More than 60,000 "hidden" health care professionals work among us, according to a 2004 Health Resources and Services Administration's publication, The Registered Nurse Population: Findings from the March 2004 National Sample Survey of Registered Nurses, receiving few resources and little support from other care providers. Who are these invisible workers? They are your nurse colleagues working in elementary, middle, and high schools, where every day they care for millions of children.
In just one week earlier this year, posts to the National Association of School Nurses' online discussion list (a public forum found at http://bit.ly/8VXMb) exemplified the range of issues confronting these nurses. One asked for information on how to administer antibiotics through a peripherally inserted catheter line. Others wanted postoperative health care plans for children undergoing heart and liver transplantation and for a child with Wolff-Parkinson-White syndrome who would be undergoing an ablation procedure. Another school nurse asked about the legal ramifications of delegating insulin administration to nonlicensed personnel.
A growing base of evidence helps to guide practice in the schools-obesity prevention and asthma and diabetes management programs from the U.S. Department of Health and Human Services, for example. But most school nurses don't have access to medical databases, librarians, or other nurses, particularly clinical nurse specialists or advanced practice nurses. Consider for a moment how different your work would be if you were isolated from your peers for days or weeks at a time: no quick brainstorming sessions at the nurses' station, no advanced practice nurses readily available for consultation, no nurse manager or practice committee to formulate policies. Just you, on your own, caring for children who are experiencing everything from poorly managed asthma to depression to neglect or abuse. It's a monumental job.
Many children receive fragmented care or lack continuous health care coverage. Making better use of school health care providers would help to address these failings in our health care system, but it would require that schools forge partnerships with local health care providers and facilities. Although some policymakers are warming to the idea, many health care providers in the community and school administrators still fail to understand the scope, complexity, and importance of the role of school nurse.
So do many of their nurse colleagues. But here's how you can help. If you work in acute care, remember the school nurse when planning for a patient's discharge. For example, if asthma management is an issue, call the school nurse or provide her or him with written instructions regarding the type of medications needed (an emergency inhaler, perhaps) and the correct dose and frequency. It's highly likely that the child you have just cared for will return to school within the next few days; children are anxious to be with their friends, and parents need to return to work.
Providing a seamless transfer of care between the acute and school settings will, it's hoped, lead to better outcomes and give patients an informed advocate when they return to school. The hospital's education department can initiate this relationship by inviting school nurses to join in nurse-related activities and celebrations at the hospital and by offering access to databases, librarians, and advanced practice nurses with expertise in the issues that most frequently confront school nurses.
If you work in primary care, consider forging a partnership with the local school nurse. This collaboration will be especially helpful to students who are undergoing procedures or require hospitalization. Additional teaching or follow-up observation is often necessary, and it's the school nurse who will be in daily contact with the student long after she or he has left the primary care office or hospital.