Nurses have been involved in school health since the late 1800s. With roots in public health, their role was to identify students with communicable disease needing treatment. School nurse pioneer Lillian Wald graduated from New York Hospital School of Nursing in 1891. She was among a group of nurses working in the tenement sections of New York’s East Side. These nurses maintained records on the number of children who were unable to attend school for medical reasons.

Wald met with the chairman of the New York Board of Education to present documentation supporting a recommendation that nurses treat children within their schools. Lina Rogers was appointed to launch this project that started on Oct. 1, 1902.

Four schools were chosen with the greatest number of medical exclusions and the highest absenteeism. Rogers’ work entailed the cleaning and dressing of wounds and treating mild cases of conjunctivitis and minor skin infections. As a result of nursing care within the school system 98 percent of students who had previously been excluded for medical reasons were now back in their classrooms.

Today the practice of school nursing has evolved and is recognized as a specialty area clearly defined with standards of practice. In New Jersey, certified school nurses are graduates of a baccalaureate degree program, licensed by the New Jersey Board of Nursing as registered nurses and certified by the Department of Education (DOE) after completing specific education requirements.

Frequently, the school nurse is the sole health professional for students with financial or other burdens to routine medical care.

The school nursing model has also evolved and focuses on the inclusion of all children in the school setting, ensuring that students have optimal wellness and enter the classroom ready to learn. The school nurse is often the only health professional within the school system to take leadership on health issues, and frequently the school nurse is the sole health professional for students with financial or other burdens to routine medical care. The school nurse is a member of both the education and the medical/nursing community and acts to connect both communities by collaborating with professionals from both fields.

School nursing services have expanded from the focus on reducing communicable disease-related absenteeism to providing episodic care, managing chronic conditions, taking care of students with disabilities, advocating for student health by planning and leading health care programs and policies, assisting students and their families with the utilization of available health and community resources, tracking communicable diseases and handling medical emergencies.

As a direct benefit of the expansion of these nursing interventions, students with a full-time school nurse have about half the student illness or injury related early releases from school where no school nurse is present.

School nurse/teacher collaboration essential

The classroom teacher is often the first person to recognize signs of illness or imbalance and as such is an integral part of the school health team. The number of students with chronic health conditions and mental health problems continues to rise year after year. It is common to have one or more students in a classroom suffer from a chronic condition such as heart disease, asthma, cancer, diabetes or arthritis.

Teaching staff, oriented to the student’s individual health care plan, are able to recognize early signs of disease exacerbation and make a timely referral to the school nurse. This early intervention allows the school nurse to make an appropriate assessment of the student’s needs and possibly prevent further disease progression. This in turn decreases the amount of school time a student  misses.

Teachers are also essential in identifying students with symptoms needing immediate, emergency treatment. School nurses work to educate staff on recognizing early symptoms of many conditions including, but not limited to anaphylaxis in students with severe allergy, hypo/hyperglycemia in students with diabetes and respiratory distress in students with asthma.

Frequently, the school nurse is the sole health professional for students with financial or other burdens to routine medical care.

This collaboration is essential for students not only with actual health problems, but also for those with undiagnosed, potential health problems. Each day is a teaching opportunity for the school nurse, from formal teaching such as training Epipen delegates to informal training on exclusionary criteria for ill or injured students.

In order to succeed in school every student needs to be healthy, safe, and ready to learn. School nurses are vital in assessing challenges children face that may impact their ability to perform well in school and as such are key members of the education team. School nurses have an important role as health leaders in the community ensuring all children have equal access to health and learning. Healthy students have better attendance records and are thus able to achieve a higher level of academic performance. 

Sheryl Lapp is a school nurse at John F. Kennedy Elementary School in South Plainfield. She can be reached at slapp@spboe.org.

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