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Getting Educated: Health and Student Services Professionals

Licensed Practical Nurses; Nurses' and Health Aides; Medical Technicians; Family and Parent Services Aides; Community Welfare Service Workers; Nonmanagerial Supervisors


  "A lot of people have this perception that school nurses sit around their office and wait for someone to put a Band-Aid on ...but that simply isn't true." -Marge Knuuti School Nurse Searsport, Maine 

Who Are We?

School nurse Paula Apa-Hall scribbles on a yellow legal pad the numbers of kids struck with chronic ailments in Oregon City schools: Diabetes, 15. Seizures, 31. Cardiac problems, 16.

The tally reaches 95 children in the 7,671-student district. It includes seven who have tubes that drain extra brain fluid and two in wheelchairs who were born with spina bifida. And the list doesn't count the number of hours she has spent counseling students since two of their classmates went missing and were later found dead.

"It's overwhelming," said Apa-Hall, president of the Oregon School Nurse Association.

Who Are Health and Student Services Professionals?

  • We comprise 3 percent of NEA ESP members -- nearly 10,000 people
  • 79 percent of us work full time
  • 40 percent of us have advanced degrees, and 29 percent of us plan to earn one within the next four years
  • 88 percent of us have attended professional development training in the past two years
  • 9 percent of us are currently attending school or college
  • 65 percent of us work with special education students
  • 65 percent of us are paid on an hourly basis, with an average wage of $12.29 per hour
  • Our average annual salary is $21,720
        *Source: 2002 Status of NEA K-12 ESP Membership Study


3 Myths About Health and Student Services Professional

Myth #1: "School nurses only hand out band-aids."

"A lot of people have this perception that school nurses sit around their office and wait for someone to put a Band-Aid on," says Marge Knuuti, a veteran nurse in Searsport, Maine and 1998 School Nurse of the Year. "But that simply isn't true."

Today, school health officials face a dizzying array of responsibilities in addition to the traditional roles of providing first aid, monitoring immunizations, conducting health screenings, and assisting sick and injured children. They must interact with teachers, doctors, child study teams, administrators, school counselors, coaches, parents, police, special law enforcement, drug and substance abuse professionals, courts, truant officers, social workers and other ESP staff. In short, says Knuuti, their roles have expanded to now include social worker, physical therapist and clinician.

As a school nurse in Seattle, Muriel Softli offers students much more than ointment and bandages. Not only does she make referrals to social agencies and help disadvantaged students get breakfast, "Muriel consoles students when they have problems," says special education instructional assistant Rosa Cook. "And when some are not as clean or dressed up as they should be, Muriel cleans them up and provides clothing."

For Clare Stewart, the sole registered nurse for the 5,580-student Fallbrook Union Elementary School District in California, being a nurse means visiting a different school every day to check on individual students, testing children in special education classes, and looking for ways to help families unable to afford medical or vision care for their children. This is in addition to the mandated hearing and vision tests she oversees.

Stewart says she relies heavily on health care technicians at each school who are responsible for checking temperatures and administering first-aid to injured students and employees. The technicians also assist students who require feeding tubes, help disabled students and students in wheelchairs use the lavatory, and assist students who have epileptic seizures.

Myth #2: "It's easier to work in a school than at a hospital or private practice."

"Back in the '70s, all you needed was first aid and some office nursing skills to be a school nurse," says Martha Bergen, Nursing Instructor at the University of Minnesota. "But today, kids who once couldn't leave the hospital are living at home and getting on a school bus everyday."

And it's the Health and Student Services employees who are taking care of them. Deborah Burton, Executive Director of the Oregon Nursing Center, a nonprofit group that studies nurse work issues, says school nursing used to attract many experienced hospital nurses.

"Here is a job that's nine months of the year, 8 to 5," she says. "The hours, the independence -- plus it's rewarding. But now, working in a school is not so attractive because everyone knows that school nurses are just so stretched."

According to the National Association of School Nurses and the Centers for Disease Control and Prevention, schools should have one nurse for every 750 students. But that is a far cry from reality. A national survey in 2000 found that there are roughly 2,200 students to every nurse in the state of Oregon -- three times the recommended number. And in Utah, there is one school nurse for every 6,330 students, the worst ratio in the nation.

Like California's Clare Stewart, Health and Student Services employees are spending much of their time racing from school to school. Meanwhile, the number of students with medical needs continues to increase, partly due to legislation that has opened schools to more medically fragile children. At the same time, school budgets and funding for student services continues to get cut.

Stewart, a former emergency room nurse, says there has also been a major upsurge in the number of children with severe asthma, diabetes and children taking prescription medication while at school.

"In the past five years, there's been a 10 to 20 percent increase in the number of students with diabetes, a lot of it due to childhood obesity," she says. "And we've seen a 30 to 40 percent increase in referrals for children with emotional or mental problems."

Paula Apa-Hall -- Oregon's 2002 School Nurse of the Year -- spent 15 years in hospital nursing before becoming a school nurse. While she is overwhelmed in her school job, she won't go back to emergency room nursing. "I get to see the kids as themselves, not as 'appendectomy in room three,'" she says.

Regardless of the difference in workloads, like their counterparts in private practice, school nurses and health professionals must earn the credentials to practice. For example, in Seattle's Public Schools, nurses must have a four-year bachelor's degree in nursing, hold a current Registered Nurse license and have a Washington State Educational Staff Associate (ESA) certificate. Many school nurses also have advanced degrees and additional health education training.

Myth #3: "There's minimal correlation between health care workers and student achievement."

Employees who provide health and student services programs are the lifeline of a school -- directly advancing the well-being, academic success and lifetime achievement of students. Without them, equal access to education for students with substantial disabilities would not be possible.

Like guidance counselors and school psychologists, school health professionals are an integral part of the educational community, actively participating in policy making, curriculum planning, IEPs, classroom teaching, and most other aspects of the school environment.

They also care deeply about the students they work with, and the students know it. Often nurses and health technicians console children whose hurts are invisible. These may be children whose parents are divorcing, who have lost a grandparent or who are worried about a parent in the military.

Grace Lee, a veteran school nurse at Frelinghuysen Middle School in Morris County, New Jersey, is just one of the thousands of compassionate school health professionals. In addition to her daily duties, she has organized a health careers club, a loss and grieving group, health and safety fairs, a faculty weight-loss group, after-school fitness walks, and a cooperative program for physically challenged students. "Every child needs, and is entitled to, primary health care in order to reach his or her optimal learning potential," she says.

Cecilia Baker, a school nurse in Marianna, Arkansas, 50 miles outside Memphis, teaches health, hygiene and anger management to both elementary and high school students, and has also organized several after-school programs to help at-risk students. Additionally, she talks with parents about the importance of providing good care and nutrition.

"Above all, in everything I do, I always stress the importance of getting an education," she says. "Every day in my office, I follow up with students because I want them to know I care about their health, and their education."

Teaching Each Other

Because health and safety are paramount community concerns, ESP staff are sustaining innovative programs to address these concerns -- especially Health and Student Services members.

In Seminole County, Florida, members of the Seminole Educational Clerical Association (SECA) recently planned and coordinated training for school staff on invasive health procedures necessary to serve some special education students. In partnership with the district's exceptional student support services division, teacher assistants, nurses, and clerical staff planned and organized the voluntary training, which was provided during the workday.

SECA members participating in the training received broad-based information; those working with medically fragile students received more intensive training on site. SECA also offers their ESP members a training manual as well as a task force report to help them better serve students with special medical needs.

Expanding Skills and Knowledge

If there is one downside to working in a school, say members, it's that they are isolated from the usual exchanges with the medical community. There are few opportunities to attend seminars and workshops. And the literature and Web offerings are so overwhelming it's hard to keep up.

Meanwhile, comprehensive preparation and ongoing training is increasingly important as more students are attending school with severe and/or life-threatening medical conditions, injuries or birth defects. Staying up to date about new state requirements, communicable diseases and policies about administering medications is critical.

Health professionals report many areas where little training is available, including computer skills, recordkeeping, time management, liaisons with community health organizations and social services organizations, appropriate communication with local law enforcement, familiarity with child abuse services, local and state courts and substance abuse agencies, current medical insurance availability, and funding information in order to adequately stock and supply medical equipment.

Any of the above would make excellent training topics. Others include:

  • Background information on new medications and their effects on children
  • Updates on use of new or improved medical equipment or technology
  • Communications skills related specifically to communicating with parents and staff relating to a sick child.

Health and Student Services Web Resources

Academy for Educational Development. This is an independent, non-profit organization committed to solving social problems in the U.S. and throughout the world. Major areas of focus include health, education, youth development and the environment.

Advance for LPNs Magazine Online

American Nurses Association

American Occupational Therapy Association

American Physical Therapy Association

American School Counselor Association

NEA Health Information Network's Asthma and Schools Web site

The Center for Health and Healthcare in Schools is a project of the George Washington University School of Public Health and Health Services.

Child Health Toolbox Home Page. This online resource can help state and local policymakers, program directors and staff answer questions about measuring health care performance in child health programs.

The Children's Bureau of the U.S. Department of Health and Human Services is the oldest Federal agency for children.

Connect for Kids has resources to help education personnel and parents to support children dealing with trauma and grief.

U.S. Dept. of Education, Education Publications, School Health and Student Services, P.O. Box 1398, Jessup, Maryland 20794, 1-877-4-ED-PUBS fax: 301-470-1244. Offers free publications on student health and health services and programs available through the Federal government.

NEA's Health Information Network, the non-profit health affiliate of the National Education Association, addresses numerous health issues that affect NEA members and students, including HIV/AIDS, substance abuse, cancer, teen pregnancy, mental wellness, nutrition, school safety, asthma and environmental hazards in schools.

The National Association of School Psychologists provides tools and resources for educators to help children cope with crises.

National Library of Education, Educational Resources Information Center. Free publications and material on every aspect of public school student health and services, including public health information.

National Network for Immunization Information. This site provides the public, health professionals, policymakers and the media with up-to-date, scientifically valid information related to immunization. The site includes the latest immunization news, a vaccine information database, a guide to evaluating vaccination information on the Web and more.

Nurses.Com. Information and resources for the nursing and health professional industry, including legislation, products, services, training, and health technology updates.

National Clearinghouse on Child Abuse and Neglect Information. The clearinghouse is a national resource for professionals seeking information on the prevention, identification and treatment of child abuse and neglect and related child welfare issues.

The Red Book -- Exposure to Blood on the Job: What School Employees Need to Know. Contains basic information that every school employee should know about dealing with Hepatitis B and C and HIV/AIDS viruses. Order a free copy from the NEA Health Information Network (HIN) on-line at, or download it  in English  (PDF, 32 pg) and Spanish   (PDF, 32 pg) versions.

Safe Health Care: The Role of Educational Support Personnel. A how-to resource by NEA for support professionals on working with medically fragile children and how to best help them.

School Health Resource Services. Hosted by the University of Colorado, School Health Resource Services (SHRS) is a way to access the diverse resources needed to implement or improve school health programs and services. SHRS is a network of services designed as a coordinating link between school nurses and information available from school health, maternal and child health, education and other disciplines. SHRS provides school health personnel with technical information, resource materials and research assistance.


More NEA Resources for Health and Student Services ESP

Go to "Getting Educated: Paraeducators"


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