“As part of the obtaining school health information from parents, school nurses get parental permission for information sharing,” she said. “Also, pediatricians have parents sign consent [forms] to talk with school nurses about children with chronic health conditions.”
The first and second recommendations lead to the third: establish a working relationship with school nurses to help manage students’ chronic health conditions. Such a relationship would include standardized communication, permission, and information forms, which can help when developing Individualized Health Care Plans.
Finally, the AAP recommends that pediatricians include nurses as part of the health care delivery team for children and teens, working toward designing integrated health systems with school-based health centers.
Intimidated by the idea of community advocacy or implementing these other recommendations? Dr. Holmes said the first step is to learn about the community.
“We want pediatricians to know where their patients go to school, and then we want them to know if that school has a nurse,” Dr. Holmes said. “Then they can decide where their advocacy best fits, but it often best fits at the school board.”
One next step might be asking the district to form a school health advisory committee, with at least one local pediatrician member, if one doesn’t exist, Ms. Sheetz said. She described a variety of ways that communication systems could be set up and listed the various tasks that school nurses can do to help pediatricians understand what’s happening at local schools, such as in-school screenings.
“The best model is for a school district to have a school physician who coordinates with school nurses to assure communication with community pediatricians, including creating communication expectations,” Dr. Holmes added. “Since this model is not common, we encourage pediatricians to know who the nurses are in their district, and to treat them as part of the team.”
Funding or other models
Funding is definitely a serious concern for many districts, but pediatricians can investigate other successful models, such as hospitals or the Department of Health paying for nurses in schools, university programs who “lend” nurses to schools, and programs where pediatric nurses in physician offices share time in schools.
Ms. Sheetz also recommended joining forces with parents who can pressure the district to address health in schools. Parents of children with chronic illnesses often are especially motivated to advocate for better care availability in the school setting.
“The parents have the biggest stake in all of this,” Ms. Sheetz said. “If there’s no school nurse there for an emergency or to manage chronic illnesses or to respond to an emotional issue, it’s the parent and child that gets hurt.”