). Framework for 21st century school nursing practice. NASN School Nurse, January 2016, pp. 45-53.