School nurses: policies, working practices, roles and value perceptions

BACKGROUND: In the UK, school nursing has recently been at the forefront of policy change, with school nurses being considered pivotal to child-centred public health practice. There is very little literature on this topic and, in particular, little that is written from a practitioner perspective. AIM: This paper reports a survey that examines the work of school nurses compared with the expectations of their first line managers and policy-makers in government, in order to discover any potential practical or ideological areas of conflict. METHODS: We first applied a theoretical framework of sensitizing concepts to the historical, political, cultural and contextual background of school nursing. Following this, 46 school nurses in the West Midlands region of the UK were randomly selected and asked to complete a questionnaire about their personal characteristics, experience, training and working practices. The 38 nurses who completed this were then interviewed. Job descriptions for school nurses and governmental job expectations were obtained from various official sources and compared with the self-reported practices of school nurses. FINDINGS: All the nurses met the work criteria of their local employers, except in respect of health needs assessment activities, which two nurses had not yet attempted. All 38 also carried out a range of additional work activities, including providing sexual health services and parental support clinics. They also had a diverse range of skills and qualifications relevant to supporting the needs of their local communities. Qualitative data from interviews provided a useful insight into nurses' feelings of being valued by their clients and by local and national employers, and feelings of professional undervaluing by their peers. They felt positive about role changes in the last few years, and that they supported the child-centred public health role advocated by public policy. CONCLUSIONS: The practice of the school nurses in this study covered what employers and policy-makers required, with the notable exception of health needs assessment, which nurses were uncomfortable and unconfident about. The theoretical framework used provides a useful starting point for examining how school nursing has developed into its current role.