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School nurses – the secret superheroes
By Nick Buchan, APNA PR/Corporate Affairs Advisor
Source: APNA Primary Times Winter 2022 (Volume 22, Issue 1)
Despite the huge contribution that school nurses make to their students and communities, fewer than one in six Australian schools has a nurse on staff. However, opportunities to join this rewarding nursing fraternity are starting to open up across the country.
When Lisa Chalmers tells someone about being a school nurse, the response is sometimes a chuckle and a joke about putting band-aids on a skinned knee.
The reality could not be more different.
'One minute you’re applying a wound dressing for a burn and the next minute you're down in junior school giving an EpiPen,' Lisa said.
'Then you are heading over to the basketball court because someone's rolled their ankle or fractured their arm. You might have asthma. You might have vomiting.'
Lisa is the director of Health and Wellbeing at Sydney’s Barker College and got her first taste of being a school nurse almost 30 years ago.
'No two days are the same, no school is the same, no group of students is the same,' Lisa said.
'We have planning for excursions or camps, doing the risk assessment and planning, packing first-aid kits, and training staff on how to use Ventolins, EpiPens, or demonstrating how to put a snake bite bandage on,' Lisa said.
'We have a lot of students nowadays who are on scheduled S8 medications. We may have students who need some help or mental wellbeing support. We have students with eating disorders who come and have their recess and their lunch with us.'
'Staff members get sick during the day. Our Year 7 students have quite a significant vaccination program with their HPV doses and the booster for tetanus, diphtheria, pertussis,' Lisa said.
'I often think of school nursing as an iceberg profession – what is seen on top is just a fraction of the scope and scale of what school nurses do on a daily basis. I suspect it is one of the most diverse and interesting jobs a nurse can have.'
School nurses are the secret superheroes of the school system, providing a wide range of primary health care services and support to students, staff, and student families. They are often the first person that a student encounters when seeking help.
Research shows that more than 75% of mental health issues develop before the age of 25,1 meaning that school nurses present a significant cost-effective primary health care measure in addressing the mental health concerns of students and their families.
Michelle Roberts is health coordinator at Ashcroft High School, a public school in south-west Sydney. The support she offers students can include accessing a GP, accessing hearing and vision screening, NDIS support, advocating for referrals to paediatricians, coordinating allied health services, attending appointments with students/families and linking in with external services for ongoing support.
Michelle has been a registered nurse in the primary health care space for nearly 40 years and says helping students reach their potential is one of the best parts of the job.
'Oh, it's incredibly rewarding. I'm not sitting outside looking in, I'm inside looking out. And that's the best part of being a nurse within a school rather than an external provider coming in and just bringing in a health perspective,' Michelle said.
'If students cannot hear or if they cannot see, they are not going to be able to learn. And if children are put into a learning environment where they have not had those health needs met, then they definitely will not be able to engage in that learning environment, so they become disruptive, or they become disengaged or they just do not turn up,' Michelle said.
Michelle said that students who receive primary health care support achieve better academically, attend school regularly and integrate into the school and classroom environment well [see student Pauline’s case study as an example].
'One student's reading levels jumped almost 10 levels in a term once we identified her health issues. Finally, she could hear what the teacher was saying and understand it. If the school did not have a nurse, that child may never have had those health issues identified.'
Lisa said that many developed countries have nurses integrated into their school systems. However, according to the latest available statistics, only a small proportion of Australian schools do. Some estimates put the number at roughly one in six schools across Australia currently having a nurse on staff,2,3 the majority of those being in private or Catholic schools.
Things are changing slowly. Some states, such as South Australia, do not hire nurses in the public school system. However others, such as Queensland and Western Australia, do have a limited number of school nurses in the system.
"School nursing as an iceberg profession – what is seen on top is just a fraction of the scope and scale of what school nurses do"
New South Wales is recruiting up to 100 nurses for a ‘Wellbeing and Health In-reach Nurse’ program. Victoria has a well-established school nurse program, while its ‘Doctors in Secondary Schools’ program is funded by the state government’s and administered through primary health networks. The program seeks to put a doctor and a nurse on campus for one day each week during term time at 100 schools in the state’s most under-resourced metropolitan and regional areas.
Both Lisa and Michele welcome more nurses joining the school community; however, they caution that not every nurse would be a good fit.
'The only problem, and we're identifying it now, is that often the nurses that come from hospitals have a very tertiary lens to their work because they're so used to working within a hospital' Michelle said.
Michelle said that nurses from other primary health care backgrounds were ideal candidates for a school nurse position. She also said that programs such as APNA’s Student Nurse Placement Program were another good way of building a sustainable pipeline of school nurses to meet future demand.
'School nurses come from a wide range of backgrounds. Primary health care is a good solid base,' Lisa said.
'We have students from [university] Master of Nursing programs who come to our school and they are all “Oh, we had no idea that this is what school nurses did. We had no idea the breadth and scope of what you do in a week.'
'School nurse student placements also open up educational institutions and universities to see what pathways there are for students, and then accommodate their programs accordingly.'
Lisa said that becoming a school nurse is an opportunity to build a great career and at the same time teach generations of students the healthy habits and life skills they need to thrive.
'School nurses build healthy communities. We want to teach our kids that health literacy is as important as English literacy or even financial literacy.'
To find out more about APNA’s Student Nurse Placement Program, visit: https://www.apna.asn.au/profession/student-nurse-placement.
Case study: The difference a health coordinator (school nurse) can make
Pauline (not her real name) was 5 years old when she started kindergarten. She was referred to the health coordinator by her teacher with what she described as 'thick green fluid coming out her ears'.
The health coordinator was responsible for the initial assessment and creation of a care plan, a GP referral, weekly monitoring, health education with the parents, and attendance at ENT appointments to support Pauline’s mother. Pauline subsequently had bilateral surgical repair of her perforated ear drums, then 12 months of intervention and care coordination.
The subsequent improvements to Pauline’s education and health were outstanding. She progressed her reading ability from Level 9 to Level 16 within 5 weeks after her operation. Speech therapy continued at school with a marked improvement of her expressive and receptive language skills. In addition to this, her eczema improved – an individual eczema care plan was initiated, and she had cream applied twice a day at school. No further admissions to hospital were required and Pauline’s school attendance increased from 76% to 94%.
1 PD McGorry, C Mei, ‘Early intervention in youth mental health: progress and future directions’,
Evid Based Ment Health, 2018, 21(4):182–184, doi:10.1136/ebmental-2018-300060.
2 Australian Government Department of Health, ‘Factsheet selector dashboard: nurses and midwives’, Department of Health, 2020, accessed 17 May 2022. https://hwd.health.gov.au
3 Australian Curriculum, Assessment and Reporting Authority (ACARA), ‘School numbers’, ACARA website, 2021, accessed 17 May 2022. www.acara.edu.au