School-sponsored Before, After, and Extended
School Year Programs – The Role of the School Nurse
It is the position of the National Association of School Nurses (NASN) that the registered professional school nurse (hereinafter referred to as school nurse) has the knowledge, skills and expertise to assess, plan, and evaluate the health needs of students in programming and activities beyond the regular school day (Clark, 2017). All students, including those with disabilities identified in accordance with the Americans with Disabilities Act (ADA) and Section 504 of the Rehabilitation Act, must have equal opportunity to participate in school-sponsored before, after, and extended school year programs. School-sponsored extended school year programs and before and after school programs that are a part of the school system should, at a minimum, engage the school nurse to act in an advisory capacity to address the health and safety needs of students (Afterschool Alliance, n.d.; American Nurses Association & NASN, 2017).
The National Center for Education Statistics (2017) estimated that, as of fall 2017, 50.7 million students would be attending public schools in the United States and an additional 5.2 million would attend private schools. For many students, time in school does not begin or end with the bell. In 2014, 10.2 million children (18%) participated in an after-school program, an increase from 2009 (8.4 million; 15%) and from 2004 (6.5 million; 11%). Nearly 1 in 4 families (23%) currently has a child enrolled in an after-school program (Afterschool Alliance, 2014). The Americans With Disabilities Amendment Act (ADA) that went into effect in January of 2009 resulted in increasing numbers of students being identified with medical conditions eligible for accommodations under the ADA or Section 504 of the Rehabilitation Act; and therefore, an increased need for school nurse involvement in developing Section 504 accommodation plans (Zirkel, Granthom, & Lovato, 2012). These federal laws mandate that schools must provide all students with equal opportunities to access all activities, both academic and extracurricular, including access to health services (Erwin, Clark, & Mercer, 2014). According to the U.S. Department of Education, Office for Civil Rights (2015), students with disabilities may not be excluded from participating in nonacademic services and extracurricular activities on the basis of disability. Persons with disabilities must be provided an opportunity to participate in nonacademic services that are equal to those provided to persons without disabilities. These services may include physical education and athletics, transportation, health services, recreational activities, special interest groups or clubs sponsored by the school, and referrals to agencies that provide assistance to persons with disabilities and employment of students.
School-sponsored extended school year programs and before and after school programs that are a part of the school system should, at a minimum, engage the school nurse to act in an advisory capacity to address the health and safety needs of students (Afterschool Alliance, n.d.; American Nurses Association & NASN, 2017). “School-sponsored” refers typically to the agreement between the school and the program irrespective of whether the personnel are contracted directly by the program or the school. The school nurse’s knowledge of the individual health needs of students uniquely qualifies the school nurse to coordinate care enabling students to fully and safely participate in school-sponsored programs outside of the school day (NASN, 2016). The Framework for 21st Century School Nursing Practice™ (NASN 2016) provides direction for the school nurse to support the health and safety needs of students. “They [school nurses] are leaders in the provision of health services and in the training and support of educational professionals who are educating these students” (Clark, 2017, p. 598). In addition to understanding the individual and population health needs of students, school nurses develop individualized healthcare plans (IHPs) and emergency action plans (EAPs) for students with acute, chronic or life-threatening health needs (Clark, 2017). The school nurse plays a vital role in preparing school personnel working in school-sponsored before and after school and extended school year programs with the necessary resources to respond to health emergencies and reduce the risk of injuries.
The school nurse is qualified to collaborate and consult on many issues including, but not limited to, the following:
- Response to health-related emergencies, including first aid and CPR
- Disaster preparedness
- Recognition of signs and symptoms of child abuse and neglect and mandated reporting responsibilities
- Blood borne pathogen awareness
- Medication administration (if allowed depending upon each state nurse practice act) including proper training, handling, and storage
- Confidentiality of health information
- Chronic health conditions such as asthma, diabetes, seizure disorders, gastrointestinal diseases (e.g., Crohn's disease), and cardiac disorders\
- Severe allergy protocols and anaphylaxis management
- Communicable diseases
- Nutrition and food safety
- Mental health and substance abuse screening and referral
- Environmental safety issues
- Injury prevention
The school nurse also has the knowledge and expertise to determine staffing and resources necessary to meet the health needs of students. Depending on the state nurse practice act and other applicable state laws, it may be appropriate or essential for the school nurse to engage in or monitor direct care in accordance with the student’s IHP, EAP or specific medical needs. The local educational agencies should provide adequate financial compensation for school nursing services that are required beyond the regular school day or regular calendar year contract. The compensation received should be comparable to that received by teachers and other professional staff that are providing extended school day or school year services (Clark, 2017).
School nurses have the knowledge, skills, and expertise to assess, plan, and evaluate the health needs of students in programming and activities beyond the regular school day (Clark, 2017). Given the legal requirements to meet the accommodations standards set forth in the Individuals with Disabilities Education Improvement Act (IDEIA), Section 504, and the ADA and to promote access for all students, school nurses are required to address the health needs of students participating in activities and programs outside the regular school day. School nurses, in conjunction with students’ healthcare providers, are the professionals responsible for determining health services for students with identified health needs. They can also provide necessary training and support to ensure the safety of all students in school-sponsored programs. Extended school year programs and before and after school programs that are a part of the school system should, at a minimum, engage the school nurse to act in an advisory capacity to address students’ needs (Afterschool Alliance, n.d.).
ADA Amendments Act of 2008. Retrieved from http://www.eeoc.gov/laws/statutes/adaaa.cfm
Afterschool Alliance. (n.d.). Afterschool & health: Opportunities for advocacy. Retrieved from http://www.afterschoolalliance.org/policyActiveHoursObesity
Afterschool Alliance. (2014). America after 3PM: Afterschool programs in demand. Retrieved from http://afterschoolalliance.org/documents/AA3PM-2014/AA3PM_National_Report.pdf
American Nurses Association & National Association of School Nurses. (2017). School nursing: Scope and standards of practice, 3rd ed. Silver Spring, MD: Author.
Clark, E. (2017). School-sponsored before, after and extended school year programs. In C.A. Resha & V.L. Taliaferro (Eds.), Legal resources for school health services, (pp. 597-601). Nashville, TN: SchoolNurse.com.
Erwin, K., Clark, S., & Mercer, S.E. (2014). Providing health services for children with special health care needs on out-of-state field trips. NASN School Nurse, 29(2), 85-88. doi: 10.1177/1942602X13517005
National Center for Education Statistics. (2017). Fast facts: Back to school statistics. Retrieved from https://nces.ed.gov/fastfacts/display.asp?id=372
National Association of School Nurses. (2016). The role of the 21st century school nurse (Position Paper). Silver Spring, MD: Author. Retrieved from https://www.nasn.org/nasn/advocacy/professional-practice-documents/position-statements/ps-role
Rehabilitation Act of 1973, 29 U.S.C. § 504
U.S. Department of Education, Office for Civil Rights. (2015). Protecting students with disabilities. Retrieved from https://www2.ed.gov/about/offices/list/ocr/504faq.html
Zirkel, P.A., Granthom, M.F., & Lovato, L. (2012). Section 504 and student health problems: The pivotal position of the school nurse. The Journal of School Nursing, 28(6), 423-432. doi: 10.1177/1059840512449358
Acknowledgment of Authors:
Elizabeth McDermott, BA, BSN, RN, NCSN
Marianne Manzi, MEd, BSN, RN, NCSN
Elizabeth Zeno, MA, BSN, RN
Cheryl Resha, Ed.D., MSN, RN, FNASN
Adopted: January 2014
Revised: June 2018
Suggested citation: National Association of School Nurses. (2018). School-sponsored before, after, and extended school year programs— The role of the school nurse (Position Statement). Silver Spring, MD: Author.
All position statements from the National Association of School Nurses will automatically expire five years after publication unless reaffirmed, revised, or retired at or before that time.