Lack of School Nurses May Endanger Student Well-Being

A new advocacy campaign in Virginia has refocused the role of school nurses as crucial healthcare providers in schools.

The campaign, led by school nurse Dana Holladay-Hollified, aims to require a school nurse in all Virginia public schools, especially in schools with higher numbers of students with chronic illnesses and those unable to access primary healthcare.

“In looking at the health of a child, if they’re not healthy then they can’t learn. And the role of a nurse is to help kids be healthy,” said Holladay-Hollifield.

Holladay-Hollifield released a Change.org petition for new legislation in Virginia to provide registered school nurses daily in schools, per the recommendations of the National Association of School Nurses, American Academy of Pediatrics, American Nurses Association and the Center for Disease Control (CDC).

The American Academy of Pediatrics’ June 2016 policy statement calls for a minimum of one full-time registered nurse in every school. The policy statement replaces a 2008 version that supported ratios of one school nurse to every 750 students. According to the updated policy statement, the use of a ratio for school nursing is insufficient to fill the increasingly complex health needs of students.

“The value of the school nurse cannot be overlooked. To do this is to compromise the health and safety of schoolchildren. Access to education is not possible without adequate healthcare,” said Erin Held, a former Philadelphia school nurse.

Current Virginia Standards of Quality, set for public schools by the state’s Board of Education, require a pupil-to-staff ratio for secretaries and guidance counselors, but do not require a school nurse in each school. The state suggests a ratio of one nurse per 1000 students.

Holladay-Hollifield’s petition, “A School Nurse in All of Virginia’s Public Schools,” addresses the negative consequences associated with a lack of properly trained nurses in school settings.

“In a school setting, we may be the only link to emergency medical care that a child or a staff has, and the problem is even more amplified when you try to get laypeople who act as emergency care providers to try to do that work. You can’t expect a teacher to act as a nurse in an emergency situation to the same level of training as a registered nurse,” Holladay-Hollifield said.

“We take care of children with all kinds of acuities including chronic asthma, daily feedings, and diabetes … these are tasks that can only be done by a nurse. The third leading cause of death in the U.S. is medical errors, and when you start thinking about delegating those tasks to unlicensed laypeople in Virginia, I can’t help but think that that could increase the chance of those errors,” Holladay-Hollifield added.

Leveraging the role of school nurses with the need for healthcare makes public schools the ideal environment for creating a lasting community health approach, according to the petition.

“Using the school is a good setting because it is where kids spend a majority of their time. When kids are healthier and can access primary care and healthy food, we know that their ability to be a learner both in and outside of school improves,” said Kristina Shelton, the Washington, D.C., Maryland and Virginia coordinator for Action for Healthy Kids, a nonprofit dedicated to promoting healthier schools.

School nursing is a key component of a coordinated school health framework and is included in the CDC’s recommended school health approach, the Whole School, Whole Community, Whole Child model.

“We are a wonderful public health resource. We save more money than we cost. When you look at the care we provide for children who have chronic illness, we reduce that long-term health cost that could spread throughout the community,” Holladay-Hollifield said.

Beyond providing critical health care, school nurses often find themselves aiding student victims of child abuse. In Virginia, school nurses are mandated to report children suspected of abuse and/or neglect. Local and state child protective services cannot act until a report is made, placing nurses in a critical role to prevent future harm to children.

The National Association of School Nurses summarizes the importance of school nurses in recognizing and reporting child abuse in a statement: “Prevention, early recognition, intervention and treatment of child maltreatment are critical to the physical well-being and academic success of students. Registered professional school nurses serve a vital role in the recognition of early signs of child maltreatment, assessment, identification, intervention, reporting, referral and follow-up of children in need.”

“My personal experience has been a role of helping staff to determine, document, and report properly any suspected case of child abuse,” Holladay-Hollifield said. “The school nurse is uniquely positioned to help students and families in need to find the resources and help before situations become dire.”

In many locations, particularly in Virginia where children are not guaranteed access to healthcare, schools are identified as primary locations to address student health issues, and the school nurse is often the only healthcare provider that a student sees on a regular basis.

“There are children who don’t have access to regular healthcare. They have not expanded the Affordable Care Act with Medicaid for children, and that group of people kind of gets lost between, and doesn’t have that access,” Holladay-Hollifield said.

Virginia’s school nurse services lag behind the nation’s leaders in child healthcare. The average school nurse to student ratio in Vermont is one to 275 and one to 419 in Massachusetts respectively, compared to one to 873 in Virginia.

“With healthcare and legislation all moving towards the promotion of primary care services, school nurses can directly deliver services to children on a daily basis. Within their own school communities, school nurses can identify trends in community health and promote health and wellness in these specific populations,” Held said.

Achieving the campaign’s goal of at least one registered nurse in every Virginia school rests on garnering more support for from community leaders, healthcare professionals and policymakers alike. Holladay-Hollifield spoke at a recent Virginia Department of Education Board Meeting, and support has risen from various health-related organizations.

“The Virginia Chapter of the American Academy of Pediatrics supports having a nurse in every school. We consider them an integral part of a child’s medical team providing on site care and observation of children. The absence of nurses in the school leads to greater early dismissal of children from the learning environment unnecessarily and general absenteeism from school that may be avoided. With the myriad of children with chronic issues and emergencies that arise, having a nurse in every school leads to safer schools and better health outcomes,” said Jane B. Chappell, executive director of the Virginia Chapter of the American Academy of Pediatrics in a written statement.

To date the petition has 1,306 signatures and dozens of public comments.

“I am a supervisor in school health. Our children and students need and deserve this level of care. In no other venue is care provided by unlicensed personnel at the level it is in our schools,” commented Robin Gilbert of Mechanicsville, Virginia.

“I have worked as a public health nurse in our community and observed first-hand the positive impact on maintaining a healthy population having a registered nurse in each school. During outbreaks and investigations, trained and experienced registered nurses are imperative,” wrote Colleen Kotb of Arlington, Virginia.

The campaign’s goal is to have a piece of legislation to be voted on when the Virginia state legislature convenes in January 2017.

“A great victory would be to acknowledge that we need to be there, that we are a requirement for the children. Just to get us into the schools so each school has a school nurse—and then educating why we need school nurses,” Holladay-Hollifield said.