Where are all the school nurses?

Written by: Nick G. on 6 April 2020

In all of the very important debates about whether or not to keep schools open in the current pandemic, one significant question has not been asked.

That question is: “Why don’t many Australian schools have registered school nurses?”

For the last half a century, most schools at secondary level were provided with school counsellors after demands were raised by education unions.  Counsellors provide personal advice, help sort out problems between teachers and students, and offer career advice. In some states like NSW, all school counsellors are qualified teachers with majors in psychology. Most are now registered psychologists as well. They assist with educational and personal issues, and much more.

After some further demands from education unions, counsellors were made available at primary level as well. Yet, apart from school nurses appointed to some private and Catholic schools, most state schools are without dedicated registered school nurses.  A non-teaching school assistant will often undertake first aid training and be on call for medical emergencies. In NSW, personal development, health and physical education teachers (often known as PE teachers) are first aid trained and able to help in an emergency.

How do we compare?

A survey of global school health services released in 2015 found that school health services exist in at least 102 countries. Usually services are provided within school premises (97 countries), by dedicated school health personnel (59 countries).  

Provision varies between schools in the advanced capitalist countries and those in the Third World, with the latter often unable to provide universal schooling, let alone medical staff in schools.

There are 45,000 registered nurses in US schools, whilst in Britain qualified Registered School Nurses make regular school visits. They are common throughout the Nordic countries.

A US study found that school nurses save money. The cost of putting full-time nurses into schools in Massachusetts was compared with the savings gained by keeping parents at work and teachers in front of their classes. The study concluded that for every dollar required to support the employment of school nurses, there were savings elsewhere amounting to $2.20.

In China, primary health care for children aged 6 to 15 years in full-time compulsory education is provided mainly by school nurses under the guidance and coordination of the government departments of education and health at the national and local levels. In 1990, the National Education Commission and Ministry of Health of China jointly issued the document Regulations on School Health, which stipulated that the tasks of school nurses should include supervising student health status, providing health education, improving the school environment, and controlling common diseases among students.  The principal of a school can decide how many nurses the school can hire in keeping with local education authorities regulations on personnel, and the number of students in the school. According to Regulations on School Health, at least one nurse should be employed in schools with more than 600 students. 

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It is hard to get a clear picture of how and where school nurses operate in Australia.  Victoria has primary and secondary school nurses employed in regional offices who make occasional visits to schools. For the most part they manage health programs aimed at encouraging risk-free behaviours by students, rather than providing immediate clinical assistance in the event of an accident, illness or allergic reaction.

The School Nurses Association of NSW has more than 300 members, with representatives from over 100 schools throughout New South Wales. Most are private schools with boarding facilities.

South Australian state schools do not have school nurses. There are Health Services 0fficers who do things like changing feeding tubes. But they are allocated to specific students and do not have nursing qualifications. If a student requires complex or invasive health support, they generally have a health plan administered by non-nursing staff under a Registered Nurse Delegation of Care Program provided through the Women’s and Children’s Hospital Disability Services unit. 

The situation is worse for country schools and those on the APY Lands. Poor and over-crowded housing, few medical facilities and general neglect could see large number of deaths if Covid-19 gets into the Lands. The Education Department can't even provide bleach and other cleaning products. But then no cleaners are employed on the Lands anyway.

Given the mainstreaming of most students with disabilities and/or special medical needs, the explosion in numbers  of students with allergies and other medically-related syndromes, and the general run of illnesses and accidents in schools, the pandemic now underway in Australia makes sense that the demand be raised for all schools to have an on-site registered school nurse (or access to one shared between no more than two nearby schools with low enrolments).

Take care of the young!

Better health care for students!

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