School Health Services in the United States: A View for the United Kingdom

By Thompson, June | Journal of School Health, August 1989 | Go to article overview

School Health Services in the United States: A View for the United Kingdom


Thompson, June, Journal of School Health


School Health Services in the United STates: A View from the United Kingdom

Inevitably, one goes to a country such as the united State of America with some fixed ideas. I assumed, for example, the salary and resources available to school nurses would be much more in the U.S. than in the United Kingdom, especially since I went at a time when the U.K. National Health Service had been going through a prolonged crisis. However, though we may be "divided by a common language," I was surprised by the similarity between problems facing U.S. school nurses and those facing health visitors and school nurses in Britain. I include health visitors here because some of the functions carried out by U.S. school nurses, such as involvement in infant program schemes, would be carried out by health visitors in Britain, and some health visitors also work as school nurses.

The similarity first struck me when I attended a conference of the California School Nurses Organization. Complaints of lack of resources, lack of time, no one understanding their role, and other professionals usurping that role made me feel I was back at a meeting of health visitors and school nurses in the U.K. Discussions throughout the remainder of my tour inevitably centered on government cut backs and their effects in both countries. Salaries in the U.S. were not as high as I expected, and in some cases they were lower than in Britain. New York nurses were surprised to learn that Britain had a growing problem with homeless families and with poor quality bed and breakfast accommodation; they thought these problems only existed in New York. The causes were similar: lack of public housing, lack of low rent accommodations, high housing prices, and upscale development of former working class neighborhoods.

COMPARISONS AND CONTRASTS

As in the U.K., quality of U.S. schools and funding for them depend on the area, with boards of education in more middle class areas providing better facilities than in the poorer areas and being more likely to employ more school nurses. In both California and New York, however, state lotteries are held with around 40% of the profit going toward school funds -- an idea presently being considered for the U.K. National Health Service.

The American system of education differs substantially from the U.K., and an associate or baccalaureate degree is the norm for nursing. Education and further qualifications appear to be much more valued in the U.S. than in the U.K., though at times the emphasis placed on obtaining degrees seems somewhat obsessional, and less stress seems to be placed on the importance of clinical practice. Even the smallest town appeared to have its own university, some within a couple of miles of each other, and I felt there was a danger of a degree becoming devalued. Qualifications such as the Health Visitor Certificate probably would be equivalent to a bachelor of arts degree in the U.S. and apparently an American master's degree is equivalent to a BSc (Hons) in Britain.

Nevertheless, the fact that nurses pursue further degrees and post registration training in their own time on a part-time basis while working full time and at their own expense is most admirable. Surprise was expressed that nurses in Britain get paid while training and that university students can get free grants. The enthusiasm for further education and the fact that nurses are expected to continue their professional development also helps ensure they remain stimulated by their work and are up-to-date.

I also admired the more positive attitude that the U.S. has toward age compared to a more negative attitude in the U.K. In the U.S., discrimination against employing school nurses on the grounds of age is illegal, and there appears to be no expectation that nurses should retire at 55 or 60 yers as in Britain. Indeed, one 60-year-old school nurse with a master's degree was studying for a school administrator's credential -- a change of career which would be unheard of for a 60 year-old in the National Health Service in the United Kingdom. …

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