It is the position of the National Association of School Nurses (NASN) that healthy and safe communities are essential for the optimal health, well-being, academic success, and lifelong achievement of all school age youth (NASN, 2022a). Bridging education and healthcare, the registered professional school nurse (hereinafter referred to as school nurse), is uniquely situated to protect and promote student and community health, to work collaboratively to respond to public and population health needs, and to contribute to building an equitable culture of health that places “well-being at the center of every life, decision and policy” (NASN, 2022b, p. 100).
Healthy communities strive to provide safe, healthy, and supportive physical and social environments that enable all people to develop and thrive (Cassells, 2019). An actionable blueprint for healthy communities in the U.S is articulated in Healthy People 2030, a national healthcare framework that is updated every decade. This plan is comprised of evidence-based measurable goals and objectives to build a “society in which all people can achieve their full potential for health and well-being across the lifespan” (Office of Disease Prevention and Health Promotion, n.d., para 4).
The circumstances in which people are born, grow, work, live, and age are often referred to as social determinants of health (SDOH) (World Health Organization, 2022). These non-medical, upstream population-level social, political, and structural factors shape the conditions of daily existence and impact the opportunities and choices people have to lead healthy lives. Examples of SDOH include education, housing, transportation, employment, access to health care services, and food (Centers for Disease Control and Prevention, 2021). The availability and quality of SDOH in a community have a greater impact on long term health than clinical healthcare and are responsible for about 80% of health outcomes (County Health Rankings, 2022). A data map from the Centers for Disease Control and Prevention vividly demonstrates that life expectancy, a health status indicator (Li et al., 2018), differs depending on the communities where people live (Tejada-Vera et al., 2020).
School nursing addresses the health and social needs of individual students and their families and also incorporates a population and public health approach along a continuum of care that includes upstream prevention and system-level interventions (Campbell & Anderko, 2020; Ackerman-Barger et al., 2022). Community/public health is a key principle of NASN’s Framework for 21st Century School Nursing PracticeTM (NASN, 2016; NASN, 2020) and school nurses are vital partners in “the complex work of integrating the social and health sectors in support of the health and well-being of individuals, families, and communities'' (National Academies of Sciences, Engineering, and Medicine, 2021, p. xv). Data-informed evidence-based interventions that address barriers to health and learning, and that help build community conditions that create a healthy place to live, can lead to better lifetime educational and health outcomes for school-age youth (Rattermann et al., 2021). Health issues can pose significant barriers to learning that “affect children’s ability to see, hear and pay attention in the classroom, their ability and motivation to learn, their attendance, their academic performance, and even their chances of graduating from high school” (National Academies of Sciences, Engineering, and Medicine, 2019, p. 2-3). Children who encounter these types of health barriers to learning can benefit greatly from school nursing expertise and intervention. School nurses may also attend to population-level student health concerns, driven by social and economic conditions in communities by supporting the development of policies, regulations, and laws that foster the health of school age youth and families (Castrucci & Auerbach, 2019).
Each community uniquely possesses strengths as well as challenges in handling preventable risks and harm that can lead to obesity, chronic diseases, substance misuse, mental health disorders, violence, injury, and the spread of infectious illnesses. By striving to provide clean air and water, sanitation services, and access to healthy foods, recreation, transportation, adequate healthcare, and quality education, including a full time school nurse, communities contribute to the foundation of health for the nation’s youth, which enables children to learn better (Selekman, et al., 2019). Fostering the circumstances in which children achieve better academically supports the development of a stronger, more productive citizenry (Maughan et al., 2018; Kolbe, 2019). Healthy People 2030 affirms that “the health and well-being of all people and communities is essential to a thriving, equitable society” (Office of Disease Prevention and Health Promotion, n.d., para 11). In addition to the benefits for society, the Whole School, Whole Community, Whole Child (WSCC) model for addressing student health in schools brings the focus back to the long-term development and success of the whole child so that all children can be healthy, safe, supported, engaged, and academically challenged (ASCD, 2022).
The communities where children and families live, learn, work, and play strongly influence many aspects of physical and emotional health and well-being. Healthy communities provide the infrastructure and resources that create the conditions and opportunities to support healthy lifestyles. School nurses are indispensable partners in improving and enhancing school and community health by effectively collaborating across sectors to address barriers to health and learning and improving health processes and outcomes. School nursing is vitally integral to helping advance and sustain healthier, more equitable places to live (Schroeder et al., 2018). These efforts align with a vision where all students can be optimally healthy, safe, and ready to learn (NASN, 2022a).
Ackerman-Barger, K., Cooper, J., Eddie, R., Gualtieri, C., Martin, L., Nichols, B. & Perez, G. (2022). Building coalitions to promote health equity: A toolkit for action. https://campaignforaction.org/wp-content/uploads/2022/04/AARP_CCNA_HealthEquityToolkit_Revi_051122.pdf
ASCD. (2022). The ASCD whole child approach to education. https://www.ascd.org/whole-child
Campbell, L. & Anderko, L. (2020). Moving upstream from the individual to the community: Addressing social determinants of health. NASN School Nurse. 35(3),152-157. doi: 10.1177/1942602X20902462
Cassells, H. (2019). Community assessment. In M. Nies & M. McEwen (Eds.), Community/public health Nursing: Promoting the health of populations (pp. 92-106). Elsevier.
Castrucci, B. & Auerbach, J. (2019). Meeting individual social needs falls short of addressing social determinants of health. Health Affairs Blog. doi: 10.1377/hblog20190115.234942 https://www.healthaffairs.org/do/10.1377/hblog20190115.234942/full/
Centers for Disease Control and Prevention (2021). Social determinants of health: Know what determines health. https://www.cdc.gov/socialdeterminants/about.html
County Health Rankings. (2022). County health rankings model. https://www.countyhealthrankings.org/explore-health-rankings/measures-data-sources/county-health-rankings-model
Kolbe, L. (2019). School health as a strategy to improve both public health and education. Annual Review of Public Health, 40(1), 443–463. https://doi.org/10.1146/annurev-publhealth-040218-043727
Li, Y., Pan, P., Wang, D., Liu, X., Dhana, K., Franco, O., Kaptoge, S., Di Angelantonio, E., Stampfer, M., Willett, W., & Hu, F. (2018). Impact of healthy lifestyle factors on life expectancies in the US population. Circulation, 138(4), 345–355. https://doi.org/10.1161/CIRCULATIONAHA.117.032047
Maughan, E. D. (2018). School nurses: An investment in student achievement. Phi Delta Kappan, 99(7), 8–14. https://doi.org/10.1177/0031721718767853
National Academies of Sciences, Engineering, and Medicine. (2019). School success: An opportunity for population health: Proceedings of a workshop in brief. The National Academies Press. https://doi.org/10.17226/25370
National Academies of Sciences, Engineering, and Medicine. (2021). The future of nursing 2020-2030: Charting a path to achieve health equity. The National Academies Press. https://doi.org/10.17226/25982
National Association of School Nurses. (2016). Framework for 21st Century School Nursing Practice™: National Association of School Nurses. NASN School Nurse, 31(1), 45-53. doi: 10.1177/1942602X15618644
National Association of School Nurses. (2020). Framework for 21st Century School Nursing Practice™: Clarifications and updated definitions. NASN School Nurse, 35(4), 225-233. doi: 10.1177/1942602x20928372
National Association of School Nurses. (2022a). About NASN. https://www.nasn.org/about-nasn/about
National Association of School Nurses. (2022b). School nursing : Scope and standards of practice, 4th edition. National Association of School Nurses.
Office of Disease Prevention and Health Promotion. (n.d.). Healthy People 2030 Framework. https://health.gov/healthypeople/about/healthy-people-2030-framework
Rattermann, M., Angelov, A., Reddicks, T. & Monk, J. (2021). Advancing health equity by addressing social determinants of health: Using health data to improve educational outcomes. PLoS One. 16(3), e0247909. doi: 10.1371/journal.pone.0247909. PMID: 33730057; PMCID: PMC7968680.
Selekman, J., Chewey, L. Cogan, R., & Conway, S. (2019). School nurse collaboration with community partners. In J. Selekeman, R. Shannon & C. Yonkaitis (Eds.), School Nursing: A Comprehensive Text (pp116-133). F.A. Davis.
Schroeder, K., Malone, K., McCabe, E. & Lipman, T. (2018). Addressing the social determinants of health: A call to action for school nurses. Journal of School Nursing, 34(3), 182-191. doi: 10.1177/1059840517750733
Tejada-Vera, B., Bastian, B., Arias, E., Escobedo, L. & Salant, B. (2020). Life expectancy estimates by U.S. Census Tract, 2010-2015. National Center for Health Statistics. https://www.cdc.gov/nchs/data-visualization/life-expectancy/#
World Health Organization. (2022). Social determinants of health. https://www.who.int/health-topics/social-determinants-of-health#tab=tab_1
Acknowledgment of Authors:
Wendy A. Doremus, DNP, RN, FNP-BC (retired), PHNA-BC (retired)
Mary Heiman, MS, RN, LSN, NCSN
Char Kizior, BSN, RN, NCSN
Camille Wheeler, MA, BSN, RN
Adopted: January 2018
Revised: January 2023
Suggested Citation: National Association of School Nurses. (2023). Healthy communities (Position Statement). Author
“To optimize student health, safety, and learning, it is the position of the National Association of School Nurses that a professional registered school nurse is present in every school all day, every day”
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.