The Need for National “Scope of Care” Standards for School Nurses

By Nick Dobrzelecki, MBA, BSN, RN, Managing Partner and co-founder  

For the past couple of months we’ve addressed the need for school nursing reform and standards. In a nutshell, it’s high time that we have consistent guidance across every state regarding school nurse certification, education and specific job duties and roles. School nurses play a crucial role in children’s health, often the only medical professional that a child may have access to. 

Last month we addressed the need for national standards regarding the education level of a school nurse in the United States. This month we’re tackling what that nurse’s scope of care should be and why it should be defined and standardized. 

School nurses need defined roles, or a generally accepted “scope of care” regarding treating students in order to level the playing field for children nationwide. A standardized scope of practice would also provide school nurses with much-needed support and resources. The National Association of School Nurses has developed a framework for school nursing practices, incorporating a wide range of practice and performance standards that are essential in the specialty of school nursing, regardless of the role, population served, or specialty within school nursing. We’ve added our own thoughts to some of theirs, pinpointing what we feel are five important standards that should be adopted:

1. Education & Training: Nurses should be required to have a minimum level of education and specific training in common in-school health issues such as illness breakout, chemical burn treatment, bone injuries, skin lacerations, and concussion protocol — and be tested against these agreed-upon care points on a regular basis (i.e. annually). 
2. Whole Child Involvement: The scope of work of a school nurse should also include requiring the nurse’s input on developing IEPs, 504s etc., especially if any recognized learning disability is the result of a medical issue, behavioral issue or other health concerns. This would require a minimum level of education regarding common learning disabilities and behavioral issues, including how to spot them. 
3. Location of Care: Our nation’s schools should agree on where care can be received by the student. Should nurses be limited only to treatment within the school’s four walls? Or should they be allowed to execute home visits when the child isn’t able to get to school, or refer students to public health officials when warranted? 
4. Role in Community Health: A school nurse needs to remember that the students she/he serves are members of a broader community that needs to stay healthy. This means skills such as critical thinking beyond the school’s grounds, and using motivational interviewing to empower students to understand their personal health. School nurses should also focus on screening follow-up, developing solutions when social determinants/health equity issues are identified, and be required to stay current on public health research and evidence-based outcomes. 
5. Technology Use. Today’s healthcare is often executed with the help of modern technology. Whether technology is used via devices designed for pediatric use, using electronic health records to create better communication with students’ primary care providers or public health authorities, or using video-call technology to consult colleagues when needed, a nurse needs to embrace what tech can bring to the profession. Even using weather apps to check on recess conditions, or following school nurses on social media can be great resources.

We welcome any comments from you — do you agree with these thoughts? What ideas might you have to the contrary?