ROLE OF THE SCHOOL NURSE
INTRODUCTION
The practice of school nursing began in the United States on October 1, 1902 when the initial role of the school nurse was to reduce absenteeism by intervening with students and families regarding health care needs related to communicable diseases. While the nurses role has expanded greatly from its original focus, the essence of the practice remains the same. The school nurse supports student success by providing health care assessment, intervention, and follow-up for all children within the school setting.
BACKGROUND
In 1999, the National Association of School Nurses Board of Directors defined school nursing as:
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.
Inherent in this definition is the framework that school nurses engage in professional nursing practice, use the nursing process for decision-making, document the care they provide, and assure confidentiality. Professional nurses address the physical, mental, emotional, and social health of their clients. In addition, professional school nurses have as the ultimate outcome of their practice, the support of student success in the learning process. In this context the school nurse provides services to the entire school population, which may include infants, toddlers, pre-schoolers, children with special needs, traditional school populations, and, to a limited degree, adults within the school community.
ROLE OF THE SCHOOL NURSE
Seven roles of the school nurse have evolved from this definition.
The school nurse provides direct health care to students and staff.
The school nurse provides care to students and staff who have been injured or who present with acute illnesses. Care may involve treatment of health problems within the scope of nursing practice, communication with parents for treatment, and referral to other providers. The school nurse uses the nursing process to assess, plan, implement, and evaluate care for students with chronic health conditions. This care should begin with the development of a nursing care plan (also known as an individualized health care plan) that should include an emergency action plan. The school nurse is responsible for medication administration and the performance of health care procedures that are within the scope of nursing practice and are ordered by an appropriately licensed health care provider. The school nurse also assists faculty and staff in monitoring chronic health conditions. As the scope of nursing practice expands to utilize the increasingly complex technology needed to provide up-to-date care for clients, the school nurses body of knowledge grows through personal professional development.
The school nurse provides leadership for the provision of health services.
In addition to providing health services directly, the school nurse must take into account the nature of the school environment, including available resources. As the health care expert within the school, the school nurse assesses the overall system of care and develops a plan for assuring that health needs are met. This leadership role includes developing a plan for responding to emergencies and disasters and training staff to respond appropriately. It also involves the appropriate delegation of care within applicable laws. Delegation to others involves initial assessment, training, competency validation, supervision, and evaluation by the school nurse.
The school nurse provides screening and referral for health conditions.
In order to address potential health problems that are barriers to learning or symptoms of underlying medical conditions, the school nurse often engages in screening activities. Screening activities may include vision, hearing, postural, body mass index, or other screening. Determination of which screenings should be performed is based on several factors, including legal obligations, the validity of the screening test, the cost-effectiveness of the screening program, and the availability of resources to assure referral and follow-up.
The school nurse promotes a healthy school environment.
The school nurse provides for the physical and emotional safety of the school community. The school nurse monitors immunizations, assures appropriate exclusion from and re-entry into school, and reports communicable diseases as required by law. The school nurse provides leadership to the school in implementing precautions for blood borne pathogens and other infectious diseases. The school nurse also assesses the physical environment of the school and takes actions to improve health and safety. Such activities may include an assessment of the playground, indoor air quality evaluation, or a review of patterns of illness or injury to determine a source of concern. Additionally, the school nurse addresses the emotional environment of the school to decrease conditions that may lead to bullying and violence and/or an environment not conducive to optimal mental health and learning.
The school nurse promotes health.
The school nurse provides health education by providing health information directly to individual students, groups of students, or classes or by providing guidance about the health education curriculum, encouraging comprehensive, sequential, and age appropriate information. They may also provide programs to staff, families, and the community on health topics. Other health promotion activities may include health fairs for students, families, or staff, consultation with other school staff such as food service personnel or physical education teachers regarding healthy lifestyles, and staff wellness programs. The school nurse is a member of the coordinated school health team that promotes the health and well-being of school members through collaborative efforts.
The school nurse serves in a leadership role for health policies and programs.
As the health care expert within the school system, the school nurse takes a leadership role in the development and evaluation of school health policies. The school nurse participates in and provides leadership to coordinated school health programs, crises/disaster management teams, and school health advisory councils. The school nurse promotes nursing as a career by discussions with students as appropriate, role modeling, and serving as a preceptor for student nurses or as a mentor for others beginning school nursing practice. Additionally, the school nurse participates in measuring outcomes or research, as appropriate, to advance the profession and advocates for programs and policies that positively affect the health of students or impact the profession of school nursing.
The school nurse serves as a liaison between school personnel, family, community, and health care providers.
The school nurse participates as the health expert on Individualized Education Plan and 504 teams and on student and family assistance teams. As case manager, the nurse communicates with the family through telephone calls, assures them with written communication and home visits as needed, and serves as a representative of the school community. The school nurse also communicates with community health providers and community health care agencies while ensuring appropriate confidentiality, develops community partnerships, and serves on community coalitions to promote the health of the community.
The school nurse may take on additional roles to meet the needs of the school community.
CONCLUSION
Healthy children are successful learners. The school nurse has a multi-faceted role within the school setting, one that supports the physical, mental, emotional, and social health of students and their success in the learning process.
That's classic 
Well we sent word back that yes we knew and it was on her file about this. They then sent back word saying we had to have a note from her doctor! What! All of this was already on her file for pete's sake. 
