The observed site was the Woodbridge High School in Woodbridge, NJ where the school nurse was interviewed. The school nurse has a wide variety of responsibilities which cover primary, secondary, and tertiary care. Most often it is tertiary care by responding and administering care to students and staff as needed. This ranged from offering first aid to administering minor medication if permitted by the state regulations and a student’s medical status and permissions (i.e. allergy medication). If a student has a chronic ongoing condition, a nurse is notified of this, and a care plan is in place for the student while they are on school grounds to either manage the condition or how to act if the illness is exacerbated. The second most common type of care offered by school nurses is primary care, focused on prevention. This includes monitoring immunization records as a prevention mechanism as well as offering comprehensive education and health awareness initiatives. The school nurse would often ensure seasonal awareness of flu shots and offer short educational seminars in classes about hygiene techniques.
Finally, the nurse engages in secondary care, consisting of screenings. Hearing, vision, and basic health screenings which are conducted through the school system are conducted by the school nurse, and although simple in nature can help identify potential issues in those students who either lack or choose not to access healthcare providers and redirect the students and parents to a specialist. The combination of primary and secondary care that a school nurse offers is vital from a public health perspective since adolescents are often susceptible to disease and changes in their organisms but can struggle in seeking medical help or advice. As a free resource at the school, the nurse is a frontline public health worker that aids in disease prevention.
To fulfill all the responsibilities listed above, school nurses must have a registered nurse (RN) license and have knowledge or experience in a variety of areas of health, including mental health. BLS and CPR certifications are commonly a must alongside knowledge of state health policies as well as the regulations of the school district. Experience is helpful but not vital since there is a general shortage of nurses, especially ones willing to work in schools. School nurses should have excellent communicative skills and the ability to work with underage individuals. Specific technical skills are not required but administering medication and knowing how to conduct screenings is necessary.
School nurses are commonly given relative autonomy in their roles, but they are bound by the commonly strict school district and state regulations that limit their actions. Essentially, school nurses cannot go outside the boundaries and responsibilities described above, even if it is giving aspirin to someone with a headache without predetermined approval. This can be extremely limiting but the system is set up to ensure the safety of students and avoid legal liability for the school. It is the biggest issue, in my opinion, that school nurses are so limited. Therefore, students may not always get the care they need right away. If the responsibilities and therefore qualifications of the school nurse were to be expanded, even as they are in primary care offices such as conducting a variety of screenings, establishing a diagnosis, and prescribing medication, this would improve the quality of care in schools, provide greater access to care for adolescents, and potentially relieve some of the pressure on the family healthcare system.
Overall, even with limited constraints, school nurses contribute more to public health than most realize. This role deserves significant respect since they are often forced to work in much worse conditions (even the tools they have at their disposal) for lower pay than typical nurses. Cultural issues were problematic at times due to a high diversity of students, with some not even speaking English well. However, there was a translator available for Hispanic students, and the level of care is so basic that cultural misunderstanding was not an issue. School nurses can have a profound impact on promoting more public health initiatives to students and parents, serving as a messenger for vital health initiatives.