The Relentless School Nurse: Safely Caring for Students with Food Allergies Is a Collaborative Effort

by Robin Cogan, MEd, RN, NCSN, FNASN, FAAN

Understanding the roles and responsibilities of school nurses and the challenges they face is vital for parents and caregivers in creating a supportive and safe learning environment for all students. School nurses play a pivotal role in the school community, ensuring the physical and mental well-being of students. From conducting health assessments and managing medications to providing first aid and emergency response, their contributions are instrumental in addressing the diverse health needs of students.

However, up to 60% of schools lack a school nurse completely or have only part-time coverage, leaving many students without access to adequate healthcare during school hours. In schools where there is a full-time nurse, the ratio of one nurse to hundreds—even thousands—of students can strain the nurse’s ability to deliver personalized care effectively.

Amid these constraints, school nurses work diligently to educate students, staff, and parents about various health-related topics, including nutrition, hygiene, and managing chronic conditions. They create and implement individualized health plans to accommodate students with specific medical needs, such as diabetes management or severe allergies. Moreover, school nurses play a crucial role in ensuring immunization compliance and actively monitoring and responding to communicable diseases, effectively safeguarding the school community from potential outbreaks.

Nonetheless, the challenges faced by school nurses can impact the level of care they can provide. Limited availability, coupled with heavy workloads, may lead to delayed responses to health concerns and emergency situations, compromising the immediate medical assistance some students might urgently require. Furthermore, coordinating with a school nurse across multiple schools can introduce communication challenges, emphasizing the need for efficient communication systems.

Resource constraints, including budget limitations and staffing shortages, can further impede the level of healthcare support available to students. This necessitates a collaborative effort among parents, teachers, administrators, and the broader community to advocate for increased resources and support for school health services.

Families can take proactive steps to ensure effective communication and collaboration with school nurses. Providing comprehensive medical information, including allergy action plans, and scheduling meetings to discuss a child’s health needs can help the nurse gain a deeper understanding of individual requirements. Engaging in open and honest conversations about a child’s medical condition and preferences for care can contribute to a more supportive and personalized approach.

Involving older children and teens in accommodation meetings can empower them to take an active role in their educational experience, promoting self-advocacy and decision-making skills. However, respecting a child’s choice if they prefer not to attend such meetings is equally crucial in fostering a trusting and respectful environment.

Ultimately, creating a safe and inclusive school environment requires collective effort. Raising awareness about various health conditions, fostering collaboration among stakeholders, and providing individualized care are integral to promoting the well-being of all students.

Roles and Responsibilities of School Nurses

• Health Assessments: Conduct health assessments of students to identify medical conditions, including chronic illnesses and allergies.
• Medication Management: Administer medications to students who require them during school hours, following proper protocols and guidelines.
• First Aid and Emergency Response: Provide first aid and respond to medical emergencies that occur on school grounds. They are trained to handle a wide range of health-related incidents.
• Health Education: Educate students, staff, and parents about health-related topics, such as nutrition, hygiene, and managing chronic conditions.
• Individualized Health Plans: Create and implement individualized health plans for students with specific medical needs, such as diabetes management or severe allergies.
• Immunization Compliance: Ensure students are up to date with immunizations based on state and district regulations.
• Communicable Disease Control: Monitor and respond to communicable diseases to prevent their spread within the school community.
• Health Screenings: Conduct vision, hearing, and other health screenings to identify potential issues and refer students for further evaluation if needed.
• Health Advocacy: Advocate for students’ health needs within the school setting and collaborate with parents, teachers, and healthcare professionals.
• Health Promotion: Promote overall health and wellness in the school community.

Limitations and Challenges

• Limited Availability: School nurses may cover multiple schools within a district, which can limit their presence at each school and result in delayed responses to health concerns.
• Workload: The workload of school nurses can be demanding, especially when they are responsible for several schools. This may affect the time they can dedicate to individual student needs.
• Emergency Response: In emergency situations, the distance between schools covered by a single nurse can pose challenges in providing timely medical assistance.
• Communication: Coordinating with a school nurse across multiple schools may lead to communication challenges.
• Resource Constraints: Budget limitations and staffing shortages may affect the level of healthcare support provided in schools.
• Parent Involvement: Parents and guardians may need to be more proactive in communicating with the school nurse and keeping them informed about their child’s health needs.
• Professional Development: School nurses must stay updated on best practices and the latest medical developments, which can be challenging when covering multiple schools.

Despite these limitations, school nurses play a vital role in ensuring the health and safety of students. It's essential for parents, teachers, and administrators to collaborate and support school nurses in creating a healthier and safer school environment for all students.

Steps Families Can Take To Ensure A Smooth and Effective Partnership With The School Nurse

• Provide Detailed Medical Information: Share comprehensive medical information about your child’s health needs, including any chronic conditions, allergies, medications, and emergency contact numbers. Prepare a written document summarizing this information.
• Develop an Allergy and Anaphylaxis Emergency Plan: Work with your child’s healthcare provider to create an Allergy and Anaphylaxis Emergency Plan or an Individualized Healthcare Plan (IHP) that outlines specific instructions for managing your child’s allergies at school. Include emergency procedures, medications, and any accommodations required.
• Schedule a Meeting: Request a meeting with the school nurse to discuss your child’s health needs and allergy and anaphylaxis emergency plan. This meeting can be in person, over the phone, or via video conference.
• Be Open and Honest: Be honest about your child’s medical condition and any concerns you may have. Share relevant information about past experiences with allergies or medical emergencies to help the nurse better understand your child’s needs.
• Ask Questions: Don’t hesitate to ask the school nurse about their experience in handling allergies and medical emergencies.
• Educate the Nurse: Provide information about your child’s specific allergens and the signs of an allergic reaction. Educate the nurse about how to use your child’s medications, such as an epinephrine auto-injector, if necessary.
• Discuss Medication Storage and Access: Ensure that the school nurse knows where your child’s medications will be stored. Discuss how accessible the medications will be during school hours and activities.
• Emergency Contact Information: Provide up-to-date emergency contact information for all designated caregivers and inform the nurse about the best ways to reach you.
• Share Your Child’s Preferences: Inform the nurse about your child’s preferences for safe snacks or meal alternatives, especially if they bring lunch from home.
• Be Available for Follow-Ups: Stay accessible and available for follow-up discussions. Regularly communicate about any changes in your child’s health or medical needs.
• Collaborate with Teachers and Staff: Encourage collaboration among the school nurse, teachers, and other school staff to ensure everyone is aware of your child’s allergies and the necessary accommodations.
• Be Appreciative and Supportive: Recognize the efforts of the school nurse in providing care and support for your child’s health needs. A positive and supportive attitude can strengthen the partnership.

By taking these steps, families can establish a strong working relationship with the school nurse and create a safe and supportive environment for their child at school. Regular communication and collaboration are key to ensuring the best possible care for students with medical needs.

Involving Children In Accommodation Meetings

Involving children in accommodation meetings can be beneficial in certain situations, as it gives them a sense of ownership and empowerment in their educational experience. However, whether a child should attend such meetings depends on several factors, including the child's age, maturity level, and comfort level with participating in such discussions. Here are some thoughts and general guidelines to consider:

1. Age and Maturity: Younger children may not fully comprehend the complexities of accommodation meetings or feel comfortable expressing their needs in a formal setting. In contrast, older children and teenagers may be more capable of participating and voicing their preferences and concerns.
2. Willingness to Participate: Always consider the child's willingness to attend the meeting. Some children may feel overwhelmed or anxious about being in a formal meeting with adults, while others may be eager to be involved.
3. Informal Discussion: Even if a child is not present at the official accommodation meeting, parents and educators can have informal discussions with the child beforehand to gather their input and preferences.
4. Individualized Approach: There is no one-size-fits-all rule for this matter. Each child's situation is unique, so it's essential to approach the decision on whether the child should attend the meeting on an individual basis.
5. Supportive Environment: If the child attends the meeting, ensure that the environment is supportive and inclusive. The presence of a trusted adult, such as a parent or school counselor, can help the child feel more at ease.
6. Age-Appropriate Discussions: If the child attends, keep the discussions age-appropriate and use language that they can understand. Avoid overwhelming them with technical jargon.
7. Empowerment and Advocacy: For older children, attending meetings can be a valuable opportunity to learn about self-advocacy and decision-making. It can also help them understand their rights and accommodations.
8. Respect the Child's Choice: Ultimately, respect the child's decision about attending the meeting. If they express a desire not to be present, their wishes should be honored.
9. After-Meeting Discussions: Whether the child attends or not, follow up with them after the meeting to discuss the outcomes and any decisions made. This can reinforce their involvement in the process and address any questions or concerns they may have.
10. Gradual Involvement: If a child is interested in attending but might feel overwhelmed, consider gradually involving them in meetings. Start with smaller discussions and gradually increase their involvement over time.

The decision to include a child in accommodation meetings should be made with careful consideration of the child's needs, preferences, and comfort level. In some cases, children may benefit from having their voices heard, while in other situations, they may prefer to have their parents or guardians represent their interests.

The Health and Safety of Students Are Collective Responsibilities

By working together, we can create schools that prioritize the well-being of all students. Here are a few key points to consider:

• Education and Awareness: Education is a powerful tool in creating a safe and inclusive environment for all students. Increasing awareness about food allergies, medical conditions, and other health needs in schools can lead to better understanding and support for students who require accommodations.
• Collaboration and Communication: Effective collaboration between parents, school staff, and healthcare professionals is essential in ensuring that students' health needs are met at school. Open and clear communication is the foundation of a successful partnership.
• Individualized Care: Each student's health needs are unique and individualized care plans are crucial to providing the necessary support and accommodations. Taking the time to understand and address the specific requirements of each student fosters a positive and inclusive learning environment.
• Empowering Students: As students grow older, involving them in discussions about their accommodations and health needs can empower them to take an active role in their education and well-being. Encouraging self-advocacy helps students develop important life skills.
• Gratitude and Support: Expressing gratitude and support for the efforts of school nurses, teachers, and staff goes a long way in building strong relationships and creating a positive school community.

By recognizing the critical contributions of school nurses and actively supporting their efforts, parents, caregivers, teachers, and administrators can collectively build a healthier and safer learning environment that nurtures the overall well-being and academic success of all students.

About the Author:
Robin Cogan, MEd, RN, NCSN, FNASN, FAAN is a Nationally Certified School Nurse, currently in her 23rd year as a school nurse in the Camden City School District of New Jersey. Robin is the NASN Director for the New Jersey State School Nurses Association. She is proud to be a Johnson & Johnson School Health Leadership Fellow and past program mentor. Robin serves as faculty in the School Nurse Certificate Program at Rutgers University-Camden School of Nursing and writes a popular blog called The Relentless School Nurse. Her extensive work in school nursing was included as a case study in the National Academies of Medicine Future of Nursing 2030 report. You can follow Robin on Twitter at @RobinCogan.