The role of the school nurse is multifaceted and supporting children and young people with additional health needs, including specific long-term conditions, is just one of many activities they are responsible for.
Two years on from the introduction of the duty placed on schools to support pupils with medical conditions (through Section 100 of the Children and Families Act 2014 and the accompanying Department for Education (2014) statutory guidance) the National Children's Bureau (NCB) undertook research exploring school nurses’ self-reported confidence across a range of different long-term health conditions that may affect pupils at school. We focused on five highly prevalent long-term physical health conditions in children and young people of school age, specifically asthma, epilepsy, diabetes, anaphylaxis and eczema.
- School nurses are regularly working with pupils with many different types of additional health needs/long-term conditions. Nearly two thirds (61%) of the survey respondents indicated that they had experience of working with all the conditions asked about, namely asthma, epilepsy, anaphylaxis, eczema and diabetes.
- School nurses mostly self-reported that they are a dedicated and motivated workforce (only 12% reported lack of motivation) and appear to pull together as a profession and support each other (less than a third reported limited contact with other school nurses).
- The most common activities school nurses reported undertaking were educating school staff about long-term conditions (91%), making and receiving referrals (82%) and creating individual health care plans (79%).
- 90% of school nurses have been in their role for two years or more and those with more experience reported higher levels of confidence.
- School nurses reported that they had a large role in referral processes, with many reporting that they received referrals from a range of different internal and external professionals. The most frequent referrals came from teachers (89%), parents (84%) and senior school staff (79%).
- For four out of five of the long-term conditions asked about, over half of school nurses indicated they were confident or very confident supporting pupils with these needs, However, this confidence varied considerably between conditions. School nurses reported feeling most confident supporting pupils with anaphylaxis, with 82% responding that they were confident or very confident in their ability to support pupils with this condition. However, they were less confident supporting children and young people with diabetes (42%).
- School nurses reported working across more varied types of schools, and in line with earlier studies, that the average number of schools they work across remains high. Over a third (38%) of the sample reported that they worked in more than ten schools and 30% reported that they worked in 5 to 9 schools. Furthermore, the survey findings indicate that those working in 10+ schools were less confident in dealing with long-term conditions than those working in a smaller number of schools.
- The survey also revealed a number of challenges school nurses identified as impacting on their work and some of these Included: limited resources (91%), limited time (90%), high caseloads (98%), low levels of understanding of their role among parents (88%) and pupils (85%) and difficulties being aware of pupils with long-term health conditions (70%)
We made the following recommendations:
- The Department of Health works with Health Education England and with local education and training boards to secure and develop the recruitment and training of more school nurses to service the needs of an expanding role and a larger school population.
- The Department of Health should maintain funding for public health services at a level that enables local authorities to commission the required levels of school nursing alongside other services.
- Local authorities, providers of school nursing services, and schools, should pay attention to the preparation and dissemination of information about the role of the school nurse to pupils, parents and carers and school staff, including how to access the school nursing service.
- The Department of Health, Public Health England and Health Education England should ensure that school nurses are provided with, and supported to, access training which enables them to maintain and further develop skills and confidence in supporting pupils with additional health needs.