Room for improvement

Falling school nurse numbers means some children may never see the classroom

Children with conditions such as asthma, diabetes, epilepsy or behavioural disorders require specialist care and support within the school environment. Others may need assistance with breathing or enteral feeding. And it’s up to school nurses to lead this care; training teachers to identify warning signs and intervene if a child is in danger.  

Since 2010, there’s been a steady decline in NHS-funded school nurses, with a 16% drop in numbers in England. According to NHS statistics, the number of school nurses in England in March 2017 stood at just over 2,500. Scotland has experienced a small increase in numbers, but investment in school nurses is still not meeting demand.

The RCN says this is unacceptable. “It is completely unjust that children can’t go to school because of their health conditions,” says Fiona Smith, RCN Professional Lead for Children and Young People’s Nursing. “Every child has the right to an education and it is the Government’s responsibility to make that happen.”

school children

RCN toolkit

And it’s not just children with complex health needs who are suffering from the downturn in school nurses. There’s widespread recognition that poor health contributes to underachievement in education and reduction in career prospects; but the number of children who are overweight or who have low self-esteem and mental health problems is increasing. 

School nurses perform a key role in the reduction of child health inequalities through provision of health education and information, targeted interventions, and signposting to other services. To empower school nurses and those working with children and young people, the RCN recently launched its updated School Nurse Toolkit at the RCN School Nurses Conference. It covers all the key points of school nursing, from helping children with long-term conditions to providing mental health support and promoting healthy lifestyles. 

children learning

Early health promotion 

Suzanne Watts, Chair of the RCN Children and Young People’s Staying Healthy Forum, says: “School nurse numbers are declining. Coupled with larger caseloads for school nurses and an increase in the number of students, the lack of nurses is detrimental to broader health issues in schools. It’s widely accepted that if we can promote good health early in schools, it has a positive effect later in life. Health promotion is important, as well as supporting those children who have additional health care needs. The toolkit focuses on giving guidance for school nurses on the core principles of school nursing.”

At the conference, Suzanne and her colleagues called upon the Government to address the school nurse crisis, so that every child gets the education they deserve. “There are a number of issues around training and budget cuts in post-qualification training. Austerity is having a big impact on children’s health, especially those from poorer families. School nurses are doing some really good work despite all these pressures and we hope the new toolkit will be something useful for them.”

What does the future hold?

Award-winning school nurse and RCN Children and Young People's Staying Healthy forum member, Ruth Butler, ponders the future of school nursing.

"In 2013, then Children’s Health Minister Dr Dan Poulter announced plans to ensure that school nurses would play a more influential role in the health of children and young people. He promised that school nursing teams would 'lead a strengthened, more tailored school nursing service which means better care and support for children, including those with disabilities and complex emotional needs'.

"Since then, we have seen a national decline in the number of qualified school nurses and an increase in the school population. Services are having to operate within tight financial constraints and school nursing teams are facing staff shortages and increased caseloads. Their ability to provide a service which improves the health of the school-aged population and adequately supports those with health needs is significantly compromised. It is therefore difficult to see how, as a profession committed to excellence, we can achieve the ambitious aims set out by Dr Poulter.

Our effectiveness is dependent upon adequate funding, investment and support

"Although we are a complex professional body with school nurses covering wide areas of expertise, there is little uniformity in what school nurses are commissioned to do. For some it involves close collaboration with the schools, offering visible and effective health interventions. Unfortunately for others, only a minimal service can be offered. Despite these challenges, evidenced-based practice models and innovative ways of using technological solutions to offer interventions have proved that there is much to look forward to.

"The development of Public Health England's 4-5-6 model integrating the services of health visitors and school nurses helps school nurses to focus their resources on areas where they can make the biggest difference and, in response to what young people have said they want, many trusts are now successfully exploring the benefits of digital media.

"School nurses make a difference to the health and wellbeing of children and young people who, along with their families and schools, highly value the service. Our effectiveness is dependent upon adequate funding, investment and support. Our challenge, therefore, is to embrace new evidence-based ways of working, be innovative in planning service delivery and continue to deliver a professional, high quality service to our school-aged population."

Find out more

The RCN School Nurses' Conference takes place every year and is organised by the RCN Children and Young People's Staying Healthy Forum.

Take a look at the full range of professional events coming up from the RCN that can contribute to your CPD for revalidation. 

View the RCN School Nurse Toolkit.

Words by Susan Embley

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