School nursing in the United States was born in New York City. In the early 1900s, the practice of school health in the city consisted of inspections and dismissal of students from school by a medical health team, with the focus on containing the spread of contagious diseases through exclusion.

But absenteeism was recognized as a major barrier to a child receiving a proper education, and the board of health sought a way to treat children and keep them in school.

A courageous public health nurse named Lillian Wald proposed commissioning a nurse to identify children with contagious diseases, and educate families on how to manage diseases. Nurse Lina Rogers was hired for a month-long experiment, and went into the community and visited homes to perform her work. As a result, children returned to school sooner, and the absentee rate decreased. On Nov. 7, 1902, she became the first school nurse hired by the New York City Board of Education.

While more than a century has passed since Lina Rogers first worked to identify diseases among children, today that remains part of school nurse practice. School nurses work with county boards of health to identify and report communicable diseases. Educating the school population, staff, parents, and communities is still key to obtaining proper medical treatment and preventing further spread of disease.

But the school nurse’s job has also grown significantly. In New Jersey, where there are about 2,500 certified school nurses, school nurses review all incoming students’ immunization records to make sure they meet state Department of Health school admission requirements.

School nurses are responsible for illness and injury management of an entire school population. And the advent of advanced medical care has expanded the role further. The number of children with complex medical conditions in public school is increasing. Federal law ensures students with a disability are provided with a Free Appropriate Public Education (FAPE) tailored to individual needs. The school nurse’s job now includes case management for students with acute and chronic health issues.

Similar to public health nurses, school nurses provide case management, which means collaborating with parents, school staff and other healthcare providers to assess, plan, facilitate and evaluate care and accommodations for students. We are the only healthcare provider in a public school. Any health condition that exists outside of school may be present inside; student needs are comprehensive and may require a wide variety of interventions.

School nurses also conduct health and wellness activities to meet the needs of their school community. School nurses promote wellness through health fairs, grant-based health initiatives, and community outreach programs. They may bring in a mobile dentist, refer families to food pantries, connect a student without health insurance to a clinic, and more.

School nursing is a specialized practice requiring comprehensive understanding of health conditions, nursing care, public health, and a working knowledge of the education system and laws. To provide this level of expertise, the New Jersey Department of Education has mandated school nurses have:

  • A registered professional nurse license in New Jersey;
  • A bachelor’s degree from a regionally accredited college or university;
  • Required specific first aid certifications and asthma management training; and
  • Completion of a School Nurse Certification Program, a specifically -designed college curriculum program that includes a clinical experience practicum.

School nurses are recognized as a vital link in the promotion of wellness through the “Whole School, Whole Community, and Whole Child” health model. The American Academy of Pediatrics has a policy statement supporting the role of school nursing in the wellness continuum, and also advocates for a school nurse in every building.

The National Association of School Nurses defines school nursing as a specialized practice that “protects and promotes student health, facilitates optimal development, and advances academic success.”

Through the strength of professional practice, by delivering high-quality health care in a school setting, New Jersey’s certified school nurses are proud to advocate for and promote health, safety, and a positive learning environment.

Cecilia Spehalski, BSN, RN, NJ-CS, has been school nurse at Springville Elementary School in Mt. Laurel for 17 years. She has served as president of the Burlington County School Nurses Association, and is currently communications chair of the New Jersey State School Nurses Association.