The Australian Nursing and Midwifery Federation (ANMF) released updated national practice standards for school nurses earlier this year to provide a contemporary overview of the unique role’s broad scope of practice and its significant impact in improving health and education outcomes for children and youth.
The ANMJ spoke to South Australian school nurse Anita Greco about the challenges and rewards of the vital role.
Why did you decide to become a school nurse?
I have always been very interested in paediatric nursing and the thought of being able to specialise in this field was very appealing.
Before becoming a school nurse, I had worked in ED, and had been working in an extremely busy surgical ward.
I felt I had the necessary assessment skills and clinical reasoning to be able to step into the autonomous role of a school nurse.
I also anticipated that the work life balance and hours of a school nurse was more conducive to life with a young family.
I saw the opportunity to further my knowledge in the paediatric specialty, and when I was awarded my role of school nurse, I decided I would do further postgraduate studies in paediatrics to further enhance my knowledge and suitability for the role.
Tell us about the school setting and community you work in and the nursing care you deliver to students?
I am currently working at Prince Alfred College (PAC) in South Australia, a single sex school from Reception to Year 12 with about 1200 male students.
The school also has an Early Learning Centre for children aged two to five which is co-ed.
About 155 of our students are boarding students.
We currently have three school nurses that work at different times throughout the day and most work as sole operators.
My role sees me at the frontline responding to any emergencies throughout the school.
I need to be able to care for students from the ages of two to 18 and be available for any staff or visitor emergencies or health concerns.
Typically, caring for the boarding community is one of our main focuses.
A large proportion of our students have chronic health issues such asthma, anaphylaxis and diabetes, all of which are managed from the School Health Centre. We have many boarders on regular prescription medications and it is the school nurse’s responsibility to ensure that these medications are dispensed correctly.
My role also involves caring for a very large cohort of students with allergies of varying severity.
As a school nurse, I am also available for after school sport and Saturday sport. Working at an all-boys school, we see a large variety of fractures, dislocations and soft tissues injuries and also see regular concussions and minor head injuries.
It is important that we are have the necessary assessment skills to ensure these injuries are treated correctly and referred on for medical review if required.
We also work closely with the school doctor who consults with unwell boarders twice a week.
School nurses also manage and facilitate immunisations for students and staff within the school community.
We are responsible for promoting influenza vaccinations within the school and manage the process of providing these to staff and boarding students.
What are the most important traits that a school nurse should possess to achieve the best health outcomes?
As with any role within the nursing profession, you need a caring personality.
We need to have exceptional clinical assessment skills and strong clinical reasoning. It is important to maintain high standards of professionalism and ensure that we remain empathetic to our students and their families when dealing with difficult situations.
It is also imperative to be organised.
A school Health Centre can be extremely busy and we can see upwards of 70 students a day.
It is important that we have strong documentation skills and are able to prioritise and triage workloads.
Perhaps one of the most important qualities of a school nurse is that we are good communicators.
For many students, the Health Centre is their ‘safe place’.
We need to be able to communicate effectively and at a variety of levels.
Whether we are speaking to kindergarten aged students or senior school students we need to be able to generate conversation that is appropriate to their level. In this way we can develop a professional therapeutic relationship with our students, and they are more likely to come and see us when needed.
We also need to empathetically liaise with parents, teachers and administration staff, especially when dealing with sensitive information.
Describe a typical day in your role as a school nurse?
As soon as we are on site, we are the first responders for any medical emergencies within the school.
Typically, when I arrive, I am greeted in the Health Centre by unwell or injured boarders who need assessment.
I need to triage and assess these students appropriately and decide who requires further attention and who can return to school.
We have a ward attached to our Health Centre, so any boarders who are too unwell to attend school will be admitted to the Health Centre ward for observations and further management throughout the day.
After these initial assessments, I continue to see our regular boarding students for their morning medications.
This is a good time to speak with them to see how they are feeling.
I will then spend some time sorting excursion first-aid kits for the day and detailing any medical conditions/allergies of students attending theses excursions for their teachers.
We continue to have regular presentations from students throughout the day.
Whilst we do the best we can to get students back to school, there are times where they need greater assessments and care.
We often need to liaise with school counsellors, psychologists and other medical professionals to ensure we are supporting our students appropriately.
Our role includes working with our school doctor to arrange emergency consultations for boarders, helping students with anxiety and mental health issues, working with parents to coordinate care for their children and responding to emergencies within the school.
What are the major health issues that you encounter and what are the benefits a school nurse can bring to their community?
Whilst we see many different health issues within our role, the major health issues include:
- Asthma management
- Allergy management and/or anaphylaxis
- Soft tissue injuries, dislocations and fractures
- Head injuries and concussions and
- Mental health issues
The benefit of having a school nurse on site to deal with these conditions is immense.
We can manage a student’s vital signs and act immediately and professionally to ensure the best possible outcome for the student. We are trained to respond in emergencies and have the knowledge to deal with these health issues.
School nurses provide the initial emergency response and care while waiting for an ambulance to respond.
What are the biggest misconceptions about what school nurses do from both the school community and broader nursing profession itself?
One of the biggest misconceptions about school nursing is that it is all about ‘band-aids and paracetamol’.
It is so much more than this! Many school nurses have post graduate qualifications and specialty training that equips them to deal with serious and difficult health issues.
We deal with complex allergies, diabetes, mental health issues, chronic asthma and many other health issues, and we need to have the confidence to be able to manage these conditions appropriately.
We provide health assessments, engage in health promotion and health education and are able to link families with community-based health and well-being services.
What are the biggest challenges facing the specialty?
School nursing is a very autonomous role. When there is an emergency, you are often alone to manage the emergency.
There is no ‘met team’ available to come to your support and you are frequently the only healthcare professional in the school.
This is a huge challenge. We need to have the confidence and the skills to respond unaided, in some very difficult situations.
There is also a lack of recognition or acknowledgement for the complexity of our work.
There are limited resources and physical support in our role and we are expected to have a very broad understanding of all health issues.
Whilst we may specialise in paediatrics, we are expected to be able to care for the whole school community, so a knowledge of adult, geriatric, maternal and neonatal health is also important.
What do you love most about your role as a school nurse?
I love being able to communicate with students and develop a professional rapport with them and their families.
It is very rewarding to know I have been able to help students and their families through some tough medical issues and have provided a safe place for them when necessary.
Many students with chronic issues come to the centre daily, and it is rewarding to know that I have made a positive impact on their emotional and physical health in general, not just their school life.
What pathway would you like to see the future of school nursing take over the next 10 years?
I would like school nursing to become more recognised and acknowledged as a specialty within the nursing profession.
In June 2019, the ANMF released the National School Nursing Standards for Practice, and this has been integral in raising the profile of school nurses within Australia.
I believe, with more exposure, the nursing community will understand and value the complex work that is involved in school nursing, and I look forward to school nursing growing as a specialty in the future.