School nursing is widely recognised in policy literature as a key preventive health service for children aged 4-19 years, however the role remains underexplored. In 2014 a statutory duty was placed on schools to support pupils with recognised long-term medical conditions.
As a consequence, the National Children’s Bureau (NCB) conducted research exploring school nurses self-reported confidence in respect of 5 health conditions that affect children at school; these were asthma, epilepsy, diabetes, anaphylaxis and eczema (Edwards et al 2016). The survey achieved a response of 344 completions, approximately 13% of the school nursing workforce. Of those who responded 208 (60%) either had or were working towards the post-graduate specialist community public health nursing (SCPHN) qualification, the remainder had no formal school nursing qualification.
Findings were that over 90% had experience of supporting pupils with long term health needs, and over 60% had experience of all five health conditions. The most common activities were educating staff about long term conditions (91%), making and receiving referrals (82%) and creating individual care plans (79%). Confidence varied between conditions, with 82% confident in supporting pupils with anaphylaxis, but only 42% confident in supporting those with diabetes.
Challenges identified were high caseloads (98%), limited resources (91%), limited time (90%), low levels of understanding about the school nursing role among parents (88%) and pupils (85%), and not being aware of all pupils with long term conditions (70%).
Recommendations include recruiting and training more school nurses to meet the needs of the school population, training school nurses with the skills to support children with long term conditions and educating the public about the role of the school nurse. Importantly the authors also add that the Department of Health should maintain funding for public health services at a level that enables local authorities to commission the required levels of school nursing alongside other services.
When interpreting the findings the small numbers of respondents must be taken into account. Similarly the amalgamation of qualified and non-qualified school nurses could have an influence upon confidence in supporting pupils with long term conditions, which is not fully drawn out in this report. However, the report is timely in highlighting the scope and capacity of the school nursing role. Policy documents continues to emphasize the importance of the role (DoE 2014, PHE 2016), yet the school nurse workforce remains small. The aspiration to raise numbers to one qualified school nurse to every secondary school and its feeder primary schools by 2010 (DoH 2004) was never achieved.
Health visiting received a boost to numbers by the Health Visitor Implementation Plan in England, and Scotland is seeking to increase numbers of health visitors. By contrast the school nursing service has received no such investment, and numbers of school nurses continue to decline (RCN 2016). Cuts to the public health grant pose a threat to school nursing as well as health visiting (Nursing Times 2015). This puts into questions the ability of school nurses to effectively support school pupils with long terms conditions, despite the evidence to suggest tangible benefits. School nurses report themselves to be a dedicated and motivated workforce, but the capacity to meet pupils’ needs is inevitably limited by workforce numbers, and the extent of real financial and policy support that the profession receives.
Dr. Louise Condon
Department for Education (2014). Supporting pupils at school with medical conditions: Statutory guidance for governing bodies of maintained schools and proprietors of academies in England. https://www.gov.uk/government/publications/supporting-pupils-at-school-with-medical-conditions--3
Department of Health (2004). Choosing Health: Making Healthy Choices Easier. London: The Stationary Office.
Edwards A, Street C & Rix K (2016) Nursing in schools: how school nurses support pupils with long-term health conditions. https://www.ncb.org.uk/sites/default/files/uploads/documents/Research_reports/Nursing%20in%20Schools%20-%20Final.pdf
Nursing Times (2015). Public health nursing faces 'despair' of council budget cuts. http://www.nursingtimes.net/clinical-subjects/public-health/public-health-nursing-faces-despair-of-council-budget-cuts/7000036.fullarticle.
Public Health England (2016). Best start in life and beyond: Improving public health outcomes for children, young people and families. Guidance to support the commissioning of the Healthy Child Programme 0-19: Health Visiting and School Nursing services. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/493617/Service_specification_0_to_19_CG1_19Jan2016.pdf.
Royal College of Nursing (2016) Survey of School Nurses. https://www.rcn.org.uk/-/...of-nursing/.../rcn-survey-of-school-nurses-2016.pdf