School Nursing is a complex practice in which professional nurses care for students from young preschool age through adolescence. There are various ideas and perceptions about the school nurse role, but it is quite a unique career path for professional nurses. School nursing practice has evolved, and the responsibilities have become much more extensive since its inception. The National Association of School Nurses (NASN) recently published a position statement on Healthy Communities to support the necessity of school nurses in our schools. “It is the position of the National Association of School Nurses (NASN) that healthy and safe communities are essential for the optimal health, well-being, academic success, and lifelong achievement of all school-age youth” (Healthy Communities – the Role of the School Nurse – National Association of School Nurses, p.1).
In the State of Delaware, there is legislation recognizing the importance of a professional nurse being present in each school. Delaware Title, Free Public School outlines the Delaware code specifically under 14-1310, stating that funding be allocated for at least one nurse per school building as school nurses support the whole school community. It is the school nurses’ mission to promote a healthy environment and optimize health so that students are ready to learn and the community partners around them are prepared as well (National Association of School Nurses, 2020).
For students with chronic conditions and/or disabilities, this law could not be more crucial. The number of medically complex students who attend school daily has greatly increased. The Centers for Disease Control and Prevention reported that “more than 40% of school-aged children and adolescents have at least one chronic condition” (Managing Chronic Health Conditions in Schools/Healthy Schools /CDC, 2020, para 1). A chronic condition can greatly impact a student’s success in achieving academic goals. Without nurses to support these students in school, they may not have the support needed to be present and ready to learn during instructional time.
School nurses care for students with a variety of disabilities and chronic diseases. Examples include Epilepsy, Cerebral Palsy, Diabetes, ADHD, Asthma, Concussions, Neuromuscular Disease, Anxiety, and many more. To support these students, school nurses must be competent in a wide variety of procedures and treatments. Management might include specific treatments such as enteral feeding management, medication administration and emergency medication management, catheterizations, and other specific disease management. Without a professional nurse in the school setting, some students living with specific diagnoses or disabilities may not have the same opportunities as other children for participation in educational opportunities. Every child deserves to attend school in a safe and competent environment.
Laws and legislation supporting these groups of students have continued to improve and change since the mid-1900s. In 1975, President Ford signed the law that enacted the Education for All Handicapped Children Act to protect the rights of individuals with disabilities. This Act is now known as the Individuals with Disabilities Education Act (IDEA) (U.S. Department of Education, 2023). The U.S. Department of Education continues to revise and update this law to better support those individuals with disabilities, which represents a large number of students who rely on these services. According to the National Center for Education Statistics, “In 2021-22, the number of students ages 3-21 who received special education and/or related services under the Individuals with Disabilities Act (IDEA) was 7.3 million, or the equivalent of 15 percent of all public-school students” (Students with Disabilities, p. 1).
Once a student has been identified as having a disability, they are evaluated to determine which supports they would need in the school setting to be successful. Then, a plan is developed to implement these supports and services during the school day. This can be either in the form of a 504 plan or an Individualized Education Plan (IEP). Section 504 of the Rehabilitation Act of 1973 protects individuals with disabilities. A 504 in the school setting is a plan that outlines accommodations for a student based on their needs in the general education setting. Educational professionals on the 504 team are often the school counselor and general education teacher and include other support professionals such as the School Nurse. If a student is referred for evaluation for an IEP, the student will be assessed to determine what services they would qualify for to meet their needs within the school setting. Title 14 of the DE code section 928 outlines more specific criteria for addressing special education services in Delaware. An IEP team can consist of a combination of educational professionals that may include the Special Education Coordinator, School Psychologist, General Education Teacher, Special Education Teacher, School Administration, School Nurse, Speech Therapist, Occupational Therapist, Physical Therapist, and other supportive members depending on the child’s needs. The student can receive these services outlined in this plan in both the general education setting and the special instruction setting.
The school nurse’s role is paramount on either team for students with chronic conditions. The school nurse is identified as the healthcare professional on the team, and their knowledge is invaluable to ensure that these student’s needs are met. NASN affirms the school nurse is the team member qualified to evaluate the health needs of the student, many of which may not be apparent without thorough health assessment. If the health-related barriers are not recognized, appropriately interpreted, and addressed, those students risk academic failure.
(IDEIA and Section 504 Teams – The School Nurse as an Essential Team Member – National Association of School Nurses, p. 1). School Nurses act as the healthcare advocate, specialist, and resource for other educational professionals on the student’s behalf. The school nurse will collaborate with both teams to review medical information, evaluate, and advocate for the student.
“Case management and care coordination are essential roles for the school nurse working with these children and their families” (Selekman et al., 2019). For students with complex needs, the nurse will complete an assessment and then create an Indi-vidualized Health Plan (IHP). Depending on the student’s medical diagnosis, an Emergency Action Plan EAP) may be created as well. Each plan defines specific goals for the student focused on their disease/condition management based on the school setting. Measurable outcomes will help to evaluate the student’s progress toward these goals. For example, a student with a seizure action plan should have an updated emergency management plan on file in the health office located in their health records for each school year. Once an IHP is created, the nurse will collaborate with each student’s educational team along with the student caregivers. They will educate the team members on the student’s diagnosis and management to create a safe and healthy school environment for that student. Specific components of the IHP can be incorporated into a student’s 540 plan or IEP to address their medical needs related to the identified disability. All students with disabilities will have the opportunity to thrive academically with the presence of a professional nurse as part of their educational team.
References
Healthy communities. Healthy Communities – National Association of School Nurses. (p. 1.). https://www.nasn.org/nasn-resources/professional-practice-documents/position-statements/ps-healthy-communities#:~:text=NASN%20POSITION,youth%20(NASN%2C%202022a).
Ideia and Section 504 teams – the school nurse as an essential team member. IDEIA and Section 504 Teams – The School Nurse as an Essential Team Member – National Association of School Nurses. (p.1). https://www.nasn.org/nasn-resources/professional-practice-documents/position-statements/ps-ideia
Managing Chronic Health Conditions in Schools | Healthy Schools | CDC. (2020, January 2). www.cdc.gov. https://www.cdc.gov/healthyschools/chronicconditions.htm
National Association of School Nurses. (2020). About – National Association of School Nurses. Nasn.org. https://www.nasn.org/about-nasn/about
Selekman, J., Shannon, R. A., Yonkaitis, C. F., & Ness, M. (2019). In School nursing: A comprehensive text (third, pp. 489–489). essay, F.A. Davis Company.
Students With Disabilities. National Center for education statistics (p. 1). https://nces.ed.gov/programs/coe/pdf/2023/cgg_508.pdf
U.S. Department of Education. (2023). Individuals with disabilities education act. Ed.gov. https://sites.ed.gov/idea/about-idea
