AAP Calls for a Full-time Nurse in Every School
The statement, published online May 23 and in the June 2016 issue of Pediatrics, replaces the 2008 guidance, which supported ratios of one school nurse to 750 students in the healthy student population, and a 1:225 ratio for populations who need daily nursing assistance.
As previously reported by Medscape Medical News, according to a 2007 study, only 45% of public schools had a full-time nurse on site, whereas 30% had one working part time.
Role Has Expanded
Since the first school nurse was hired in 1902, the role has become increasingly complex. Now, the school nurse role includes surveillance, emergency preparedness, health education, chronic disease management, and behavioral health assessment.
They also liaise between schools and the public health arena, facilitating immunization, obesity prevention, smoking cessation, and substance abuse and asthma education.
"School nursing is one of the most effective ways to keep children healthy and in school and to prevent chronic absenteeism," Breena Welch Holmes, MD, a lead author of the statement and chair of the AAP Council on School Health, said in an AAP news release. "Pediatricians who work closely with school nurses will serve all of their patients better."
School nurses and pediatricians working together are a prime example of team-based care, the authors write. Nurses can connect students and their families to the medical home and can foster coordination of care.
Pediatricians can include school nurses as key team members in delivery of care and in the design of integrated care, such as school-based health centers.
The AAP also recommends that pediatricians ask their patients school-related questions, such as whether health problems are leading to chronic absenteeism; include school contact information within the student's electronic health record; and share relevant health information with the school nurse.
More Learning or Behavioral Problems
Some of the changes prompting the new AAP guidance are medical. Survival rates of preterm infants have increased to more than 90% of infants born after 27 weeks' gestation, resulting in more children with moderate to severe disabilities and learning or behavioral problems.
In addition, chronic illness is increasing: Food allergy prevalence in children younger than 18 years jumped from 3.4% in 1997 to 1999 to 5.1% in 2009 to 2011. And in 2010, 215,000 people younger than 20 years in the United States had type 1 or type 2 diabetes.
About 1 in 10 school-aged children has asthma, which contributes to more than 13 million missed school days a year, and the percentage of kids aged 6 to 11 years with obesity increased from 7% in 1980 to nearly 18% in 2012, the authors note.
"One in ten children and adolescents has a mental illness severe enough to cause some level of impairment; yet, in any given year, only about 12% of children in need of mental health services actually receive them," they write.
Legal and Societal Demands
There are legal and societal changes as well. Federal and state laws demand adherence to privacy regulations and compliance with rights and accommodations for the disabled and people needing additional services.
The authors note some research has shown cost savings as well for full-time school nurse staffing. "In 1 study," the authors write, "for each dollar spent on school nurses, $2.20 was saved in parent loss of work time, teacher time, and procedures performed in school rather than in a more costly health care setting."
Yet, with tightening budgets, school nurse staffing has been inconsistent. And using a nurse-to-student ratio to determine the necessary number of nurses no longer works to fill increasingly complex needs, the AAP says.
"[G]ood health and strong education cannot be separated," the authors conclude.
All authors have filed conflict of interest statements with the AAP. Any conflicts have been resolved through a process approved by the Board of Directors.
Pediatrics. Published online Mary 23, 2016.
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