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Background: Nurses have been a part of the school setting since the late 1800s when they provided

student inspections to identify those with communicable diseases needing treatment. With the widespread use of antibiotics and vaccines to prevent common childhood diseases the role of the school nurse has evolved to a new level. Students with chronic diseases, mental health issues and high-risk behaviors have driven school nurses to gain expertise not only in public health but also in pediatric and mental health nursing. Additionally, the need for nursing services in the school setting increased with the passage of Public Health Law 94-142 in 1975, requiring the mainstreaming of physically and mentally challenged students into the general student population A later version of P.L. 94-142, known also as the Individuals with Disabilities Act (IDEA), did not specifically fund school nurses, but a ruling by the Supreme Court in 1999 confirmed that nursing services were to be provided by the school district for students needing nursing care. Under IDEA regulations, school nurses provide nursing assessments for students in special education programs as well as deliver nursing services for students in need of procedures such as gastrostomy tube feedings, clean intermittent catheterizations, tracheostomy care, and others. Roles: The primary role of the school nurse is to support student learning. The nurse accomplishes this by implementing strategies that promote student and staff health and safety. The nurse takes a leadership role in serving as the coordinator of all school health programs in the following manner: Health Services -- serves as the coordinator of the health services program and provides nursing care Health Education -- provides health education to students, staff and parents Healthy Environment -- identifies health and safety concerns in the school environment and promotes a nurturing social environment Nutritional Services -- supports healthy food services programs Physical Education/Activity -- promotes healthy physical education, sports policies and practices Counseling -- provides health counseling, assesses mental health needs, provides interventions and refers students to appropriate school staff or community agencies Parent/Community Involvement -- promotes community involvement in assuring a healthy school, serves as school liaison to a health advisory committee. Staff Wellness -- provides health education and counseling, promote healthy activities and environment for school staff

As the health services expert, the school nurse serves as the health professional for the school community. Some of the services provided include: illness and injury assessments and interventions; health assessments and participation in development of Individualized Education Plan for students with special needs; pediatric nursing procedures such as gastrostomy tube feedings, tracheostomy care, and catheterization; screening for health factors impacting student learning; activities to promote health and prevent teen pregnancy, sexually transmitted diseases, tobacco, alcohol and substance use and abuse; chronic disease management and education, administering medications; crisis team participation; recommending health curricula and guidelines for school district health policies; and serving as a health care provider liaison between the school and community. Specialties: School nursing is recognized as a specialty nursing area and has become more clearly defined with the development of standards of practice. Additionally, school nurses might further specialize their practice with a focus on children with special needs, early childhood programs, elementary or secondary age children, adolescents, or students with high-risk behaviors. Many states require school nurse certification either through the Department of Education or Health. National certification is available through a national board.

Practice Settings: School nurses practice in schools throughout the United States and overseas military bases in settings that include: Elementary schools Middle schools Junior High schools High schools, Alternative schools Private schools Parochial schools Pre-schools Vocational schools

Qualifications: The National Association of School Nurses recommends that all school nurses have a minimum of a baccalaureate degree and achieve School Nurse Certification. The school nurse needs expertise in pediatric, public health and mental health nursing and must possess strong health promotion, assessment, and referral skills. School nurses also need to have knowledge of laws in education and health care that impact children in the school setting. The school nurse works independently in the school setting to provide health care and education primarily to students and needs strong skills in critical thinking, decision-making, communication, individual and classroom education, and child advocacy. Education: Many educators responsible for hiring nurses are not aware of the various levels of nursing preparation. Consequently nurses in the school setting range from LPNs to PhDs, many with practitioner training and/or licensing. The National Association of School Nurses recommends a minimum of baccalaureate preparation for school nurses. Salary Range: In the1999-2000 school year, school nurses nationally earned salaries ranging between $20,000 and more than $70,000 across a range of job assignments. The majority of school nurses earn salaries between $28,000 and $49,000 based on a nine- month contract. Nurses are health care professionals who work in a wide variety of settings including hospitals and nursing homes. School nurses are nurses employed in a school setting. A school nurse has many different duties she is expected to perform each school day. Such tasks include supervising the health of the entire school body as well as serving as a liaison between the health care community and the school population. School nurses perform a vital role in the educational setting. 1. Assist Students With Medical Needs o School nurses assist students with chronic health care conditions. Some students may have ongoing health care needs necessitating the intervention of a health care professional. Diabetics may need a nurse to help them keep track of their blood sugar on a daily basis. Students combating childhood cancer may need assistance in administering medications. Students with special needs such as a student with a metabolic

disorder such as PKU may need assistance in choosing a proper diet. A school nurse can not only assist such students but also help them achieve their optimal long-term health goals. Assist Faculty Members Facing Ilness o School nurses assist faculty members with chronic health care conditions. Some faculty members may have health care conditions that necessitate the need of a professional such as cardiac care problems or posttransplant care. A nurse can help a faculty member attend to his health care needs, thus decreasing the need for absences. This can help students learn better by making sure that faculty members are available to teach without the need for substitute teachers.

Teach Classes o Nurses teach health care classes. School nurses may teach students basic classes in hygiene. Such classes can help students learn about the proper way to decrease germ transmission or how best to avoid sexually transmitted disease.

Emergency Leadership o School nurses assume a leadership role in case of an emergency. If a school faces an emergency such as a fire or bus crash, a school nurse can assist faculty members and students in coping with the emergency. A school nurse can administer medication and treat any resulting injury. School nurses can also help students cope with any trauma as a result.

Health Care Screening Tests o School nurses administer health care screening tests. School nurses may help check students for signs of all kinds of medical conditions. Such conditions may include screenings for otherwise unnoticed health care problems such as scoliosis, eye problems, malnutrition or physical abuse. A school nurse can also offer referrals if students require them for conditions such as speech problems that may need further medical intervention to correct.

The Roles & Responsibilities of School Health Nursing From skinned knees sustained on the playground to headaches, the school nurse seemed to be able to cure it all. School nurses have been present in American schools since 1902, according to the National Association of School Nurses. The school health aid governing body says that school nurse positions were established to reduce the number of days pupils missed and to ensure that students had adequate access to quality health care while in school. School nurses act much as their early predecessors did, working to ensure that students and staff are safe and healthy.

Tending to Medical Needs The most obvious and vital job of a school nurse is to provide health care to students and faculty when necessary. While the nurses station is not often equipped to handle serious medical issues, the office usually holds all the supplies necessary to handle minor abrasions and simple diagnostic tests, such as temperature taking. School nurses have basic first aid training in lifesaving procedures such as CPR and the Heimlich maneuver. Some schools even have inhouse defibrillators that nurses can use should an emergency occur. As the most highly trained health practitioner on the premises, the school nurse is responsible for tending the medical needs of people on campus, or handling the situation until help arrives in the event of an emergency.

Providing Screenings Students routinely receive a variety of screenings for conditions spanning from scoliosis to head lice. Schools nurses arrange or administer all necessary annual health screenings. In most schools, these screenings include vision and hearing tests. The school nurse also sets up special screenings when necessary to check the student body and staff for illnesses that are being passed around the school, such as chicken pox and aggressive flu strains. By providing

these screenings, school nurses work to ensure that the sick receive treatment before others are infected and that health-related issues, including poor eyesight, are handled promptly. Dispensing Medicines When students require medicine during the school day, they visit the nurse to receive the appropriate dosage. All medicine, prescription or over-the-counter, is to be kept safely in the nurses station to ensure that students receive the correct dosage, that the medicine is only taken when needed and that medicine is not shared among students. Along with dispensing the medicine, nurses keep track of the frequency and quantity of medicine used by each student to monitor the worsening of medical conditions such as asthma.

Promoting Healthy Living With childhood obesity on the rise, there is an ever-growing push toward promoting healthy lifestyles. In many cases, the school nurse is the party responsible for establishing and overseeing healthy-living programs within the school. These programs can include student-focused wellness programs or staff fitness and healthy-living programs. In some schools, obese or at-risk students can be referred to the school nurse and receive special counseling on health-related concerns that they need to consider and on ways they could reduce their weight and increase overall health.

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