A Lack Of School Nurses Puts Pupils At Risk

Why are our children being short-changed?

Daily access to a registered professional school nurse can significantly improve pupils’ health, safety, and abilities to learn.

A new report from the Nuffield Trust and the Association for Young People’s Health (AYPH) recommends that every school adopts a health-promoting ethos. It says that there “is an urgent need to prioritise and invest in the 10–24 age group to create a future healthy adult population.”

No one can argue with that. We all want healthy schools but like other things, it’s a postcode lottery. The report found that British children are far more likely to die from asthma compared with their peers in other developed countries. A key part of this is the lack of access to a school nurse. Out of the 32,000 schools in the country, only 1,500 have school nurses which is simply dreadful.

I feel sick

As every teacher knows, the default answer to whenever a child says, “I don’t feel well” is “Let’s see how you are in a bit. Perhaps some fresh air at playtime will help.”

Teachers are not health care professionals and although most of us can manage a bit of first aid and some sympathy, we are out of our depth.

Schools need someone trained to do the job and nurses play an essential role in protecting the health and wellbeing of students. You would imagine therefore that with all the attention focused on wellbeing we’d be well set up. You’d imagine that we’d have a Specialist Community Public Health Nurse (SCPHN) and a Mental Health Nurse in every school. Yes, that’s right – in your dreams. On the privileged will have more than one nurse. Count yourself lucky if you have just one. If you do, this nurse is probably dealing with everything.

Nurses in schools are rare than hen’s teeth. They are pretty rare in hospitals too. If teachers think we have the monopoly on recruitment and retention then take a look at the nursing crisis. Nursing is on the brink.

Short-sighted cost-cutting will always leave a mess and this has certainly been the story of both education and the NHS. Schools need nurses but only a few can actually afford them. Nurses were never supposed to be a luxury and a nice thing to have but that’s how it looks for most schools now.

Barmy cuts to health budgets means school nurses are almost some sort of distant memory. Local authorities don’t have the money and schools have been bled dry. Some teachers won’t have ever worked with a nurse in their school before.

What do school nurses do?

Loads. Nurses carry our health assessments and provide immunisations. They offering important education and advice on healthy living and diets. They are there if needed and they are so much more than nits, jabs and tummy aches. There is plenty more a nurse does.

According to Getting it right for children, young people and families, the fundamental role of the school nurse is to improve children and young people’s health and wellbeing by:

• leading, delivering and evaluating preventative services and universal public health programmes for school-aged children and young people, within both school and community settings;
• delivering evidence based approaches and cost effective programmes or interventions that contribute to children and young people’s health and well-being e.g. reduction in childhood obesity, reduction in under 18 conception rates, reduction in prevalence of chlamydia and management of mental health disorders (such as depression and conduct disorder), co-ordinating services, referring to other agencies and delegating within the team to maximise resources and utilise the expertise of other skilled professionals;
• supporting a seamless transition into school, from primary to secondary school and transition into adulthood;
• managing the interaction between health and education so that the child or young person enjoys good health and well-being (including emotional health and wellbeing) therefore achieving optimal education
• leading support for children and young people who have complex and/or additional needs including providing or co-ordinating support, education and training for families, carers and school staff;
• identifying children and young people in need of early help and where appropriate providing support to improve their life chances and prevent abuse and neglect. This includes working with children and young people at risk of becoming involved in gangs or youth violence;
• contributing as part of a multi-agency team, to the response for children, young people and families who have multiple problems.

Multi-taskers

School nurses engage in “a range of skilled activities and communications at individual group and community level. It includes health promotion, advice, signposting to other services, active
treatment/procedures, education, support, protection, safeguarding and service coordination.”

So, yes, that is a lot and probably only really a fraction of what nurses do. But if a school doesn’t have a nurse, then just who is doing all this? Teachers are picking up a few of these jobs but let’s not kid ourselves, no one else is gap-filling. This means that children’s health and wellbeing is being neglected. School nursing is one of the most effective ways to keep children healthy.

Children at risk

Health and wellbeing is just novelty noise without the vital human resources qualified to support pupils and staff. School teachers cannot and should not be expected to do what nurses do because children’s medical needs are far too complex. You can’t treat everyone with plasters and Calpol. As Delisio (2010) says, teachers aren’t in a position to help children “with physical disabilities, diabetes, feeding tubes, catheters, emotional disorders, and life-threatening allergies” and teach. Who helps children with long-term medical conditions?

Nurses are uniquely qualified to support in emergencies and it should be a legal requirement to have a nurse on site. What will you do if a child needs insulin? As Fiona Smith, RCN professional lead for children and young people’s nursing, said in The Guardian in 2017 “Children with conditions such as asthma, epilepsy or allergies could experience a life-threatening emergency at any time. Without the right training, guidance and support from school nursing services, teachers could be completely unprepared for this kind of situation – putting children’s lives at serious risk.”

The numbers of young people experiencing emotional and mental health difficulties has sky-rocketed but there are no nurses to help them. Every school needs a nurse not one nurse covering several schools. One school, one nurse should be a basic entitlement and it’s something the American Academy of Paediatrics has pushed in the US. We need that message in the UK too. The idea that “we can’t afford nurses” is nonsense, especially when there is evidence to suggest that employing nurses would actually save schools money.

Situation critical

Frederick Douglass once said, “It is easier to build strong children than to repair broken men.”

How true. Nurses provide a critical service and yet they are seen as some sort of add-on. Would we have so many children contacting Childline if school nurses were around? Probably not. If children aren’t healthy then they can’t learn. There is an urgent need for nurses in every school for pupils and for staff. As Maughan (2016) says, “A skilled school nurse can be a lifesaver (both literally and figuratively) for teachers.”

School nurses are key professionals in supporting children and young people to have the best possible health and education outcomes. We need thousands of nurses for schools but with so many hospitals crying out for them too, where are they all going to come from?