Academy recommends one nurse per school

The American Academy of Pediatrics is recommending one school nurse per school nationwide, according to a May 2016 policy statement that suggests the role comprises much more than just health services. "The role of the school nurse has evolved and become increasingly important since first introduced in the United States more than a century ago, yet school district policies regarding school nurses lack uniformity and should be updated, according to a policy statement issued by the American Academy of Pediatrics," the AAP press release stated. The policy statement was published in the June issue of Pediatrics and calls for a minimum of one full-time RN in every school, replacing a prior policy statement from 2008 that recommended ratios of one school nurse to 750 students in the healthy student population, and a 1:225 ratio for populations who need daily nursing assistance. In the 2016 statement, lead authors Breena Welch Holmes, MD, and Anne Sheetz, MPH, RN, wrote "as more children with special healthcare needs attend school, the school nurse plays a vital role in disease management, often working closely with children and their parents to reinforce the medical home's recommendations and provide treatment(s) during the school day. Feedback mechanisms regarding student response to the treatment plan in school are critical to timely medical management in areas such as attention-deficit/hyperactivity disorder, diabetes, life-threatening allergies, asthma, and seizures as well as for the growing population of children with behavioral health concerns. School nurses play an important role in interpreting medical recommendations within the educational environment and, for example, may participate in the development of action plans for epilepsy management and safe transportation of a child with special healthcare needs." The policy statement comes just two months after U.S. News and World Report published the article, "Many School Districts Don't Have Enough School Nurses," by Lauren Camera, Education Reporter. The March 2016 article stated that "less than half of the country's public schools employ a full-time nurse and in some of the worst cases -- largely in poor, urban school systems -- there's only one school nurse for every 4,000 students." The article quoted Beth Mattey, MSN, RN, NCSN, president of the National Association of School Nurses, who said, "This absolutely has real consequences. If you have a child who isn't healthy, who doesn't feel well, who has a toothache, they will not learn. School nurses keep kids in schools." According to the National Education Association website, a school nurse is doing much more than offering Band-Aids and flu shots. "A typical schedule can encompass immunizations, healthcare screenings, hearing and vision testing; dealing with home accidents, diseases such as diabetes and asthma, student obesity, special needs like tube-feeding, preventing the spread of disease through blood exposure; and the fallout from mental, emotional, and social problems, including arranging for disadvantaged students to receive breakfast and clothing, and even helping students cope who are homeless or whose parents are incarcerated," the website stated. "For some students, the school nurse is the only health care professional they ever see." According to NEA statistics, about 50,000 nurses are employed in American schools, but more are needed to meet the one nurse to 750 student ratio recommended by the CDC. "The reality is a far cry from the recommendation; about 59% of schools have a higher ratio of students to available nurses," the NEA website stated. To comment, email editor@nurse.com. For more information on school nurses, read the CE module, "School RNs Lead Education Efforts for Students with Diabetes".