School nurses can be an important source of mental health support for students, but most schools don’t have access to a full-time nurse.
That is the case even though students’ mental health needs have been rising for more than a decade and the pandemic has—if anything—accelerated that trend.
In 2019, 37 percent of high school students reported feeling so sad and hopeless that they couldn’t take part in their day-to-day activities—up from 26 percent in 2009, according to the U.S. Centers for Disease Control and Prevention.
Add to that the increased stress, isolation, and grief many K-12 students have experienced through the pandemic, and children and teens are now in a “mental health state of emergency,” warned the American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry, and the Children’s Hospital Association last fall.
While school counselors, psychologists, and social workers are important sources of mental health support, so, too, are school nurses, said Kate King, the president-elect of the National Association of School Nurses. But, unfortunately, she said school and district leaders don’t always leverage their nurses as mental health resources.
King specializes in adolescent psychiatric nursing and is a school nurse at World Language Middle School in Columbus, Ohio. She recently talked to Education Week about the evolving role of nurses in helping students with mental health needs. The conversation has been edited for length and clarity.
What role do school nurses play in supporting students’ mental health?
King: School nurses are the sentinels for mental health for students. Students [frequently] come to the school nurse first when they’re having difficulties. Quite often, their mental health concerns manifest in what we call psychosomatic complaints, or physical complaints. So, headaches, stomach aches, symptoms of panic attacks that students don’t recognize as panic attacks, even muscle pain, sleepiness. So, school nurses are often the first people to recognize some of those things as mental health concerns.
School nurses are often not included, or recognized, as being able to provide mental health services and certainly school nurses are able to provide mental health services. Now, we’re not therapists. We don’t do long-term therapy, and yet mental health encompasses a large percentage of school nurse time in addressing student needs.
In a high school, sometimes that’s a huge amount. When I was [working] in a high school, I would say, at least two-thirds to three-quarters of my time was spent on the mental health concerns of students.
What happens if you don’t have enough school nurses? What gets lost in terms of providing mental health supports?
The first thing is that students just get sent back to class. If they are asking for help over and over, and if they are turned away often enough, they stop asking. They internalize their issues and their problems and we can see a spiral into decreased evidence of learning and increased mental health concerns.
The second thing which I think could be even more damaging, is the student—and it’s not that people don’t care, it’s just that everybody is so busy right?—The student gets judged for those things. “Oh, she’s a whiner or a complainer. Oh, she’s trying to fake it to get out of class. She’s lazy or he’s lazy.”
What are you seeing in your own school? Are you seeing an increase with students struggling to cope with the effects of the pandemic?
I think the pandemic adds another layer to the mental health problems we were seeing before COVID.
So many students have lost a significant other to COVID—a parent, grandparent, caregivers. Schools provide so much more than they used to and so much more than education. That identification, that safe place to go, that safe person to talk to about all of those things, was missing for quite some time.
And then there’s the mental health of the school staff themselves. This has taken a great toll. This is something we say often: You need to be a well-regulated adult to assist children to self-regulate. Our own mental health, and where it is, and coping mechanisms, plays a big part in the ability of school staff to provide that support to students. I don’t mean to say that they’re not, but it’s a different ballgame.
The National Association of School Psychologists and the American School Counselors Association both recommend a certain number of students to psychologists and counselors. Does the National Association of School nurses recommend a ratio of students to nurses for schools?
We no longer recommend ratios—and neither does the American Academy of Pediatrics. What we have found is that student acuity [or need for more care and monitoring] and then other indicators and factors should be assessed when we are determining does your school need a full-time nurse?
You might look at the number of students in the school who have chronic diseases, such as diabetes, asthma, seizure disorders, sickle cell disease, allergies—those are kind of your top five—and how well they can manage their own care at school and how much assistance they need. Those are those acuity factors. And then mental health needs are, again, another huge factor in that.
Kids with mental health needs tend to have more physical health complaints and need more support.
What then is your general sense on whether schools have enough nurses or not?
In general, they don’t. We know about 25 percent of schools have a full-time nurse and about 25 percent have no nurse whatsoever. And about 50 percent share a part-time nurse with one, two, or three other buildings. So, no, we don’t have enough school nurses. And every child deserves access to a school nurse all day, every day.
