The Relentless School Nurse: Let’s Get to The Crux of the Disconnect Between Health Services and Educational Services

Pat Hamilton, an Iowa School Superintendent, is choosing to reduce school nursing hours in order to “emphasize what our top priority needs to be, which is teaching and learning.”

I listened to the circular conversation several times and could not help but feel that the disconnect between health and learning is the crux of the problem that stands, like a huge brick wall between school health services and educational services. You cannot have learning without health. Most urgently students need to be healthy and feel safe in order to be ready to learn, a long held message from the National Association of School Nurses. 

Cutting school nursing hours in order to save budgets directly impacts students. The rationale is that the nurses only need to be in buildings when children are present, so the first and last thirty minutes of the day are not needed. What a flawed premise. First of all, everyone needs time and space and uninterrupted time to plan their day. School nurses are not machines that cannot turn on and off when the school bells ring.

School nurses are also an integral part of the school community and spend time providing care coordination services and case management to both students, staff and families. Yes, we are there for the children, but we are also part of what should be, a holistic approach to bridging health and learning. We are not a summation of our tasks performed. Many of our responsibilities are less tangible and more complicated to quantify. Does that make them less important? I believe that no matter what I plan on a given day, my true work comes in what interrupts my plans in order to serve the vast needs of my school community.

It is beyond time that educators and administrators take a deeper look at the full scope of school nursing practice. We are an investment in student achievement, not a mere cost center located on an inanimate excel spreadsheet. Our work is vital to the well being of the school community. We breathe life into what it means to create a school community of connected learners. There is no learning without healthy students. That is our role, to ensure the health, safety and wellness of our students, staff and be that bridge to families and outside healthcare providers. 

In the midst of a mental health crisis, this is not the time to reduce hours of school nurses, often the only healthcare professional in buildings. Recently, my dear colleague, Nurse practitioner, Eileen Gavin, the in-coming President of the New Jersey State School Nurses Association, testified in front of the NJ State Education Committee about the mental health crisis in schools. Her words, reprinted with permission, need to be shared in districts across the country who are thinking about decreasing the school nursing workforce:

Prior to the COVID-19 pandemic, mental health challenges facing children and teens were a growing concern. School nurses spent up to 34% of our time on mental health issues.  The pandemic only exacerbated what was already escalating. Soaring rates of depression, anxiety, trauma, loneliness and suicidality will have lasting impacts on our youth, their families and school communities. We know that schools are among the best resources for families in our communities and school nurses are well-positioned to intervene in this public health crisis. 

Everyday it is common to have the school nurses be the first professional touchpoint to identify concerns, determine interventions, and link families to resources.  Students often present to the school nurse with physical complaints when they may be suffering from a mental health problem. The percentage of time school nurses now spent on mental health issues have skyrocketed over the last three years.

We cannot separate mental health from physical health. In order for our children to flourish, they must be healthy, safe and ready to learn. This is our charge as school nurses!  Today’s reality is that our charge is challenged by a mental health crisis that is revealing highly concerning behaviors that have impacted almost 11% of our students according to the just released National Kids Count Report.  This is a 40% increase since 2016 but this does not reflect the depth of the data from the last 3 years.   While the data is concerning, we must give “oxygen to hope,” that we can come together as a State that cares for all of our children. The consensus study has specific recommendations that are important to have the Senate Education Committee review and consider:

• 1st, “We need to prioritize meet­ing our students’ basic needs. Youth who grow up in pover­ty are two to three times more like­ly to devel­op men­tal health con­di­tions than their peers. Chil­dren need a sol­id foun­da­tion of nutri­tious food, sta­ble hous­ing and safe neigh­bor­hoods — and their fam­i­lies need finan­cial sta­bil­i­ty to fos­ter pos­i­tive men­tal health and wellness.
• 2nd, We need to ensure every child has access to the men­tal health care they need, when and where they need it. Schools should increase the pres­ence of school nurses, social work­ers, psy­chol­o­gists and oth­er men­tal health pro­fes­sion­als on staff and strive to create inter-professional teams that provide real-time, on-site or virtual care in the moment of need.
• 3rd, We need to bol­ster men­tal health care that con­sid­ers young people’s expe­ri­ences and iden­ti­ties. It should be trau­ma-informed — designed to pro­mote a child’s heal­ing and emo­tion­al secu­ri­ty — and cul­tur­al­ly rel­e­vant to the child’s life. It should be informed by the lat­est evi­dence and research and should be geared toward ear­ly inter­ven­tion, which can be espe­cial­ly impor­tant in the absence of a for­mal diag­no­sis of men­tal illness.”

Integrating care and creating inter-professional teams will help to decrease the stigma to accessing mental health services. Identifying mental health problems before they spiral further is key in helping our students succeed. But we must also consider the needs of the school staff.

We need to look through a new lens for answers, a public health lens that centers the population health challenges we currently face. We are living in a world shaken by a lengthy global pandemic, the grief of losing so many family caregivers for our children and added to that a disconnected student body who are overly dependent on technology that may be fueling the very mental health crisis we are witnessing today. – Eileen Gavin, MSN, RN, FNP-BC, NCSN

Let’s revisit the importance and urgency for appropriate, safe, and effective school nursing services in school districts across the country. While school nurses may seem like the lowest hanging fruit in the orchard of budget cuts, it is a misguided and unsafe cut that can impact the health and well being of your students, staff and school communities. We need to be present to make a difference, not left on the floor of a tattered excel spreadsheet that is not representative of the true returns on investments that schools realize when they have a fully staffed health services department. Let’s meet this moment, long past due, by supporting the presence of at least one school nurse in every building, every day.