history of school nursing in the united states
history of school nursing in the united states
The profession of school nursing began in 1888, when the first public health nurse was hired in Buffalo, New York to work with children and families.
You might be surprised to learn that school nursing has a long history in the United States, dating back to 1888. It was in this year that the first public health nurse was hired in Buffalo, New York to work with children and families. Her focus was on improving their overall well-being by providing basic treatments within the community.
In 1911, the New York City Department of Health designed a model program based on public health principles of disease prevention and health promotion.
It was developed by Lina Rogers Struthers, a nurse and public health leader who had previously worked in the New York Charity Organization Society.
The program was based on the public health principles of disease prevention and health promotion. It focused on the following services: vision, hearing, dental and nutrition assessments; detection of physical, mental and emotional problems; immunizations; first aid care; treatment for minor illnesses; oversight of playgrounds and outdoor activities to ensure safety; referral to community resources when necessary; instruction in personal hygiene as well as school sanitation practices (e.g., food handling); and maintenance of school health records.
This program grew rapidly to include over 200 nurses in its first year!
In 1912, the National Organization for Public Health Nursing (now the National Association of School Nurses) was established.
To better understand the history of school nursing, it’s important to know that in 1912, the National Organization for Public Health Nursing (NOPHN) was established. The National Association of School Nurses (NASN) was established in 1968 from a division of NOPHN. These two organizations are similar and have overlapping goals. However, they do have some different responsibilities. As you can tell by name alone, NASN is specifically dedicated to serving the needs of school nurses while NOPHN is focused on public health nursing in general.
The original conception of NOPHN can be seen as part of a broader movement toward a progressive approach to public health. In its heyday, this organization played an important role in establishing public health as a separate category from medicine and also made important inroads into improving community healthcare practices. As society changed, so did its attitude towards education. It became apparent that there were specific issues that only affected school children and their relationship with nurses and doctors.
In response to this shift in perspective over time, NOPHN evolved into NASN because it was felt more appropriate to have an organization specifically devoted to providing guidance and support for nurses who worked directly with students at schools rather than just having them lumped together under the larger umbrella of public health nurses.
During World War II, public health nurses coordinated civil defense measures and trained volunteers in emergency preparedness.
During World War II, public health nurses coordinated civil defense measures and trained volunteers in emergency preparedness. The demand for registered nurses was so great that many were asked to serve as military officers in the Army Nurse Corps rather than serve in their civilian positions. School nurses were assigned to the schools’ civil defense unit. In this position they trained teachers and other school personnel in the use of gas masks and were responsible for the distribution of masks to each student. They provided first aid training for volunteers, maintained maps of air raid shelters, and conducted regular drills with students to ensure that everyone knew what actions needed to be taken in an emergency situation.
School health programs became increasingly concerned with health education rather than simply caring for individual students who became ill or injured during school hours . Public health nurses provided “health teaching” lessons on issues such as first aid, good nutrition, dental hygiene, and tuberculosis prevention . Nurses promoted specific topics during particular months (e.g., April was known as “Oral Hygiene Month”) using posters hung throughout the school building . Nurses also held classes for teachers on sanitation practices such as hand washing between students or proper methods of cleaning drinking fountains .
The war effort required significant involvement from all members of society; therefore it is not surprising that public health nurses were expected to contribute to military-related activities while still providing healthcare services within their schools. School nurses had a unique opportunity during this time period to influence the physical and mental health of an entire generation through promoting healthy lifestyles among young people and preparing them for roles as citizens in a global conflict that would shape history.
The 1960s ushered in a new era with rapid social change, especially regarding women’s roles.
The 1960s ushered in an era of rapid social change, particularly for women. Women were fighting for equal rights and we’re starting to take on roles outside the home. The school nurse profession was affected by these changes, as more women became nurses during this time and the role of nurses in schools started to be reconsidered.
The 1970s focused on legislation, licensure and professional identity.
During the 1970s, there was a renewed interest in health education and prevention programs. The National Association of School Nurses (NASN) defined the role of school nurse as: “The school nurse, a member of a multi-disciplinary team, is responsible for the health care needs of students attending the school. Health services are directed toward health promotion and disease prevention to optimize academic success.”  The NASN also stated that “the focus [of school nursing] is on the physical, mental, emotional and social health of students”. Another acronym used during this time period was SCHOOL (School-Based & Community Health Opportunities Using Local Resources).
The 1990s, also referred to as a decade of accountability, saw more mandates and funding for school health.
> The 1990s, also referred to as a decade of accountability, saw more mandates and funding for school health.
School nurses were encouraged to be more accountable. They were expected to do more with less money, and they were expected to contribute information that could be used in evaluation processes. School nurses did not resist the need for accountability in their work; however, they did request clear professional standards by which they could be evaluated and supported.
During this decade, school nursing was a recognized specialty area of nursing practice (American Nurses Association [ANA], 1991), and National Association of School Nurses (NASN) with its newly defined scope of school nurse practice became a recognized specialty organization. During this time period, school nursing continued to expand into providing more services beyond acute care: services related to chronic care management and health counseling and education that affected student learning!
Since the turn of the century, school nurses have continued to expand their role in improving academic outcomes for students by providing health care that enhances student readiness to learn.
A child who is malnourished, has an untreated infection, or suffers from a chronic disease is less able to learn. Since the turn of the century, school nurses have continued to expand their role in improving academic outcomes for students by providing health care that enhances student readiness to learn. School nursing also supports healthy social-emotional learning and a safe school environment for all students. The presence of a school nurse is critical during a public health emergency such as COVID-19 to provide information and recommendations on how to minimize risk in schools.
School nursing has evolved from the early 1900s until now into a profession that is essential to the well-being of students and teachers
School nursing is a unique practice that has evolved from the early 1900s until now into a profession that is essential to the well-being of students and teachers. The National Association of School Nurses (NASN) developed a definition of school nursing in 2009 that stated, “school nurses facilitate positive student responses to normal development; promote health and safety including a healthy environment; intervene with actual and potential health problems; provide case management services; and actively collaborate with others to build student and family capacity for adaptation, self-management, self advocacy, and learning” (NASN, p 1).
These efforts are accomplished utilizing the practice essentials of:
- Provide health care that enhances student readiness to learn
- Cooperate with school personnel, community, and home
- Ensure students are receiving the best care possible
School nurses have an important role in the development of students. Utilizing these three components as part of their daily practice supports their goal to improve health outcomes for students.