What do you think of when you hear “school nurse?” Ice packs and band aids? What about being a school nurse at a virtual school? There is a lot more to school nursing that you may realize, especially here at PA Virtual. Let’s start with a little background…
The concept of pupil health began in the early 1900s as a tactic to increase attendance and decrease transmission of disease in schools. At that time, physicians were responsible for daily exams in classrooms to assess students for communicable diseases, excluding them if ill until they received treatment. Under recommendation from the first ever school nurse, Lillian Wald, the NYC Board of Health and NYC Board of Education placed nurses in schools as well to facilitate follow-up of ill children. The school nurses ensured they received appropriate treatment and returned to school in a timely manner by making referrals to community health providers and going on home visits to check on students’ progress. This process quickly evolved into nurses treating their students in school which effectively reduced the amount of class time they missed. The value of early detection and intervention became very clear and school nurses began regular screening for issues with hearing and vision.
Lilian Wald, Courtesy of the Visiting Nurse Service of New York
The role of school nurses grew throughout the 20th century from healthcare provider to educator. The education efforts of school nurses expanded as their physical presence in schools decreased when they began being recruited for war efforts. Teachers and other school staff were taught by school nursing professionals how to manage common illnesses, provide first aid and what emergency signs or symptoms they should be aware of in their students. In 1949, Pennsylvania began to require school nurses to obtain a certification with the state department of education. This requirement prepared school nurses with the training and education they needed to continue fulfilling the growing responsibilities of their role.
As major legislative changes were continuing to be made in public education, the position of school nurse expanded further to include taking part in the protection of rights a student with disabilities has in the school setting. As technology advanced, so did the management of chronic diseases such as diabetes and epilepsy. School nurses took on a collaborative approach with students’ medical providers to administer medication in school and provide education about emergency procedures to school staff. Although school nursing has evolved quite a bit in the over 120 years since its inception, the foundation of supporting the health of their students and communities has remained consistent.
PA Virtual student participating in a regular eye screening provided by the school
School nurses not only advocate for student accommodations, treat acute injuries or illnesses and manage students’ chronic conditions. They also monitor their school building for safety by ensuring that appropriate emergency and evacuation plans are in place and participate in attendance initiatives as well as student assistance programs. School nurses are responsible for sharing important health and safety education with school staff and collaborating with their local health care providers to monitor trends in communicable diseases. Nurses also must complete health screenings and ensure all their students are immunized according to state mandates.
All students enrolled in school in the United States are required to have been given a specific set of immunizations. This initiative has dramatically reduced, and in some cases eliminated, the spread of damaging and deadly diseases. All students in Pennsylvania, including those enrolled in cyber programs, are required to have these mandated immunizations. In a virtual school setting, students are in contact with each other during social events and at testing. There are children that are unable to be vaccinated and their classmates who have been immunized protect them from becoming very ill and missing important instruction time. Students attending school virtually are still a part of their local community and at its foundation, school nursing remains an integral part of public health programs. Immunizations are just one way that school nurses can support the academic performance of their students as well as the health of their community. A very recent example of how school health and community health collided was visible during the COVID-19 pandemic. As new evidence emerged and updated guidelines were developed, school nurses were responsible for communicating these to their school in an effort to keep their students in attendance whenever possible while protecting their local community.
Although the pandemic highlighted it, school nurses have always had a large responsibility to monitor and improve the rates of attendance among their students. School nurses work closely with teachers, guidance counselors, social and outreach workers as well as administrators to identify causes of chronic absenteeism. The information from the school nurse can be valuable during SAP (Student Assistance Program) or attendance committee meetings. Often, a school nurse is already familiar with a student that has missed many days of school. The health room can be a safe place for a student to visit when they are not feeling well or having physical symptoms of a mental health issue. If a significant illness or injury occurs that would keep the student from attending school for a long period of time, school nurses work closely with their family and doctor to make a plan for the student to continue with their studies when and as they are able to. If a medical issue arises that may impact a student’s academic performance or participation in the classroom for an extended period of time, the school nurse can help develop a plan for appropriate accommodations. The school nurse is also responsible for educating students about the importance of proper hygiene, dental care, sleep and nutrition. They may do this on an individual basis as students visit the health room, organize school wide communications, or teach a lesson during health class. Staying healthy is imperative for students staying in school and being prepared to learn in the classroom.
As mentioned, school nurses ensure students of all abilities have the opportunity to fulfill their academic potential by advocating for accommodations they may need based on a medical diagnosis. A student with a condition that impacts their ability to succeed in school may benefit from a plan that outlines the specific additional support they need. These accommodations can be constructed into a 504 plan or if a student requires specialized instruction, a health plan can be written into their IEP (Individualized Education Plan). The development, review and implementation of 504s and IEPs are a team effort and school nurses are an important part of that team for students with medical concerns. They communicate with students and their families as well as review medical documentation to gain a better understanding of that student’s unique needs. With this information, they collaborate with other members of the academic team to develop a plan that will best support that student. These plans are re-evaluated annually with the school team, student and learning coach to ensure that each student is being always provided with all the tools they need to succeed.
PA Virtual student preparing for PSSA testing
School nurses in the virtual school setting are tasked with thinking outside the box when it comes to what their students may need in different situations. The virtual classroom is much different than a physical one and requires a different set of accommodations for students with medical concerns. Students at PA Virtual are also out in the community throughout the school year, at testing sites and attending outings. Ensuring the safety of our students is a school nurse’s number one priority. We collaborate with our teachers, guidance counselors, FSCs, principals and learning coaches to identify which students require additional support for medical concerns and how they can best be supported. Prior to Keystones and PSSA testing, the school nurses at PA Virtual look at every student scheduled to determine if there are any medical issues the staff on site need to be aware of. In certain situations, a nurse may need to travel to a testing site to be present for a student. We always enjoy the opportunity to meet our students in person and offer our support in any way we can.
The online classroom can offer a better fit for students with different abilities or needs. Some students and their families may consider a virtual learning environment for this reason. Despite learning from home, the same hard work, participation and communication from students is expected just as would be in a traditional classroom setting. The pupil health team here at PA Virtual is dedicated to support and advocate for all of our students. Each certified school nurse is available to help the students in their respective grade levels achieve the highest possible level of success regardless of any medical issue.
Another well known way that school nurses support the health of their students is by completing annual health screenings. Health screenings in the virtual school environment are just as important as they are in the traditional school setting. In fact, the state of Pennsylvania mandates every single student to have an annual health screening, regardless of what school they are enrolled in. The state requires students in all grade levels to be screened for growth and vision each year. Hearing is required to be tested every year from Kindergarten to 3rd grade and then again in 7th and 11th grades. Scoliosis screenings check for an abnormal curve of the spine. School nurses are required to examine every 6th and 7th grade student for scoliosis as this is when the rapid growth spurts of puberty make the spine more susceptible to developing an abnormal curve. The state also mandates submission of health forms for all students.. A physical exam form is required for kindergarten, 6th and 11th grade. Dental exam forms are due in kindergarten, 3rd and 7th grade. PA Virtual families can submit their mandated health forms to their school nurse here. Regular physical and dental exams along with annual school health screenings are powerful tools that can catch significant medical issues early on. A prompt referral to a child’s doctor ensures appropriate treatment can begin without delay, preventing potential complications and their consequent impact to academic performance. Super Squirrel, our school mascot, attends a health screening
Super Squirrel, our school mascot, attends a health screening
At PA Virtual, we have to think outside of the nurse’s office to organize our health screenings! We meet with our students out in the community at hotels, libraries and other spaces where we can provide comfort and privacy for screening. There are about 10 different screening sites organized for the Fall and again in the Spring, strategically planned across the state so that every PA Virtual Student has an opportunity to attend. The health screenings are free and a small stipend to cover transportation costs will be provided to each family that attends. Learning coaches can sign their children up right on the PA Virtual Pupil Health webpage where an interactive map shows which screening location is closest to you.
School nursing encompasses so much more than I ever thought before I began my career. Although school nursing is not new to me, this role at PA Virtual is. I have really enjoyed being welcomed into this supportive community and getting to know more of our students each day. Being a school nurse has given me the rewarding opportunity to advocate for what our students need to be successful- not just academically but mentally, socially and emotionally- despite any health challenges they may face. I truly look forward to continuing to grow here at PA Virtual and learning how to best support our students.
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