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School nursing practice started in the United States in 1902 when a school nurse was hired to help intervene with students and families regarding health care needs related to communicable diseases, thereby reducing absenteeism. After a month of successful nursing interventions the first school nurse was able to provide the leadership necessary to implement evidence-based nursing care across New York City schools. The role of the RN School Nurse has expanded greatly from its initial focus but the goals and essence of the practice remain the same.

The student’s ability to learn is directly related to the health status of the student. Children with health needs have difficulty engaging in the educational process. The School Nurse helps students success by providing health care through assessment, intervention and follow-up for all the children within the school setting. The RN will address the physical, mental, emotional and social health needs of students and support their achievement in the learning process. The School Nurse provides for the safety and care of students and staff and will address the need for integrating health solutions into the education setting.

Over the past four decades the number of children with chronic illnesses or conditions has increased dramatically. Chronic conditions such anaphylaxis, type 1 diabetes,, asthma, epilepsy, obesity and mental health concerns can all impact the student’s ability to be in school and ready to learn. The number of students with special health care needs has also dramatically increased over the past decade. Students come to school with complex medical problems, intricate medical equipment and complicated treatments. 

The School Nurse RN has a commitment to lifelong learning. The school nurse should continue to pursue professional development and continuing nursing education. The RN in the school setting normally practice independently and must assess student health, develop and execute plans for care management, act as first responders in an emergency, engage in public health functions such as disease surveillance, immunization compliance and health promotion. The School Nurse RN is a vital member of the school team and can lead change to advance health of the staff and students as well as collaborating with staff members, parents and community members to keep all the students safe at school and healthy to learn. Healthy children are successful at learning.

The scope and role of the School Nurse RN has multiple components and is dependent on many factors, including the school setting (urban, suburban or rural), the health needs of the students and the availability of specialized instructional student support services and programs. School Nursing is defined as a specialized practice of professional nursing that serves to advance the well-being, academic success and lifelong achievement and health of students. School nurses will help facilitate normal development and positive student response to interventions, promote health and safety including a healthy environment, provide case management services, intervene with actual and potential health problems, and actively work with others to build student and family capacity for self-management, adaptation, self-advocacy and learning. The School Nurse may take on additional roles as necessary in order to meet the needs of the school community.

Some duties of the School Nurse RN may include (based on the setting)

Provide health assessments, obtain health and development history

Screen and evaluate findings for problems with vision, hearing, scoliosis, growth or any other issue.

Observe the student for development and health patterns in order to make a nursing assessment and/or nursing diagnosis.

Identify health findings which are outside of the normal range.

Assist with physical examinations when conducted in the school.

Initiate referrals to parents, school personnel and community health resources for intervention, remediation and follow through.

Provide ongoing health education and information to students, parents, school personnel and health agencies.

Recommend and help implement modifications to school programs to meet health needs of the student population and the staff.

Utilize resources existing in the community to provide appropriate care of students.

Participate as the health specialist on the child education evaluation team to develop the health individualized educational plan (IEP)

Maintain, evaluate and interpret cumulative health data to accommodate individual needs of students.

Plan and implement school health management protocols for the student with chronic health problems, including administration of medications.

Promote and assist in the control of communicable diseases through preventive immunization programs, early detection, surveillance and reporting of contagious diseases.

Act as a resource person in promoting careers in healthcare.

Educate and provide information to students and families to assist them in making health-related decision.

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