There seems to be a misguided theme popping up in recent articles about School Based Health Centers (SBHC) and the collaboration with school nurses. The theme is that prior to the introduction of SBHCs, school nurses were relegated to providing basic care for run-of-the-mill conditions. Does this fall into the category of “fake news” or is there a lack of understanding of the scope and practice of what school nurses provide to a school community?
The most recent article that has been widely shared is about a wonderful SBHC in a Baltimore, Maryland KIPP charter school. The article was school nurse focused, which was refreshing and most welcome. The school nurse featured in the article presents herself professionally, clearly has a passion for her students, and linking health and learning.
Click here for the article:
School-Based Health Center Works to Keep Kids in Class, out of Emergency Rooms
The description of the SBHC in this article sounds like any school nurse’s nirvana - all-hands-on-deck, staff down the hall, administrative support, on-site Pediatrician, space, budget to support the operations and on and on. Wow, I would dream of this kind of collaboration, wouldn’t you? I read with great delight of the synergy between the various staff meeting together to provide the best care for the students until this line: “At least at these schools, the days are gone when a school nurse could only offer basic care for scrapes, fevers and stomach aches.” Then the air went out of my enthusiasm balloon, and the reality of the continued misperception of school nursing was front and center again.
We know the issue - misinformation, misunderstanding, misguided perceptions or assumptions. But what can we do as a group to change the conversation? Can we tackle this misconception by having an honest discussion about how we need to understand the current “culture of nursing?” Does the “culture of nursing” lead to categorizing the importance of a nurse based on licensing and/or level of education? Is the NP more effective than the school nurse based on his/her licensing? Isn’t experience in school nursing also valuable? Where did this hierarchy come from and how do we move to a flat hierarchy, where all contributions are equally valid and impactful to improve student health outcomes?
The “Culture of Nursing” is an important conversation that is not only timely but essential if we are to leverage our position as the most trusted profession. Can we as a profession stand together for student care? Collaboration means moving from practicing in silos to working for the health of the population in which we serve. I intend to contribute to a “Culture of Nursing” that reflects collaboration based on professional courtesy and collegiality.
School nursing is undergoing a significant transformation. The schools that are fortunate to have SBHCs that are as well-funded and staffed as the one described in this article are clearly the gold-standard of community-based care. Primary care within a school does not negate the need or impact of having a school nurse as the coordinator of this care. Nurse-managed primary care is an ideal that all schools can choose to provide to their students and families.
School nurses strive to provide a high level of care to their students, staff, and families whether or not they have an SBHC or are the sole provider covering 4,000 students in multiple buildings. The level of complexity that 21st Century school nurses face in caring for students is high, they may have limited supplies, but not limited skills.