SCHOOL NURSING Role of the scho

What is the role of a school nurse? Aberdeen teacher Tina

Stockman discusses her research into the different expectations school staff can have of the school nurse, and the problems this can cause

workload (see later). another report in SecEd last year carried details

of a campaign, More School nurses for better Child health, launched by the British Journal of School Nursing (Campaign calls for more school nurses, SecEd 231, november 19, 2009). The campaign advocated increased numbers of qualified nurses as well as the necessity for quality training. The campaign also sought to improve understanding of the role of the school nurse. It is this area of understanding – or perhaps

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misunderstanding – that motivated a small-scale action research exercise which examined the conflict of expectations between school nurses and their associated audiences.

Background

School nurses are a vital part of school life but their work is not always recognised. There is now an emphasis on “wellness” and less emphasis on dispensing medicines and first aid. School nurses are encouraged to participate in programmes concerning aspects of physical and mental health including sexual health and drug awareness. as well as delivering routine health checks and

immunisation programmes, they are involved in the implementation of health plans, liaison with external support agencies, and computerised record-keeping. even though government guidelines exist,

knowledge and interpretation of those guidelines can differ. The 2005 Ofsted report, Personal, social and health

education in secondary schools, contained an example of a school nurse providing an exceptional service not only to pupils but also to teachers, parents and outside agencies. Confidential support strategies were in place,

including a drop-in clinic as well as email and text contact. Further involvement included consultation in the PShe curriculum, delivery of wellbeing courses, and sex education programmes. These activities were performed in addition to all the other (unmentioned) tasks expected of a school nurse working in the public sector. The results of a census survey of RCn school nurses

undertaken in 2005 demonstrated the variation between the expectations of the nurses and those of their employers. The major problems were the lack of role definition and the blurring of role boundaries – inspite of official guidelines. More recently, the pressures under which school

nurses operate was illustrated by a report from the RCn showing that there was, on average, one school nurse for every 2,590 pupils. In Scotland, the extent of the school nurse’s role has

been acknowledged in an advisory document called A Scottish Framework for Nursing in Schools (the Scottish executive, 2003), but the extent to which the recommendations of this document have been accepted by education and health practitioners is unclear. Details of the Scottish government’s Getting It

Right for every Child programme have been available since September 2008. The programme provides a basis for work with

young people and builds on existing health and education services. The role of the school nurse is

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have been working in partnership with a school nurse on a programme for depressed adolescents. This collaborative work identified a need for greater understanding of the role of the school nurse, particularly in view of reports from the Royal College of nursing (RCn) about the school nurse

included, yet awareness of the programme – including the role of the school nurse within it – is uneven.

Aims and methods

The aim of our research was to: • Gain first-hand information regarding the role of the school nurse.

• Demonstrate the variation in expectations of the role of the school nurse and consequent tensions.

• Consider the findings of national research. Information was gathered using a short questionnaire

and we targeted, among others, headteachers and deputies across primary and secondary, as well as school nurses (practising and former), subject teachers, pastoral staff, learning support staff, other school staff, parents, and a pupil. The questionnaire consisted of the following

questions: •What is the main function of the school nurse in mainstream schooling?

•Which aspect of a school nurse’s work consumes most of their official time allocation?

• how are school nurses seen with regard to the whole school community?

• how aware are individual members of the school community of the changes in the school nurse’s role

Responses

Functions of a school nurse? The headteachers (primary and secondary), practising school nurse, subject teachers, pupil, and a member of the ancillary staff thought the main function of the school nurse was to carry out routine medical inspections and immunisation programmes. Pastoral and learning support staff thought the main

role was to promote healthy living through advice on general wellbeing, including drugs, sexual health, diet, oral hygiene, and smoking. The former school nurse, public health professionals

and parents said it was to attend to pupils who were sick or injured, including pupils with mental or physical disabilities. The deputy headteacher said it was to work with support agencies and other health professionals.

Where is their time spent? The headteachers, practising school nurse, subject teachers, parents, pupil, and member of the ancillary staff thought carrying out routine medical inspections and immunisation programmes consumed most of the school nurse’s time. The former school nurse pointed to pupils who were

sick or injured (including pupils with mental or physical disabilities). Learning support staff thought promoting healthy

living through advice on general wellbeing made up most of the school nurse’s time. Pastoral staff and public health professionals said it was the administration of records and health plans.

Who is the school nurse? The headteachers, public health professionals, pastoral staff, learning support staff, and the pupil saw the

operate was illustrated by a report from the RCN showing that there was, on average, one school nurse for every 2,590 pupils

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school nurse as a member of the extended care and support services. both the practising and former school nurse, the

deputy headteacher, subject teachers, ancillary staff, and parents saw the school nurse as an integrated member of the whole school staff. The headteachers (primary) and practising school

nurse were most aware of changes in the role of the school nurse, but the headteacher (secondary), pastoral, ancillary and learning support staff, and pupils recognised the emphasis on “wellness” rather

• Only the responses of the headteachers (primary) to all four questions corresponded with those of the practising school nurse.

The uncertainty surrounding expectations of the ’

nurse’s role led to role confusion on the part of some members of the school community. Some acted on the belief that the main function of the school nurse was to attend to pupils who were ill. also, there was a division in the interpretation of the

nurse’s professional status with some school personnel seeing the role as that of a provider of extended care and

SecEd • August 26 2010

than illness, including the delivery of sexual health programmes, routine health checks and immunisations. Pastoral, ancillary and learning support staff

were aware of greater participation in mental health programmes. The headteacher (secondary), subject teachers and

learning support staff were aware of less emphasis on dispensing medicines and first aid. Finally, the deputy head and public health

professionals were aware of the increased liaison with support agencies.

Analysis

Two points emerged from the responses to the questionnaire: • Only two reference groups had shared expectations of the role of the school nurse: headteachers (primary) and pupils.

The pressures under which school nurses