School nurses play an important role in supporting the health and wellbeing of children and young people, yet across Australia there is no consistent national approach to how school nursing is delivered, according to new research.
Speaking at the recent Australian Primary Health Care Nurses Association (APNA) Festival of Nursing in Melbourne, researchers Anita Moyes and Brent Hayward explored re-imagining school nursing in Australia, highlighting a fragmented landscape shaped by different models of care, increasingly complex student health needs, and an under-utilisation of the specialty.
Dr Moyes, who leads the Australian Nurses Working in Schools Project, a national research initiative investigating the scope, daily realities and diverse service delivery models of registered nurses working across government and non-government schools, shared new research with delegates examining what RNs working in Australian schools do in their typical working day.
A diverse and complex role
Published in The Journal of School Nursing, the study, “It’s the Most Diverse Job I’ve Ever Had”: What do Registered Nurses Working in Australian Schools do?, provides the first comprehensive national picture of school nursing practice in Australia.
The study interviewed 45 RNs with experience working in government and non-government schools across every Australian state and territory. Participants were asked to describe a typical working day, with researchers analysing their responses to identify different areas of practice undertaken.
Six distinct domains emerged: responding to diverse individual health needs; promoting health to groups; working with families; planning for health needs at school; collaborating for positive student outcomes; and facilitating service delivery.
Researchers say the findings highlight a multifaceted nursing role that extends far beyond treating playground injuries or caring for students who become unwell during the school day.
School nurses described responding to a vast range of health issues, including acute illness and injury and chronic conditions such as asthma, diabetes and epilepsy, through to complex disability and less common medical conditions.
Mental health and psychosocial concerns were also a significant part of the workload for many nurses, with participants reporting supporting students experiencing issues including anxiety, eating disorders, family and friendship breakdowns, body image concerns and other emotional difficulties.
Their work also extended to neurodevelopmental and behavioural conditions, sexual and reproductive health, medication management, immunisation, child protection, family and domestic violence, disability and learning difficulties.
“It’s the most diverse job I’ve ever had. This year alone I’ve given EpiPens for anaphylaxis, twice. We’ve had seizures… a cardiac arrest in [the] boarding [school]… skin infections like scabies [and] fungal infections… sexual health situations that needed follow up. Mental health… Mixed in with all of that is the usual ice packs, bumps and scrapes… I’ve never been more challenged in my life,” one study participant said.
“We found that nurses, far from just individual student consultations, were working extensively with families all along the student schooling,” Dr Moyes told delegates.
“They were running groups. They were working in the classroom. They were teaching CPR and adrenaline pen management. They were working with health professionals outside the school to try and optimise care for children and young people. And of course, they were instrumental in their schools, in improving liaison between teachers and student services teams and nurses to make sure that we’re all on the same page in a school and how we’re supporting a young person experiencing any type of health or physical disability or mental health care need.”
An underused nursing workforce
Despite the introduction of the National School Nursing Standards for Practice, first developed by the Australian Nursing and Midwifery Federation (ANMF) in 2012 and updated in 2019, researchers argue the standards remain underutilised, with a lack of a coordinated national approach continuing to create barriers to school nursing practice.
“I left the job because I wasn’t allowed to do what I believed were basic nursing duties. I was told no. And there was never an explanation. I was just told no, it’s not within my scope of practice,” one study participant said.
Another participant said: “I would hazard a bet that if you asked any other member of staff, including my line manager, what it is that we do in the health centre, there wouldn’t be much understanding of it.”
“Management don’t know what we do,” another participant said.
“A girl had taken an overdose at midnight and she came and told me. My first thoughts were, how was she clinically? Do I need a parent, or do I need an ambulance now? I had a manager phone me later to ask me if I did nursing observations, and I said yes. And I was told this is completely out of my scope of practise.”
Dr Moyes told delegates the latest research provides an evidence base for a broader conversation about how Australia approaches healthcare in schools – including funding, regulation, and legislation – so that the role of the RN can be better understood, supported and optimised to enable comprehensive practice.
“The main finding is that collectively school nurses in Australia are engaged in a complex, multidimensional role that extends well beyond individual student consultations,” the study states.
“However, this expertise remains underutilised due to the absence of school nurses in many schools and the absence of a national approach to school nursing in Australia.”
Read the latest paper here
