Source: Robin Fleming, school nurse, Seattle Public Schools
As front-line providers in child health, school nurses protect the health and promote the educational outcomes and life opportunities for the nation’s 49 million public school students. When children are healthy, it is empirically established that they have higher rates of academic achievement. Students in schools with school nurses and other school-based health providers are healthier on measures of health status, access to care, school attendance, and they engage in fewer risky behaviors. On the flip side, students who are unhealthy face numerous social and academic risks. Research consistently demonstrates that untended health problems originating in childhood usually worsen over time, interfere with academic success, and sustain the health disparities that are disproportionally allotted to the growing numbers of poor and ethnic minority children who populate schools. This puts undue strain on the nation’s economy, unnecessarily helps to feed an already bulging criminal justice system, and lays to waste the potentially limitless talents and contributions that are left to wither in growing numbers of health-impaired children attending financially burdened school systems.
The School Nurse Organization of Washington estimates that approximately 500 to 1,000 school nurses tend to the health and academic preparation of 1 million public school children. School nurses develop plans of care for students with potentially life-threatening conditions and chronic illnesses. They provide health assessments for thousands of children statewide with individual education plans; provide health education to students and staff, and provide referral and case management services. They also manage and monitor communicable disease outbreaks to protect the health of students and staff, as has been recently highlighted by the presence of H1N1 influenza. School nurses also provide health promotion and disease prevention services and tend to acute care emergencies. They support the safety of school buildings and communities, participate on school committees, and advocate for the health of many of the state’s most vulnerable children and families. All school nurses in Washington state are required to have a minimum of a bachelor’s degree in nursing. Many more have master’s degrees, some have credentials as nurse practitioners, and others have doctorates.
At a time when school districts are reporting increased numbers of children with mental and physical health problems (approximately 20 percent of children have a diagnosable physical or mental health condition), and an increase in the severity of health problems such as asthma, diabetes, and an epidemic of obesity, proposed reductions in the state budget are bound to have deleterious effects on delivery of school health services, and consequently on the health and academic success of school children.
Because schools exist to educate students, their funding priorities are naturally assigned to teachers, instruction, curricula, and other academic supports. While this makes sense, it also reinforces the notion that an academic response at the school level is the most effective answer to the problem of academic disparities and underachievement. Because research establishes student health as a necessary component to academic engagement and achievement, school health services are not simply ancillary; they are as necessary as are academic strategies in meeting the goals of improving academic outcomes for all students -- goals that have eluded educators for decades.
These goals do not need to remain out of our grasp, even in this time of state and national budget crises. Educators and school nurses are scrambling for funding to maintain core services, let alone add urgently needed new ones. While schools rely on funding primarily from two sources -- the state general fund and tax levies -- school nurses are dependent on multiple federal, state, district, and grant sources to sustain their services. School nurses in Washington already far exceed the nurse to student ratio of 1-to-750 recommended by the National Association of School Nurses. It is tempting in such difficult financial times to adopt a myopic vision that emphasizes institutional and professional self-interest in promoting student achievement: Educators want funds for education, and nurses want funding for health services. As research has shown, however, funding alone has its limitations on both academic and health outcomes. Research also has shown that resource sharing, collaborative partnerships and a culture of caring have positive impacts on student achievement. Working together to achieve collective goals is more important in times of financial hardship: It can help to build and sustain a united foundation that eventually promotes improved political clout, secures more reliable sources of funding and provides greater access to community resources.
One organization that is helping to promote a more integrated approach to health and education in Washington is Healthy Schools Washington. At its annual Healthy Schools Summit (to be held this year May 27 and 28), educators and a variety of school health providers learn about and explore topics relevant to promoting academic success through coordinated school health programs. This is a healthy start to building collaborative relationships. We teach our children to mix with others, to listen to their perspectives, and to problem solve as teams. It is important that we model the behaviors we advocate and advise. In so doing, we may at last get the results that we have worked so long and hard for.
