LESSON 4:
School nurses are important for promoting student health.

School nurses are important for promoting student health.

School nurse leaders, October 2008

Perhaps more than anyone, school nurses understand how the school environment shapes children’s health, and how children’s health shapes their ability to succeed at school. Healthy Schools Campaign engages school nurses in leadership training focused on school wellness and environmental health.

School nurse leadership creates results. The work that program graduates have done to promote student health and wellness after completing this training makes it clear that school nurses are key agents of change in creating healthy school environments. After completing HSC’s school nurse leadership training, nurses have been quick to take action: 96 percent reported changes in food in their school or district, and 93 percent reported changes in physical activity practices.

Promoting wellness as a school nurse leader. As a school nursing supervisor who completed HSC’s training, Eva Detloff took an approach to healthy change that created a balance of system-wide improvements and room for individual innovation. Detloff worked with a diverse wellness committee to implement policies that have brought healthier meals (“with higher standards than in most models,” she said), a fresh fruit and vegetable bar to every cafeteria, nutrition education to elementary schools, healthier vending options to middle schools and high schools, and more plans on the horizon.

Blaine School, November 2006

At the same time, it’s allowing room for creative steps that range from after-school physical activity to grilled pineapple skewers for sale at high school football games.

“We’re letting buildings look at their own culture and decide what changes to make first to improve wellness,” she said. The goal is for the plan to be fully implemented in four years.

Detloff said her approach to change has been shaped, in part, by HSC’s School Nurse Leadership Program. In particular, she said, the training led her to place additional emphasis on evidence-based practice, identifying measurable objectives and even tracking aggregated Body Mass Index percentiles for students in the district.

Many parents have been “thrilled” with the changes, she said, and students’ response is clear from the high fruit sales at schools.

“Staff and parents have seen the changes schools have made and are coming up with more ideas themselves,” Detloff said. “They’re ready to go there. Every change is a step in the right direction—and it’s very rewarding.”

Supporting school nurse leadership can lead to important gains for student health and for the entire school community.

Policy implications to support school nurse leadership

Healthy Schools Campaign asks that legislators make a series of changes to rules and resource allocations that will allow school nurses to make the greatest possible impact in their efforts to promote student health.

Improve the ratio of nurses to students. Evaluate the impact of improving the number of nurses available to students, thereby decreasing the student-to-nurse ratio and allowing nurses to spend more time caring for students and implementing public health initiatives.

Share the financial burden of providing health services to students in schools with others who fund our health care system.

Ensure that schools are able to receive Medicaid reimbursement for qualified medical and health-related services that they provide to students.

Fund the Individuals with Disabilities Education Act (IDEA) at the level promised by Congress when it was enacted. The bill now covers only 17 percent of costs that schools incur, in contrast to the 40 percent promised in the legislation.

Require that managed care providers share capitation dollars with schools when schools provide services, and provide funding for public health mandates that schools are required to implement.

Modernize and improve rules related to the collection and use of school health data.

Ensure that the national data sets for health and education include information about school health. These data sets should include school health data points to ensure that public health and education leaders have a complete and accurate picture of the impact of school health on child health and achievement.

Revise FERPA and HIPAA to allow data sharing among schools, primary health care providers, and the public health system as this data relates to treatment, immunization compliance, and surveillance.

Ensure that school health records and data are included in the development of universal health records. Discussions about the need for universal health records have often omitted school health data, although this information is a key component of many students’ medical history. Including school data in universal health records is a sensible step to improve the care students receive, both at school and in the community.

Create a high-level position for a school nurse at the Department of Education to advocate for child health within the context of our national education system. Health is intrinsically connected to learning, and school nurses are uniquely equipped to understand the role of this connection in our education system. The importance of a school nurse leadership position to coordinate school nursing services and make the connection between student health and learning is recognized in the 39 states that fund a position for a school nurse coordinator in the state government. A similar need exists at the federal level for a high-level school nurse position to make these connections and ensure that educational decisions are informed by an understanding of the ways that learning is affected by health and wellness.