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Nova Scotia has a long history of school nurses. But their role has decreased as schools turn to other health professionals. And in the midst of a pandemic, that may be a problem.
“Nurses have this ability to to look at the individual child — the whole child. But we also have the ability to look at the population as a whole,” school nurse and educator Robin Cogan said in an interview. Cogan is a nationally recognized school nurse in Camden City, New Jersey, who runs the Relentless School Nurse blog. She’s a fierce advocate for the importance of having nurses in schools. In New Jersey, she said, “there is typically a certified school nurse in every building.”
Cogan said nurses “are certainly there for emergencies and screenings and anything related to the well-being of the child from head to toe, and also their emotional well-being. But we’re also there as a resource for parents or staff. We are the only medical person in the building. And for some students and some families, we may be the only medical person that they see. So we do care coordination. We provide education.”
In a province where access to family doctors continues to be a problem, those can be crucial services.
Currently, nurses in Nova Scotia form just one small part of teams serving kids’ needs through a web of programs and partnerships. The province has 72 youth health centres, mostly in high schools. Speaking for Public Health, Lesley Mulcahy described the staffing of the health centres in an email:
Multiple service providers operate out of the youth health centres, including community partners, family physicians, NSDEECD (SchoolsPlus), the IWK and Nova Scotia Health (Public Health, Primary Care, as well as Mental Health and Addiction Services) to support youth. The work at the individual level, with students through YHCs, is supporting students in navigation to services and provision of information or resources.
Youth health centres, said Halifax Regional Centre for Education spokesperson Doug Hadley in an email, are staffed a minimum of 18 hours a week by “a qualified health professional” under an agreement with the Nova Scotia Health Authority. The staff member “could be a nurse, social worker, recreation therapist, etc.”
He added that the School Health Partnership agreement among the HRCE, the Department of Education and Early Childhood Development, and the IWK sees 2.5 full-time equivalent nurses in the entire HRCE school system.
But since the start of the pandemic, public health nurses have not been providing services in schools, Mulcahey said. “There is a plan in development on how to work with the regional centres of education, as well as schools, to support education in a successful re-opening,” she noted.
When it comes to elementary schools, there are no youth health centres or nurses. Instead, Hadley wrote, “there are a number of health supports in place for elementary students.” Elementary kids can talk to a counsellor, but other than that they are reliant on “student planning teams” identifying needs so that the students “could have access to a school psychologist, speech language pathologist, school social worker, behaviour support teacher, behaviour specialist, a Child and Youth Care Practitioner, and an autism specialist.”
But as valuable as social workers and rec therapists can be, their presence in schools is not a substitute for nurses.
“I think a rec therapist is a wonderful idea, but that does not replace having a school nurse present,” Cogan said. “There is a care coordination piece when a school nurse is present. They can provide tremendous support and be that link between school and home…. Really, we’re that soft place to land for kids. We can help identify kids who are struggling with physical or emotional issues, because we don’t give grades. We are really that safe, trusted person that students can turn to… I can’t even imagine not having access to a school nurse in a building. It’s such a disservice to the students and the staff.”
The provincial PC and NDP education critics both see gaps that could be filled by nurses — particularly during the pandemic.
Tim Halman, MLA for Dartmouth East, taught at Prince Andrew High for 10 years before being elected in 2017. Now he is the PC education critic. He said he’s seen “first-hand how supportive and helpful” youth health centre staff can be. But he also thinks nurses could be better positioned to provide frontline services right now, and that having a greater nursing presence in schools could go a long way towards allaying parents’ concerns.
“One of the things I’m hearing from parents is this is an opportunity to really rethink education, and the youth health centre is one of those opportunities to rethink in the COVID-19 era,” he said in an interview.”We are seeing an enormous amount of anxiety… If we had planned appropriately we could for example have an LPN [licenced practical nurse] assigned to each school or family of schools to deal with a situation where COVID emerges in a school.”
He added, “Perhaps an expanded role for school nurses could be a concrete solution to what happens when there is a positive COVID-19 test — having a nurse who can provide proper response and containment.”
NDP education critic Claudia Chender, who represents Dartmouth South, said in an interview that her party does not have a specific policy on school nurses, but “we know there are not enough school nurses.”
Chender said, “Obviously with the pandemic being a reality for us, we know we need increased attention and investment in health and safety in schools. And school nurses would be a part of that… Our party has advocated for increased health delivery in schools, particularly for people who wouldn’t get those services on their own.”
Cogan said that in the US, pre-COVID-19, over a third of school nurses’ time was spent on mental health issues. With the pandemic, she expects that number to rise.
Martha Paynter is a nurse, doctoral student, nursing advocate, and founder and co-ordinator of the non-profit Women’s Wellness Within. In an interview, she said, “So many children are coming into schools with trauma… Children need holistic health care. Not to mention just the things that come up — physical things, injury, illness, infection. So you need nursing care to navigate all of that. It’s really very important to teach children also about how to take care of themselves… For kids who are in school, nursing can be a source of building knowledge about themselves, the body, how to be healthy, and how to have healthy relationships — taking care of yourself and taking care of each other.”
Identifying kids in need and helping them and their families care for themselves was one of the motives underlying the presence of school nurses in the first place.
An article called “Medical Inspection of Schools in Nova Scotia” published in 1914 in The Public Health Journal sees Nova Scotia as backward when it comes to “the serious medical inspection of children in our schools.” It outlines efforts in Amherst, Truro, and Halifax to identify children who need medical or dental help. (More darkly, the paper also notes the number of “incorrigibles required to be educated in a special school.” As Paynter said, “nursing is not innocent and has a history of racism and policing in its own ways.”)
In Amherst in 1911, the school nurse’s salary was “paid by a lady interested in the work.” She arranged discreet visits to her private office for students she thought might need help, did home visits, provided clothing, boots, books and other items students might need, carried out first aid, supported doctors when they visited schools and so on. The paper notes:
Her work and influence in the school and in the home has brought teachers and scholars a buoyancy and interest and pleasure in school life and work that is very noticeable besides bringing the home and the school in close and better relationship.
In Halifax, the paper says, nurses trained teachers in efforts to prevent contagious diseases from spreading. Though written over a century ago, the next few paragraphs still resonate:
It is generally recognized that the rapid spread of infectious diseases in all schools is due largely to the conveyance of infection from the hands to the mouth, nose, and other exposed mucous membranes.
A school building is necessarily a comparatively dirty place. Even if a child comes to school clean it is almost impossible for active children to remain so during the whole of the session.
Many children do not know how to wash their own hands and faces properly. School authorities, as you are well aware, are providing facilities for the maintenance of personal cleanliness… There are any ways in which the details could be worked out and the moral effect on the children would more than repay an [sic] additional time and expense involved.
What was true then is true now too. “I just I think what we can recognize now in the time of COVID is how absolutely fundamental it is to understand how to have healthy bodies,” Paynter said. “And that is nursing. We need all kinds of other things. We need rec therapy. We need health promotion. We need those kind of things. And the core of it really is that holistic care that nursing provides.”
Cogan also thinks expanded roles for school nurses and increased health centre staffing could reduce the need for police presence in schools.
“I am a gun violence prevention activist. We’re having a national conversation about police and funding police or defunding police and what that would look like. You’re having it, too,” she said.
“My position is that we need the right staffing, which includes school nurses, school social workers, school counsellors, mental health professionals in the building… And when you dig into the root cause of [violence] in my mind, anyway, it really leads back to childhood adversity, and what’s happening at home… What do we value? We value children. We value children’s health.”
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