School Nurses & Teachers

Increasing chronic illnesses and behavioral stresses have changed today’s schools and classrooms. The demands to keep students healthy and safe require school nurses to employ new and evolving strategies. Developing and expanding the school health team is crucial to meet these ever increasing needs. With the school nurse as the lead, the school health team, in some areas, has traditionally included the front office secretaries, school counselor, and school psychologist. A recently recognized and integral member of the school health team is the classroom teacher. When included in the health team process, the teacher is often the first person to recognize signs of illness or imbalance. Early intervention and referral to the school nurse is what will help keep students healthy, safe and ready to learn.

Conditions Among Students
According to the CDC Asthma Surveillance Data from 2012, more than 6.8 million children (9%) have asthma. It is the most common chronic disease among children and is also one of the leading causes of health-related school absences. In 2008, asthma accounted for an estimated 14.4 million lost days of school among children nationally.1

Asthma is just one of the many medical conditions that impact our children at school. Increasing numbers of children are being diagnosed with life-threatening anaphylactic reactions. Between 1997 and 2007, the incidence of food allergies in school-aged children increased 19%.2 In a recent U. S. survey of 38,480 children, the prevalence of food allergies was 8 %, with 38.7% of those having a history of severe reactions.3

What is more alarming is the data from a survey of schools where epinephrine was administered. Approximately 25% of recipients of epinephrine in the school setting had no previous food allergy diagnosis.4 The results of the survey indicate the importance of a school staff member being capable of recognizing the signs and symptoms of anaphylaxis and responding with appropriate interventions. Many of our nation’s schools do not have full-time school nurses so the responsibility to recognize and treat asthma and anaphylaxis often times falls upon trained non-medical school staff.

Type 1 diabetes rates among school-age children also has increased from approximately .06/100 to 1.9/100, according to the CDC.5 However, it’s not just the number of students with diabetes that has changed; it is how they are now being managed.School staff is administering insulin based on carbohydrate intake and blood glucose numbers along with factoring in recess, PE, tests, quizzes, and field trips. They are working with insulin pumps, continuous blood glucose monitors, and now apps that let parents and staff monitor blood glucose trends throughout the school day. But this is just the tip of the iceberg.

Societal Factors
Social determinants of health also have a great impact on our students and their readiness to be able to learn once they arrive at school. Some schools have begun serving breakfast, because so many students were coming to school hungry. Anxiety and emotional disorders are common, impacting one out of every four or five students.6 Twenty-one percent of students come from homes where English is not the primary language,7 13% have parents who did not complete high school,8 and 2% of our students are homeless.9 Working as a team, school nurses, teachers, and counselors provide necessary interventions to help students succeed. Schools rely on the observations and timely referrals of teachers, more and more, so appropriate interventions can occur. Teachers are an invaluable resource and are often the eyes and ears of the school nurse and school health team.

Role of the School Nurse
School nurses are charged with overseeing the health needs of all children are met while at school. This includes developing individual healthcare plans for children with chronic illnesses and planning appropriate interventions for acute injuries and communicable diseases. When planning for healthcare delivery at school, the school nurse must consider the location of the classroom, the make-up of the classroom, and understand the teacher is responsible for all the students, including but not limited to, the children with health conditions.

School nurses work closely with teachers, orienting them to the individual healthcare plans for students with chronic conditions in their class. For example, teachers who have students with diabetes are trained to recognize low blood sugars, how to administer glucagon in a hypoglycemic emergency, and learn how to coordinate with the school nurse so they are prepared for field trips, extracurricular activities, or changes to their students’ normal schedules.

A teacher with a student who has asthma is trained to listen for the classic cough of an asthma flair and when and how to help with a rescue inhaler. In many states, there are laws that allow teachers to be trained to recognize the signs and symptoms of anaphylaxis and how to respond appropriately by giving injectable epinephrine. Teachers are often the first to hear if there is a crisis occurring at home or outside of school. By working together, the teacher and school nurse can support physical and mental health needs of their students, helping them thrive academically and behaviorally.

SEE ALSO: School Nurses and Obamacare

Here is the experience of a 7th grade teacher in Oregon, Mariela Tyler. “We’ve been really lucky to be able to work closely with our school nurse, Lindsey Novak. Last year, we had a student with diabetes and, because we had collaborated with Lindsey, our 7th grade team felt prepared to deal with any emergencies that might arise. I am also part of our ERT [emergency response team] team at school, and school nurses were integral in our training, making us feel ready to tackle any emergencies at school. For example, we had a student get stung by a bee and we didn’t know he was allergic, but we were able to recognize the symptoms of anaphylaxis and give him epinephrine, averting a potential tragedy.”

This example shows the importance of having the teacher included in the school health team and the working relationship needed between staff and the school nurse to make sure students are safe at school. The education and training school nurses provide empowers teachers so they are better prepared to address the emergency healthcare needs of their students.

“Every single young person has to be prepared for a very competitive world economy. They have to be at the top of their game, and for that, they need to be healthy,” stated Tom Vilsack, Secretary, U.S. Department of Agriculture.

Student health and readiness to learn is the primary responsibility of school nurses and the school health team. By working together, school staff can respond to the signs and symptoms of what they are seeing in the classroom and make appropriate referrals to the school nurse. Close collaboration of the school health team ensures students can be healthy, safe and, ready to learn.


1. Meng Y, Babey SH, Wolstein J. Asthma-Related School Absenteeism and School Concentration of Low-Income Students in California. Prev Chronic Dis. 2012;9:110312. doi:

2. National Center for Health Statistics. Food Allergy Among U.S. Children: Trends in Prevalence and hospitalizations, 2008.

3. Gupta RS, Springston EE, Warrier MR, et al. The prevalence, severity, and distribution of childhood food allergy in the United States. Pediatrics. 2011;128:e9-17. doi: 10.1542/peds.2011-0204.

4. McIntyre, C.L., Sheetz, A.H., Carroll, C.R., & Young, M.C. Administration of epinephrine for life-threatening allergic reactions in school settings. Pediatrics. 2005:116:1134-40.

5. Center for Disease Control and Prevention. National Center for Chronic Disease Prevention and Health Promotion. Rates of Diagnosed Diabetes per 100 Civilian, Non-Institutionalized Population, by Age, United States, 1980-2014. 2015.

6. Merikangas, K.R. et al. Lifetime prevalence of mental disorders in U.S. adolescents: Results from the National Comorbidity Survey Replication-Adolescent Supplement (NCS-A), Journal of American Academy of Child and Adolescent Psychiatry. 2010;49,980-989.

7. U.S. Department of Education. National Center for Education Statistics. English Language Learners. 2012.

8. U.S. Department of Education. Status and Trends in the Education of Racial and Ethnic Groups. 2010.

9. National Center for Family Homelessness. Children. 2012.

Nina Fekaris is the president-elect of the National Association of School Nurses.

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