Who is the school nurse?

There is a high probability that the person known as “the nurse” in your child’s school clinic is not a licensed nurse.  In fact, this individual may not have any formal health care training and has earned this title by virtue of a desk in the clinic.  The incorrect use of the title often raises the hackles of bona fide nurses that have completed formal training and passed a rigorous licensure exam.  Furthermore, misuse of the credential can mislead parents, leaving the impression that a licensed nurse is available to provide routine and emergency care for their child during the school day. 

The Department of Health (DOH) indicates that the provision of school health services is an element of the State’s public health system.  Thus all of Florida’s 2.7 million public school children receive, at minimum, “basic health services.”   Section 3.s. 381.0056(4)(a), F.S  mandates each county health department and district school board work together to develop a “health service plan” for the provision of services.  This plan details the program standards, responsible agencies, activities, and implementation strategy.  Depending on where you live, direct clinic services may be provided by a registered nurse (RN), Licensed Practical Nurse (LPN), or a health aid.   While RN and LPN practice is regulated (see our health primers on Nursing Education) there is no educational or licensure requirement for health aids.

According to DOH, “The goal of school health services is to ensure that students are healthy, in school, and ready to learn.”  This is no small task considering the steady increase of chronic health conditions in children.   For example, DOH reports that the incidence of children with parent reported seizure disorders in Florida Public Schools has increased 67 percent in the past 10 years.  Asthma, life-threatening allergies, cardiac conditions, psychiatric conditions, and diabetes have all seen similar increases. Thus, the list of basic health services specified by the service plans (either implicitly or explicitly) covers a dizzying array of duties.  While much of the care provided is relatively simple, clinic staff is being called upon to provide increasingly complex medical care such as carbohydrate counting for insulin dosing, catheterization, or tube feeding.  Clinic staff must also assess emerging or emergency situations including upticks in respiratory or intestinal disease, broken limbs, concussions, asthma attacks, or extreme allergic reactions.      

DOH publishes an annual report summarizing School Health Services.  For the 2013/2014 school year, approximately 1 in 3 public schools across the state are staffed by health aids.  In some counties, health aids are hired at just above minimum wage and placed in a school’s clinic after a short training period.   The Nurse Practice Act and School Health Service Plans specify that LPNs and health aids must work under the direct supervision of an RN.  However, in many counties each RN is responsible for multiple schools, meaning that if an emergency arises, the RN may not be available to assess and intervene appropriately.   

School health programs are supported by a varying mix of funds from health departments, school districts, and public and private community partners.  Funding differences and variations in the health service plans result in a large disparity between county school health programs, including the mix of licensed nurses and health aids.  In a perfect word, there would be a registered nurse in every school – however, many local budgets can not support the higher cost of licensed personnel.  While there is no easy solution to increase the number of licensed nurses in our schools, Florida TaxWatch encourages parents and grandparents to become familiar with the School Health Program in their county.  We should all know who is caring for our most precious resources.