Australian school nurses deliver life-changing care

Anita Moyes, Lecturer, School of Nursing and Midwifery, Edith Cowan University 

The quality of care that Australian school nurses provide to young people is crucial and can be life-changing, even though it is often overlooked in Australia. I was recently awarded the 2025 JOSN-SAGE Scholarly Writing Award. This is international recognition for my paper exploring the experiences of secondary school nurses who encountered young people with mental health problems.  

As any nurse working in primary care will tell you, every day is different, and anything can walk through the door. Nursing in schools is no different. We’ve had nurses in Australian schools since the early 1900s. Currently there are nurses working in government and non-government schools all across Australia. There’s a limited understanding of this work, however, and a tendency to think it’s all pads and Panadol, band-aids and headlice. The reality is very different.  

Nurses generally work in settings where health is the core business. However, the core business in schools is education, and adapting to the rhythms of a school can take some time. School nursing work is varied and can include direct clinical care, crisis intervention, health care planning, risk management, working with families, developmental assessment, caring for boarders and children with disabilities, facilitating small groups and even teaching in the classroom. Many school nurses work autonomously, so they need to have well-developed clinical skills and confidence. Thriving on constant change is also an advantage, with increasing numbers of children at risk of anaphylaxis, and words like ‘vaping’, ‘school can’t’ and ‘neurosparkly’ only recently having entered the public lexicon. 

Internationally, many countries invest heavily in national school nursing services and really capitalise on the skills that nurses bring to their work with young people and their families. This is in line with World Health Organization recommendations that all countries implement comprehensive school health services. In contrast, school nursing in Australia has low visibility and nurses could be used much more effectively in our schools if Australia adopted a national approach to school nursing. 

Mental health challenges 

In common with many countries, young people’s mental health is a major public health issue in Australia. As the lead author on the study of Australian school nurses working with young people experiencing mental health problems, I interviewed more than 30 government school nurses across Western Australia. Supervised by expert mental health nurse academics Professor Dianne Wynaden and Dr Shirley McGough, I used classic grounded theory to explain how school nurses responded when they encountered young people with mental health problems. The overall finding was that school nurses were actively working with young people experiencing mental health problems, but they were under-resourced and the work they did was often hidden and unacknowledged. 

One of the things that became clear early in the study was that school nurses weren't just dealing with things that happened at school. Young people were seeking support for issues such as sexual assault, family breakdown, academic stress and problems with low mood or anxiety. Some young people were so distressed they were self-harming. Others were living with family and domestic violence, or choosing to couch-surf to escape. Some young people had lost a parent to death or divorce, had a parent in prison or had been ejected from home. Others were carers for a parent with a disability or a mental illness. Young people didn’t park their problems at the school gate. They brought their lives to school with them, and these difficulties impacted not just their wellbeing but also their capacity to learn. 

The school nurses I spoke to explained that these problems were rarely resolved by referring the young person to a different organisation. In some cases, there were long wait lists or other barriers to the young person engaging with external services. Even the young people who were well-engaged with other services could still experience a mental health crisis at school. Some young people didn’t have adequate home support, making it difficult to engage with other service providers. School nurses told me that young people came back to see them again and again, often with high-stakes issues, such as deliberate self-harm and suicidal ideation. This took a heavy toll on the emotional wellbeing of nurses, but they felt that working with this group was an important part of their role. 

Tactical prioritising 

A unique and important finding of this study was that school nurses were not passive in the face of these clinical demands. They actively managed how they responded by engaging in a process that we called ‘tactical prioritising.’ This process helped them to address a young person’s problems while also caring for their own emotional wellbeing. School nurses still facilitated referrals to other service providers, but also used a toolbox of interventions to help young people develop life skills, manage intense emotions, engage in conflict resolution and problem solve. They created a safe space at school, made themselves available as a safe person to discuss problems with, and were advocates for young people and their families. Importantly, they supported young people to keep coming to school and kept the young person on a developmental trajectory into young adulthood. These interventions sought to optimise young people’s health and developmental outcomes but also improved school nurses’ feelings of professional effectiveness. 

School nursing is becoming more visible in Australia, but we could be doing better. An established and attractive nursing specialty in many countries, growing the school nurse workforce in Australia should be a priority. We should also be employing school nurses with specialist expertise in child and adolescent mental health and growing the next generation of school nursing researchers in Australia. My team and I are already working on these goals as part of the Australian Nurses Working in Schools Project. We’d be thrilled to hear from readers of Primary Times who would like to get on board with us!

Learn more about the Australian Nurses Working in Schools Project.

To learn more about school nursing and tactical prioritising, read Anita’s award-winning article: A Moyes, S McGough and D Wynaden, ‘An untenable burden: exploring experiences of secondary school nurses who encounter young people with mental health problems’, J Sch Nurs, 2024, 40(3):305–315, doi: 10.1177/10598405221088957.