Monday, May 11, 2015

Happy International Nurses Day!

For International Nurses' Day, let's highlight an area of nursing that is not often recognized--school nursing! Though not quite as flamboyant or dramatic as ER or ICU nursing (usually), it's not as simple as passing out Band-aids or comforting tummy aches, either. 

School nursing in fact provides a wide scope of direct service to school children and staff, which indirectly affects the health of the community and families of those schools. In some areas, for example, a school nurse may be the ONLY health professional a child has ever seen!

School nursing began in NYC in 1902 due to the keen observances of Lillian Wald, a prominent public health nurse and social reformer. She noticed that the practice of sending sick or infested children home from school to stop the spread of communicable diseases, especially tuberculosis, wasn't working. Too often these sick children never got treatment, and never returned to school, but just ran loose in the community, continuing to infect others. The health and education of these children were drastically affected by these tactics.

A nurse helps protect a family from TB, circa WWl.
Lillian Wald proposed a new model of practice to the NYC Board of Health--to treat sick children right there in school. The Board of Health reluctantly agreed to a one month trial. One nurse was assigned to four schools (this ratio of nurses to students is still common today, believe it or not) to treat students on-site and return them to class. After one month, the significant improvement in attendance and health of the students was undeniable. School nurses began to be hired for more schools across the country, and school nursing was born.

(click on the image to enlarge)

Since then, school nursing has continued to evolve with the needs of the moment. The mid-twentieth century saw a shift from treating contagious diseases to illness prevention and health education. In addition, in 1975, Public Law 94-142, the Education for all Handicapped Children Act, provided for the free and equal education for children with disabilities. Children with complex health needs entered the public school systems. School nurses are now managing g-tube and NG tube feedings, administering oxygen, suctioning, urinary catheterization, providing ostomy care, and monitoring shunt functioning along with their standard duties, enabling students with those needs to have the experience of going to school alongside their peers.

Today's school nurse is a licensed professional, usually with a bachelor's degree in nursing. Some states require a master's degree for this position, recognizing the multifaceted skill set that is needed. School nurses are certified with an extra year of college education, just as teachers are, to work in the school system as a specialty. They come from multiple and varied nursing backgrounds and are among the highest educated as a subgroup of nurses.

The role of the school nurse overall is one of a case manager. He/she is the liaison between the school, family, community, and health care providers. The school nurse is primary in developing the individualized health care plan for the student and participates directly in developing the educational plan and the Section 504 plan for students with health and educational needs.

Health promotion is the heart of school nursing. As Lillian Wald proved and subsequent studies have shown, health promotion and disease prevention are vastly more cost effective than treating disease once it occurs. Nurse theorist, Virginia Henderson, stated that "There is more to be gained by helping every man learn to be healthy than by preparing the most skilled therapists for service to those in crises." This single statement is an affirmation for the value of what school nurses do every day.

Thanks to Big Sister Marsha, RN, MSN, for all her help with this post.

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