The Shortage of School Nurses

It's hard to pay attention in school if you're not feeling well. That's why our health is an important part of the learning experience.

School nurses help students stay healthy. They can come to the aid of students with illnesses or students who have had an accident. But despite increasing demand for their services, many schools are having difficulty hiring a school nurse. Some don't have the money to hire one. Others have trouble finding a qualified nurse.

"School nursing is a complex and multi-faceted job in which one wears many hats," says Marian Smithey. She is the nursing education director for the National Association of School Nurses.

"Frequently, the school nurse is the only medical expert on a school campus who is licensed and trained to provide comprehensive health care and nursing medical services."

Along with providing acute medical care, school nurses offer emotional support, teach healthy behaviors, make referrals to community resources, and screen for growth, development, nutritional and emotional disorders.

That's a lot of responsibility. And changes in education have added to those responsibilities.

Today, more students with health issues can attend school. That's because school districts are working to make schools accessible to all students, regardless of any medical problems.

"Students in the educational system are now attending with a variety of health needs that were not common in the past -- students with diabetes, asthma, cerebral palsy, muscular dystrophy, students on pills, inhalants, injections and even ventilators," says Karyn Buxman. She's a registered nurse who has worked in schools.

"School nurses are needed more than ever today because many students with chronic health conditions require either regular medical assistance to safely manage their condition during the day or need assistance occasionally when their condition flares up," Smithey says.

In this important role, a school nurse also helps students struggling with serious issues like malnutrition, (overfed or underfed students), depression, grief, suicidal issues, pregnancy, threats of violence, learning difficulties, drug and alcohol abuse, and child abuse and neglect.

"School nurses are a vital link between a student, their family and [their] physician or health-care provider," Smithey explains. "For many students, the school nurse is literally a life-saver."

Although those needs often require experienced caregivers, that isn't always happening, says Buxman. "Much of the students' care is now being turned over to school secretaries, teachers and aides -- not licensed professionals."

"Each district needs to take a stand in support of nurses to care for children in the school setting," says school nurse Colleen Kahler says. "Good health is essential for optimal learning."

What's Behind the Shortage

Kahler says money -- or the lack of it -- is at the root of the shortage.

"There is a shortage of school nurses, because too many districts will not spend the money to hire nurses to care for children," she says. "There are lots of registered nurses ready to work in schools, but not enough schools willing to pay appropriately for those services."

Cuts in government funding are a major reason behind the nursing shortage.

"Schools are having a hard time keeping all their programs, and in some communities the nurses were first to go," says Kathleen Tone. She's a school nurse.

Retirement is also a factor for school nursing. "The average age of school nurses is increasing, so many are nearing retirement," Smithey says.

"As younger nurses come to fill their spots, there are concerns that the salaries, medical and retirement benefits are not sufficient enough to sustain a person through retirement. Many schools have simply not requested a nurse in recent years because of their budget constraints."

Taking Action

Some nurses feel that not enough is being done to address the shortage of school nurses.

"Schools are not working vigorously to correct this problem," Buxman says. "Hiring a nurse would probably mean having to cut a teacher or computers or other equipment."

To this end, the National Association of School Nurses is working toward obtaining state mandates requiring the presence of a nurse in every school.

"We need to convince the schools of our value and that our skills are so much more than they once were," says Tone.

Many school districts have adopted a peer-mentorship system to support longer and broader school nurse training and orientation. Some require their school nurses to become certified in school nursing.

School nursing is a specialty, Smithey says. "More and more states and employers are requiring school nurses to be certified in their specialty as a condition of employment.

. "The equipment and human resources you have to work with in a school setting are much different than in a hospital or clinic, plus you don't have physicians, interpreters, or other nurses nearby for second opinions or assistance."

Some school districts have applied for grants to obtain school nurses, contracted with employment agencies for nursing services, or have offered more appealing salary and benefit packages to attract candidates.

Breaking In

As a registered nurse and college teacher, Jay Ober has traveled throughout the U.S. and Canada to visit colleges and recruit new nurses. He has seen a growing interest in working in the field among males. Many males are attracted to the high-tech aspect that's part of the nursing field today.

Ober heads the International Academy for Clinical Simulation and Research at the University of Miami, Florida. At the academy, students gain first-hand experience working on robots that serve as patients.

Ober tells students that the field of nursing offers many opportunities to work not only in schools, but also universities, hospitals, clinics and the military. Nursing offers great opportunities for advancement as well, Ober says.

For school nurses, opportunities for work can be in different settings, including elementary, middle and high schools, as well as special education cooperatives and camps.

Before choosing a specialty like school nursing to work in, build a solid foundation in nursing.

"It is essential to have a strong clinical background in medical, pediatric, or emergency care prior to becoming a school nurse. Have strong social skills to work with students, staff, families and the community," Kahler says.

"The best opportunities for registered nurses wanting to work in schools come from those districts that hire certified school nurses."

Don't be afraid to try new experiences and learn new skills, says Smithey, who worked in different types of nursing before falling in love with school nursing.

"School nursing is a career in which you will feel connected to communities and families in ways you never felt before. You can see the direct impact you have on improving students' health, education, learning and well-being."


National Association of School Nurses
The national voice of school nurses

American Nurses Association
For information on all aspects of nursing

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