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Using texts to increase access to school nurses

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A project to make school nursing services in two secondary schools more accessible enabled young people to contact their school nurse using a mobile texting service


Although young people find school nurses approachable and caring, too few access their services. A text messaging service was set up in two secondary schools to raise awareness of the school nurse and encourage teenagers to make contact for health advice and support. Pupils were involved in developing promotional materials. The majority of text contact was for sexual health and relationship issues, with 44 out of the 202 text messages leading to face-to-face contact with the nurse.

Citation: France J (2014) Using texts to increase access to school nurses. Nursing Times; 110: 13, 18-19.

Author: Jo France is school nurse manager and professional lead, Shropshire Community Health Trust.


Adolescence can be a difficult time, often associated with increased risk-taking, especially in relation to health. The transition from childhood to adulthood can be stressful, giving rise to a unique set of health needs and concerns; young people need accessible, confidential and sensitive support to encourage and enable them to make healthy choices (Huyhn et al, 2000).

School nurses are nurses with a specialist public health qualification; they support health and wellbeing programmes for all children and young people aged 5-19 in schools and the wider community.

A British Youth Council report discovered the majority of young people found their school nurse friendly, approachable and caring (BYC, 2011). However, far too few young people access this service for care and advice. Confidentiality was found to be an important factor in this low uptake, but young people liked the idea of direct contact with their school nurse through texting or emailing, as it would remove the barrier of having to ask someone else for an appointment and give them better control of their own health (BYC, 2011).

School nurses are in a unique position to encourage self-care and promote healthy choices. Since devices such as mobile phones, smartphones and tablets are an intrinsic part of young people’s lives, school nurses should use these platforms of communication to increase accessibility and visibility.

Providing an accessible school health service was the focus of my project “TXT UR School Nurse”, to develop a text messaging service for young people in two large secondary schools in Shropshire. The project was funded and supported through the Queen’s Nursing Institute Fund for Innovation and Leadership.

To ensure that a safe, confidential service was provided, I adhered to the principles in Royal College of Nursing guidance for nurses on using text messaging services while working with children and young people (Box 1) (RCN, 2006).

The aims of the project were to:

  • Enable young people to contact their school nurse using a mobile texting service;
  • Increase awareness of the school nurse at two secondary schools in Shropshire;
  • Improve access to the school nurse for health information.

Box 1. Key principles

  • Professional accountability and safety when using messaging with young people
  • Services should be supported by local guidance
  • Nurses should be appropriately trained and have access to clinical and safeguarding supervision
  • Record-keeping guidance should be adhered to when recording text messages
  • Nurses concerned about a young person’s safety should refer to their trust or local authority safeguarding children guidelines
  • A named nurse should be responsible for a specified phone to support confidentiality; the phone should be securely locked away when not in use
  • Messaging is just another form of communication and contact with young people; nurses should respond in the same way as they would face to face Adapted from RCN (2006) 

Young people’s engagement

Having secured the commitment and support of the two head teachers, the most important step was to gain valuable help and guidance from the young people for whom the service was being developed.

Pupils from the two schools engaged positively with the project through the student council and school nurse drop-in sessions; they helped to design promotional materials including a poster (Fig 1), creating ideas for promotion and producing a short video (, which is available online and on DVD.

The video has helped bring the project to life; it shows young people how messaging the school nurse works in action, and formed a key part of the presentation given at school assemblies to promote the texting service. Staff and students made suggestions on how I could further increase accessibility and visibility, including advertising in school academic planners and on two in-school plasma screens.

After the promotional launch of the project in May 2012, the texts began to come in. Between May and December 2012, I received 202 texts, 45 of which led to face-to-face appointments, while 25 young people texted back to say thank you for the help/advice received.

Nature of the texts

The texts fell into five broad categories:

  • Sexual health including puberty and relationships (56%);
  • Emotional health (25%);
  • Physical health (7%);
  • Human papillomavirus (8%);
  • Healthy eating (5%).

To ensure continued success, it was essential to evaluate the project, which was achieved through an online Snap Survey ( With the help of our trust audit department and the school IT leads, I created an online tool that the young people could access and complete during IT lessons. I received 370 responses from young people aged 11-16 across the two schools. These included:

“I think it’s good because it helps us take care of ourselves lol.”

“It’s easier to text someone about things than to talk to them face to face.”

“I think that it is a great idea but if you don’t have a phone then it’s a problem.”

“If I had any problems, I would definitely consider using this. I think this is a really good idea and I know people who have used it.”

“It would be good to use social networking. Facebook page, Twitter page, YouTube video or in public areas such as toilets or shops near school.”

The key findings were:

  • The vast majority (344; 93%) were aware of the school nurse text service and (235; 63.5%) were aware they could access the school nurse via the lunch-time drop-in - in comparison, the BYC (2011) reported that 69% of young people did not know how to contact their school nurse;
  • 260 (70.2%) felt that the text service was a good way to seek help and advice about their health;
  • 322 (87%) were aware that the school nurse offers a confidential service - again, this is higher than reported by the BYC (2011), which found that only 61% of young people were clear that the service would be confidential.


For quality, safety and governance, it was important to keep a record of all text messages, not only to monitor text subjects but also to identify any trends or problems such as safeguarding concerns.

The recording was managed by keeping a spreadsheet log; this was time-consuming and added administration work. We are exploring the use of computer-based message management, which could safely record the texts, align them with school health records and provide an instant “bounceback” message to each young person sending a text, signposting them to local health services such as GP surgeries, walk-in centres or websites. This facility would be extremely useful for out of hours or when the school nurse is unable to respond immediately. Another challenging aspect of the text messaging service was keeping up with the lengthy text conversations that I often had with young people on my small and basic mobile phone. Being able to respond via a computer-based message system would make messaging easier, faster and safer.

Texting does not replace face-to-face contact, but it does enhance the school nurse service and enables me to use my time more effectively. Colleagues who were initially anxious about using a messaging service have seen the benefits it brings in helping to meet young people’s health needs.

The project has fuelled my commitment to further develop the use of messaging within our school nursing team. Many young people said that contact and health promotion/education through social media would further support their health - this is an area we are keen to explore as part of improving access to the school nurse. I am certain that more can be done using technology to improve health outcomes, empower young people to take control of their own health, and improve the health of our future generation.

Key points

  • Adolescence is a difficult time, associated with greater risk-taking, especially in health issues
  • The majority of young people find school nurses approachable, friendly and caring
  • Young people like the idea of contacting school nurses through texting or emailing as it puts them more in control
  • School nurses should use technology to become more accessible and visible
  • Texting gives young people another way to contact a health professional; face-to-face contact can follow
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