Not Your Parent's School Nurse
Written by Editor   
Wednesday, June 11, 2014 06:56 AM

Although the school nurse is a familiar figure, school-based healthcare is unfamiliar territory to many medical professionals, operating in a largely separate healthcare universe from other community-based medical services.  Now, as both schools and healthcare systems seek to ensure that children coping with chronic conditions such as diabetes and asthma get the comprehensive, coordinated care the students need, the schools and health systems are forming partnerships to better integrate their services. In these projects, some funded by the health law, school health professionals gain access to students' electronic health records and/or specialists and other health system resources.

School nurses today do a lot more than bandage skinned knees. They administer vaccines and medications, help diabetic students monitor their blood sugar, and prepare teachers to handle a student's seizure or asthma attack, among many other things.


A 2007 study found that 45 percent of public schools have a full-time nurse on site, while 30 percent have one who works part time. In addition to school nurses, 12.5 percent of school districts have at least one school-based health center that offers both health services and mental health or social services, according to the federal Centers for Disease Control and Prevention's 2012 Schools Health Policies and Practices Study. School nurses often work closely with school-based health centers, referring students there as needed.

"Chronic disease management is what school nurses spend most of their time doing," says Carolyn Duff, president of the National Association of School Nurses. "We do care for students in emergencies, but we spend more time planning to avoid emergencies."

School-based healthcare providers may bill Medicaid for some services, but rarely bill private insurers.  "It takes so much energy to track these bills from the commercial insurers, many just stop trying."

School nurses must get permission from parents to communicate with a child's doctor. Once the doctor gives them a care plan for the child, they generally rely on the doctor and/or parents for updates and changes.  In 2011, a health system got together with the Delaware School Nurses Association and the state Department of Education to develop a program that, with parental approval, now gives school nurses read-only access to the electronic health records of more than 1,500 students who have complex medical conditions or special needs such as diabetes, asthma, attention deficit hyperactivity disorder, seizure disorders, or gastrointestinal problems.

Eventually school nurses will be able to put information into the  electronic records system as well. In the meantime,  doctors, some of whom were initially skeptical about allowing school nurses access to health system medical records, are warming up to the arrangement. It encourages communication between physicians and school nurses, and eases the burden of routine tasks because Nemours doctors no longer have to fax over care plans or instructions to the school nurse every couple of months for students who are part of the program.

"Our primary care practices are going through the process to become certified as medical homes," says Kane. "School nurses have a big role in care coordination, and this program is integrated as a piece of that."