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Analysis: School nursing – has it been stretched too far?

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School nursing is becoming “really difficult” and “very pressurised”, so stated a community nurse specialist during a session at a conference last month.

While depressing to hear, this was sadly not surprising news.

“It is little wonder that school nurses are feeling the strain”

That same day, to coincide with its annual school nursing conference on 25 August, the Royal College of Nursing raised fresh concerns about declining school nurse numbers – a drop of around 13% since 2010 to just 2,606.

Combine that with the role’s increasing responsibilities around safeguarding children from abuse, delivering improved sex and relationships education, and expectations to train teachers in supporting children with medical conditions and it is little wonder that school nurses are feeling the strain.

What seemed more surprising to me was the potential lack of awareness among parents about the absence of school nurses and their misunderstanding of who was delivering health care in the nurses’ place.

During a session on asthma in children at the conference, Debra Forster, a children’s respiratory, allergy and community nurse at Nottingham Children’s Hospital, pointed out that some parents she saw from her local area falsely believed their school had a school nurse when in fact it was just someone who was trained in first-aid.

“I sometimes speak to people and I say ‘have you got a school nurse?’ They say ‘no’ or ‘we have got a school nurse’ – but they are actually meaning a first aider. It’s not a nurse, not a health professional,” she said to a murmur of agreement from school nurses in the room.

She suggested the expanding list of job responsibilities – such as those related to mental health and safeguarding – may be to the detriment of seeing to children’s core health needs.

And she wasn’t the only one concerned about a potential move away from the provision of core public health care for children in some areas.

During another session at the conference a similar problem was uncovered by Trudy Ward, Sussex Community Foundation Trust’s head of children’s community nursing.

“The government should be ensuring enough school nurses are trained”

Following a recent review of special school nursing in the West Sussex area, it was found that while children in specialist schools in the region were being provided with care for their complex health needs they were not always being given core public health nursing, such as drop in services, healthy weight and smoking advice, and screening tests.

This seemed shocking, considering these children could arguably be seen as the most vulnerable and therefore in need of this care even more. The review made a series of recommendations including for specialist nursing posts to be put in place at specifically identified schools.

These issues were identified by nurses in two separate regions. It is not difficult to believe that the same or similarly alarming problems are occurring elsewhere across the country. Fewer school nurses combined with increasing role requirements can only lead to a strained service that can’t deliver the care to which all children are entitled.

When it’s believed school nurses are delivering care when instead it’s a person trained in first aid, there is a problem. The government should be ensuring enough school nurses are trained. As has been repeatedly said in the past, and again this week, school nursing should be prioritised – and not left to whoever else is around to fill in the gaps.

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