Citation: Nwabuzor, O. (February, 2007). Legislative: "Shortage of Nurses: The School Nursing Experience." Online Journal of Issues in Nursing. Available: www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/Columns/Legislative/SchoolNursingExperience.aspx
The purpose of this column is to examine the problem of a shortage of school nurses in public schools in the United States. Areas of focus include the role of school nurses in schools, the definition of 'school nurse,' the major reason for the school nurse shortage, the use of Unlicensed Assistive Personnel (UAP) to provide nursing services in schools, and recommendations for alleviating the shortage of school nurses.
Recent articles indicate that there is a critical shortage of school nurses in public school districts across the nation. Horovitz and McCoy (2005) reported "an analysis of 2004 census data by USA TODAY showed roughly 56,000 nurses worked full time at schools. That's one for every 950 students, a ratio that fails to meet federal guidelines that call for one nurse for every 750 students" (p.1). According to Magnuson (2002), "the United States Department of Health and Human Services (USDHHS) recommends at least one nurse per 750 students in well populations (that ratio changes when students with disabilities are considered)." Similarly, the National Association of School Nurses (NASN) recommends a maximum of one school nurse to 750 regular education students (Green, 2006). A look at individual states may reveal an even grimmer picture. In California, for example, the school nurse to student ratio can be as high as one nurse to 5,000 students or more, as is the case with this author who has a work load of approximately 5,000 students.
The Role of Nurses in Public Schools
According to NASN (2006), the association adopted the following definition of school nursing in 1999:
School nursing is a specialized practice of professional nursing that advances the well being, academic success, and life-long achievement of students. To that end, school nurses facilitate positive student responses to normal development; promote health and safety; intervene with actual and potential health problems; provide case management services; and actively collaborate with others to build student and family capacity for adaptation, self-management, self-advocacy, and learning (para. 2).
The importance of school nurses in the nation's public schools cannot be over-emphasized. School nurses play a vital and multi-faceted role in school settings. In low-income, public school districts, for example, school nurses are more often than not the initial health care personnel with whom students who are without health insurance yet require medical attention come into contact. The role of the school nurse has expanded tremendously over the years since the introduction of school nursing over a hundred years ago by Lillian Wald, a public health nurse and social reformer. The initial focus of school nursing was the prevention of communicable diseases and the treatment of ailments related to compulsory school life (Clark, 2003). School nursing has since evolved over time to include such services as case management, providing health education to students and staff, health promotion, first aid and emergency services, medication administration, advocacy, initiating emergency and individualized health plans for students with chronic medical conditions, and tracking immunizations. Other services include reporting cases of child abuse; providing assessment for and attending Individualized Education Plan (IEP) meetings for students with special educational needs; conducting and supervising state mandated screenings, such as vision, hearing and scoliosis screenings; referring students to appropriate agencies after screening; and providing families with information on available resources for procuring free or low-cost services.
The School Nurse
The definition of a school nurse varies from state to state. …