As a school nurse educator I am steeped in academia, embroiled in marking, feedback, student support, teaching and curriculum development. How do I know what school nurses do anymore? I pondered this question from my office chair, contemplating the answers from an academic perspective with my train of thought on the theory practice gap. As I pondered I glanced around the office. After a brief moment I suddenly realised my colleague, only a a hair's breadth away presented me with a source of knowledge.
This particular colleague (with a background in health visiting and children's nursing) now working in higher education was also completing a journey of working in an alternative field of practice, the mechanics of which are outlined in NMC circular 26/2006. The NMC agreed that any registrant who had met the public health proficiencies for registration as a SCPHN in a given field of practice (e.g. health visiting) may undertake education and training to work in another field of practice (e.g. school nursing). Facilitated by a local trust and supported by a qualified school nursing community practice teacher and in response to recommendations made at a NMC SCPHN programme review (2011) my academic colleague had commenced this journey with gusto and enthusiasm. The following is an insight into her experience:
Me: ‘Is school nursing what you thought it would be?’
My colleague: ‘I thought I understood the role of the school nurse; however, it's so different from the role of the health visitor. The primary focus is different not necessarily working with parents and carers but in partnership with the young person. The community of practice is also different with the key engagement being with schools as opposed to the primary health care team in health visiting.’
Me: ‘Has your experience changed your perspective on the school nursing service?’
My Colleague: ‘It has emphasised the challenges of working directly with children and young people. Even for someone like me with a wealth of knowledge and experience of health-care, the complexity of the role is huge. For example, safeguarding a young person and building a therapeutic relationship with them while not always involving parents and carers can make the role seem overwhelming at times.’
Me: ‘If you could describe 3 key roles of the school nurse, what would they be?’
My colleague: ‘I would say the delivery of the Healthy Child Programme i.e. surveillance and immunisation, this is different than health visiting as it often delivered to large groups of children and young people, alongside providing individual support. Safeguarding and Educational role in school (PHSE)—With safeguarding there are similarities with the role of the health visitor although the difference is that as a school nurse you may be working less directly with the family and you need to manage the tensions of the safeguarding role when you don't necessarily have direct contact with the child, young person, parent or carer. In relation to the delivery of PHSE and formal education in a school setting I feel equipped to do this having a qualified teacher status and being a fellow of the Higher Education Academy. However, it could be identified as a gap in theoretical knowledge in some areas where school nurses do not have the opportunity to practice these skills while undertaking the SCPHN programme.’
Me: ‘What are the key public health issues you have experienced on your journey?’
My colleague: ‘The list could be very long but here are some of the key local issues firstly, child and adolescent mental health (years 9-13) appears to be a significant issue and again addressing this need depends on service provision. School nurses are now supporting children that may have been accepted as a referral to CAMHS. This could present a challenge for school nurses who may not feel equipped to address what can be very complex mental health issues. Secondly, obesity is a key public health issue and there appears to have been a reduction in local support provided for weight reduction. Thirdly, sexual health advice including contraception—not all school nurses are fully trained in relation to sexual health and local service reduction may have increased workload in this area too.’
Having this discussion has enabled me to identify a local school nurse role albeit from a single practitioner's perspective and one local area of practice. I would like to thank my colleague for her time and insight. It is enlightening, perhaps not unexpected, that the impact of a reduction in local service provision appears to have fallen at the feet of the school nurse. In my opinion, this demonstrates the core value of the school nursing service across the region.
Ackowledgments: The author would like to acknowledge Vicky Gilroy, Senior Lecturer at Northumbria University.