School nurses are key to keeping at-risk children in school.


Article Content

The school-to-prison pipeline refers to exclusionary disciplinary systems in schools that disrupt children's education and increase the likelihood that affected students will end up in the criminal justice system. These systems use suspension and expulsion to effectively criminalize even minor infractions, such as swearing or talking back in class, and rely on school resource officers or police to enforce them.

Figure. Disrupting t... - Click to enlarge in new windowFigure.

Zero tolerance, exclusionary discipline systems arose in the 1990s as a means of preventing drug use and gun violence in school settings. Research has shown, however, that such methods of dealing with disruptive students are unevenly applied and that Black students are disproportionately targeted, along with lesbian, gay, bisexual, transgender, and queer or questioning youths and children with learning or mental health disabilities. These students experience higher rates of discipline in general with more severe consequences and at younger ages than their peers, as well as higher rates of suspension, expulsion, and corporeal punishment.


Studies have linked exclusionary discipline to lower academic achievement, increasing the likelihood that affected students will drop out and end up in the criminal justice system. Students with disabilities are especially at risk; nurse researcher Shoshana V. Aronowitz has noted in a recent article in The Hill that up to 85% of students in juvenile detention centers have a learning disability, yet fewer than 40% received learning or behavioral support before they were expelled from school.


To reduce the toll of exclusionary discipline, various groups, including the National Education Association, have called for reforms. In a recent Journal of School Nursing literature review, Aronowitz and colleagues identified interventions school nurses can use to support children vulnerable to disciplinary action. Among the interventions are individualized health plans that provide an emergency care plan that can be activated when suspension or expulsion is being considered.


Each student's individualized health plan would record physical, mental, and emotional issues as well as social factors, such as racism, which research shows influences the school-to-prison pipeline.


School nurses can also partner with faculty and staff to introduce specific discipline reforms, such as peer mediation and peer accountability. These model interventions allow accused students, victims, and student peers to discuss how the cited behaviors affected other students and the school community, and to work out ways to repair the harm. To implement such programs, however, would require schools to have full-time nurses on site to work with individual students and serve as a resource for teachers and administrators. Most U.S. schools, however, lack full-time nurses.


"School nurses are uniquely positioned to help end the school-to-prison pipeline, but they must be present," said Robin Cogan, an AJN editorial board member and nationally certified school nurse in the Camden, New Jersey, school system. "Sixty percent of schools have either no school nurse or only part-time coverage. In planning for a post-COVID world, where we must all deal with the collective trauma of a global pandemic, school nurses are needed now more than ever." (To listen to Cogan interview Shoshana Aronowitz about her unique career pathway, go to Conversations at http://www.ajnonline.com.)-Carol Potera


Aronowitz SV. The Hill 2021 Feb 5; Aronowitz SV, et al. J Sch Nurs 2021;37(1):51-60; Anderson KP, Ritter GW. Educational Policy 2020;34(5):707-34.