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The Critical Role of School Nurses in Medication Administration

There are fewer school nurses now than ever before. NHS England shows a decrease in the school nursing workforce of around 33% between 2009 and 2022. 

A school nurse is a registered nurse who works specifically within the school system to support the health and wellbeing of students. Their role encompasses a variety of responsibilities including:

  • Providing basic medical care – school nurses may administer first aid, dispense medications, and assess and treat minor illnesses or injuries that occur during the school day.
  • Health promotion and education – they educate students about healthy lifestyle choices, such as nutrition, exercise and hygiene. They may also deliver presentations or workshops on topics like sexual health, substance abuse prevention, and mental health awareness.
  • Supporting those students with chronic health conditions – school nurses often work closely with students who have chronic illnesses or disabilities, helping to manage their healthcare needs while at school and ensuring they have access to necessary provisions and support.
  • Immunisations and screenings – school nurses may coordinate immunisation clinics and conduct health screenings, such as vision or hearing tests, in order to identify potential health concerns in students.
  • Collaborating with other professionals – they often collaborate with teachers, school counsellors, psychologists and parents to address the overall health and wellbeing of students. This may involve developing individualised healthcare plans for students with specific medical needs or participating in multidisciplinary meetings to discuss student welfare.
The scope of medication administration in schools

The scope of medication administration in schools

School nurses play a crucial role in administering medication to students, whether this might be prescription medications or over-the-counter medication and emergency interventions. The school nurse’s responsibility when it comes to administering medication usually includes:

  • Assessment and planning – school nurses are often involved in assessing students’ medical needs and planning for the administration of medication accordingly. This may involve collaborating with parents and other healthcare professionals to develop individualised care plans.
  • Administration – school nurses are trained to safely administer medications to students according to prescribed schedules and dosages. This may include oral medication, injections or other forms of medication as prescribed.
  • Documentation – it is essential for school nurses to maintain accurate records of medication administration. This includes documenting the name of the medication, dosage, time of administration, and any observed effects or adverse reactions.
  • Monitoring and evaluation – school nurses are required to monitor students for any adverse reactions or side effects following medication administration. They also evaluate the effectiveness of the medication in managing the student’s condition and should communicate any concerns or observations to parents and other healthcare providers involved in the child’s care.
  • Education and support – school nurses often provide education and support to students, parents and school staff regarding medication administration procedures, potential side effects, and the importance of adherence to prescribed treatment plans.
  • Collaboration – school nurses work closely with other members of the school’s healthcare team, including teachers, counsellors and administrators, to ensure the safety and wellbeing of students who require medication administration.
  • Emergency response – in the event of a medical emergency or adverse reaction to medication, school nurses are trained to provide immediate care and initiate appropriate emergency protocols, including contacting the emergency services if necessary.

The expertise of school nurses

School nurses usually have a range of expertise tailored to meet the health and wellbeing needs of children and adolescents in educational settings. Some areas of expertise for school nurses include:

  • Child and adolescent health – school nurses are knowledgeable about child and adolescent health issues, including growth and development, nutrition, physical activity and sexual health.
  • Immunisations and vaccinations – school nurses often administer vaccinations and immunisations according to national guidelines in order to ensure that students are protected against common infectious diseases.
  • Health promotion and education – school nurses promote health education initiatives within schools, addressing topics such as healthy eating, exercise, mental health awareness, and substance abuse prevention.
  • Chronic disease management – school nurses may provide support and education for students with chronic health conditions such as asthma, diabetes, epilepsy and allergies, helping to manage their conditions effectively during the school day.
  • Mental health support – school nurses play a vital role in promoting positive mental health and wellbeing among students. They may offer specific support for children who are experiencing specific mental health difficulties, for example anxiety or depression. They may offer counselling and referrals to appropriate mental health services. Schools have an important role to play in supporting students’ mental wellbeing, especially with the prevalence of mental health issues being a growing concern among children and young people.
  • First aid and emergency care – school nurses are trained to provide first aid and emergency care to students who become injured or unwell during school hours. They can assess and treat minor injuries and illnesses and coordinate an emergency response when necessary.
  • Health assessments and screenings – they conduct health assessments and screenings to identify any health concerns or issues that may affect a student’s ability to learn or participate in school activities.
  • Partnership working – school nurses often collaborate with teachers, parents and healthcare professionals in order to support the health and wellbeing of students and promote a holistic approach to education.
  • Safeguarding – school nurses are trained to recognise signs of abuse or neglect and work closely with safeguarding teams to ensure the safety and welfare of students.
  • Health policy and advocacy – school nurses may advocate for policies and practices that promote the health and wellbeing of students within educational settings, working to create environments that support healthy lifestyles and positive outcomes for all students.
Collaboration with healthcare providers

Collaboration with healthcare providers

Collaboration between school nurses and other healthcare providers who are involved in the child’s care is crucial for ensuring the wellbeing and health of students. This involves:

  • Communication – school nurses and healthcare providers should maintain open lines of communication. This may include regular meetings, phone calls and emails or keeping electronic health record (EHR) systems up to date in order to share relevant information about students’ health conditions, treatments and medications.
  • Medical oversight – healthcare providers, such as GPs, physicians, nurse practitioners or physician assistants, provide medical oversight for the school nurse. They may review health plans, provide guidance on treatment protocols, and make recommendations for student care.
  • Health assessments and referrals – school nurses may conduct health assessments and screenings for students, identifying any health concerns or conditions that may require further assessment or treatment. They work closely with healthcare providers to refer students to appropriate specialists or services as needed.
  • Medication management – healthcare providers prescribe medications for students with chronic conditions or acute illnesses. School nurses are responsible for administering medications according to prescribed protocols, monitoring students for adverse reactions, and communicating with healthcare providers about any concerns.
  • Health education – healthcare providers and school nurses collaborate to develop and deliver health education programmes for students, parents and school staff. This may include topics such as nutrition, hygiene, sexual health, mental health awareness, and chronic disease management.
  • Emergency response – in the event of a medical emergency at school, school nurses work with healthcare providers to coordinate emergency response protocols, administer first aid, and ensure students receive appropriate medical care.
  • Documenting and reporting – both school nurses and healthcare providers maintain accurate records of students’ health information, treatments and interventions. This documentation is essential for continuity of care, legal compliance, and monitoring students’ health progress or deterioration over time.
  • Professional development – collaboration between school nurses and healthcare providers may also involve opportunities for professional development, such as attending conferences, workshops or training sessions together to stay updated on best practices in school health services.

Individualised care plans

Individualised care plans for children requiring medication during school hours are essential in order to ensure their health and safety while in the school environment. The plans should be developed collaboratively by the child’s parents or guardians, healthcare providers and the school itself. It is important to include:

  • Up-to-date medical information – it should have detailed information about the child’s medical condition. This should include their diagnosis, symptoms and any potential complications. It should also include information on the prescribed medication, such as dosage, frequency and administration method.
  • Emergency contacts – this should include emergency contact information for the child’s parents or carers, as well as contact information for their healthcare provider.
  • Authorisation for medication administration – it should include written consent from the child’s parent or guardian authorising the administration of the prescribed medication. This should include instructions for administering the medication, as well as any potential side effects or adverse reactions to be aware of.
  • Storage and handling of medication – it should include information on how the medication should be stored and handled during school hours. This may include guidelines for temperature control, storage location, and secure access to the medication.
  • Administration procedures – clearly outline the procedures for administering the medication, including who will administer it, when it will be administered, and where it will take place. Provide instructions for documenting each administration, including the date, time, dosage and any observed side effects.
  • Communication plan – they will usually establish a communication plan between the school, parents or carers, and healthcare providers in order to ensure the ongoing monitoring of the child’s condition and medication effectiveness. This may include regular updates, follow-up appointments, and reporting any concerns or changes in the child’s health status.
  • Confidentiality and privacy – the confidentiality of the child’s medical information will mean limiting access to the child’s medical records and information to authorised individuals who are involved in their care.
  • Emergency response plan – school nurses should be involved in developing an emergency response plan outlining steps to take in the event of an allergic reaction, overdose or other medical emergency related to the child’s medication. Ensure that all school personnel are familiar with the plan and know how to respond quickly and appropriately.
  • Review the care plan – the individual care plan for each child should be periodically reviewed and revised in order to ensure that it is up to date with all of the required information.
Challenges and considerations

Challenges and considerations

School nurses face several challenges when it comes to medicine administration, and addressing these challenges requires strong organisational skills, attention to detail, ongoing training and education, and collaboration with other members of the school community and healthcare team. Some of the challenges school nurses face include:

  • Legal and regulatory compliance – school nurses must adhere to strict legal and regulatory requirements regarding the administration of medication. This includes ensuring proper documentation, obtaining parental consent, and following protocols for different types of medications.
  • Safety concerns – administering medication involves the risk of errors, such as giving the wrong dose or medication to a student. School nurses must take measures to prevent such errors and ensure the safety of the students under their care.
  • Managing medication for multiple students – school nurses often have to manage medication for multiple students with various medical conditions. Keeping track of each student’s medication schedule, dosage and any potential interactions can be challenging, especially in larger schools.
  • Communication and coordination – effective communication and coordination are essential when working with students, parents, teachers and other healthcare professionals. School nurses need to ensure that everyone involved is informed about medication administration plans and any changes in the student’s health status.
  • Emergency preparedness – school nurses must be prepared to handle medical emergencies, including adverse reactions to medication or situations where a student requires immediate medical attention. They need to have the necessary training and resources to respond quickly and appropriately to such situations.
  • Privacy and confidentiality – school nurses must maintain the privacy and confidentiality of students’ medical information, including details about the medications they are taking. This requires following strict protocols in order to safeguard sensitive information.
  • Limited resources – some schools may have limited resources, including staff, equipment and funding, which can make it more challenging for school nurses to effectively manage medication administration. They may need to find creative solutions to overcome these resource constraints while still ensuring the health and safety of students.
  • Educating students and staff – school nurses play a crucial role in educating students, staff and parents about medication safety, proper administration techniques, and the importance of adherence to medication schedules. This requires effective communication skills and the ability to tailor information to different audiences.

Emergency medication administration

In schools, medical emergencies can happen at any time. Having trained school nurses ensures there is someone on-site who can respond immediately to administer emergency medications, such as epinephrine for severe allergic reactions or insulin for diabetic emergencies. 

During a medical emergency, timely intervention is crucial. Trained school nurses can quickly assess the situation, administer the necessary medications or treatments, and potentially prevent serious complications or even save lives. Schools have a duty to ensure the safety and wellbeing of their students. By having nurses trained in emergency medicine administration, schools can better fulfil this responsibility and provide a safer environment for students with medical conditions or emergencies. 

Administering medications, particularly in emergency situations, carries inherent risks. Proper training in this is vital as it helps mitigate these risks by ensuring that medications are administered correctly and safely, minimising the chances of errors or adverse reactions.

Supporting students with chronic conditions

School nurses play a crucial role in supporting students with chronic conditions by providing both medical and emotional support. A chronic condition, also known as a chronic disease or illness, is a health condition that persists over a long period of time, typically lasting for three months or more. These conditions often require ongoing management and treatment because they cannot be cured completely. 

School nurses not only support these students with medication management but also with:

  • Monitoring their health – school nurses can monitor the health status of students with chronic conditions throughout the school day. They may check vital signs, glucose levels, or other indicators as needed to ensure the student’s wellbeing.
  • Providing an emergency response – in case of a medical emergency related to a chronic condition, school nurses are trained to respond quickly and appropriately.
  • Educating other school staff members – school nurses educate teachers and other school staff about the specific needs of students with chronic conditions. This includes providing training on how to recognise symptoms of medical emergencies and how to support students in managing their conditions.
  • Developing individualised care plans – school nurses work with students, their families and healthcare providers to develop individualised care plans that outline the student’s medical needs and how they should be addressed during the school day. These care plans ensure consistency in care across different school environments.
  • Advocacy – school nurses advocate for students with chronic conditions to ensure they have access to necessary care and support services.
  • Providing emotional support – managing a chronic condition can be emotionally challenging for students. School nurses can offer emotional support, reassurance and a listening ear to students who may be struggling with their condition or its impact on their daily life.
  • Promoting independence – school nurses can empower students with chronic conditions to take ownership of their health and become more independent in managing their condition.

The Department for Education has published statutory guidance for supporting pupils at school with medical conditions.

Ensuring medication safety

Ensuring medication safety

School nurses should receive proper training in medication administration, including dosage calculation, storage and administration techniques. This ensures they have the necessary knowledge and skills to safely administer medications. Nurses can also provide education to students, parents and school staff about the importance of medication safety. This includes information on proper medication storage, administration techniques, and potential side effects or adverse reactions.

School nurses play a critical role in ensuring medication safety for students and they do this in a number of ways, including:

  • Maintaining accurate and up-to-date records of all medications administered to students. This includes documenting the name of the medication, dosage, time administered, and any observed effects or reactions.
  • Verifying prescriptions – before administering any medication, nurses should verify the prescription details, including the student’s name, medication name, dosage and administration instructions. This helps prevent any errors in medication administration.
  • Communication with parents and healthcare providers – nurses should communicate closely with parents or guardians to obtain consent for medication administration. Additionally, nurses should collaborate with healthcare providers to clarify any medication-related concerns or instructions.
  • Storage and handling – medication should be stored securely in a designated area that is not accessible to students but is easily accessible to authorised staff members.
  • Emergency preparedness – nurses should be prepared to respond to medication-related emergencies, such as allergic reactions or overdose. This includes having emergency protocols in place, as well as access to necessary medical supplies and equipment.
  • Adherence to legal and ethical standards – nurses should adhere to legal and ethical standards related to medication administration, including following school policies and procedures, maintaining student confidentiality, and respecting parental rights and preferences.

Recognising the importance of school nurses in medication administration cannot be overstated. Through their specialised training, expertise and dedication to student health and safety, school nurses are invaluable to the wellbeing of students in educational settings, promoting a safe and nurturing learning environment for all.

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About the author

Claire Vain

Claire Vain

Claire graduated with a degree in Social Work in 2010. She is currently enjoying her career moving in a different direction, working as a professional writer and editor. Outside of work Claire loves to travel, spend time with her family and two dogs and she practices yoga at every opportunity!

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