School Nurses

The Role of a School Nurse
Registered school nurses are responsible for providing comprehensive health services to youth, which may vary between schools or even districts, based on the needs and resources of the school. They deliver health services to students, make health and mental health referrals, provide education, serve as an advocate for youth, provide or assist with access to health counseling, and facilitate communication between the student, family, and medical provider. Dickson, Parshall, and Brindis, (2019) found in New Mexico, 34% of school nurses are responsible for delivering sexual health education in the classroom.

The school nurse is responsible for complying with federal, state, and local laws, while also being guided by the ethical codes and position statements set forth by the National Association of School Nurses (NASN) and the American Nurse Association (ANA). Data outcomes conclude the delivery of CSE is inconsistent in New Mexico. Dickson, Parshall, and Brindis, (2019) found that only 15% of health educators who provided sexual health education, which includes teachers, nurses, and administrators, reported using evidence-based curriculum while 65% of health educators reported using self-developed curriculum.

Despite variations in curriculum and delivery of CSE between districts and states, NASN and ANA have integrated CSE into their code of ethics and position statements. The NASN position statement, which aligns with ANA, affirms developmentally appropriate evidence-based sexual health education should be included as part of a comprehensive school health education program and be accessible to all students.
CSE Skills and Tools for School Nurses
Pavelová et al. (2021) identified the school nurse as a valuable resource to parents and educators in the implementation of evidence-based sexual health education programs that promote healthy sexual development for all students. Access to evidence-based CSE curriculum, strengthening communication skills, and providing services in multiple settings can positively support school nurses in their delivery of CSE.
CSE Curriculum
The delivery of CSE is inconsistent in New Mexico. Dickson, Parshall, and Brindis, (2019) found that only 15% of all health educators who provided sexual health education (teachers, nurses, and administrators) reported using evidence-based curriculum and 65% of health educators reported using self-developed curriculum. In support of providing evidence-based comprehensive sexuality education curriculum, New Mexico Sexual Health has created a list of sites that offer free CSE curriculum:

• NMPED: Comprehensive Sexual Health Education
• NMPED: National Sexuality Education Standards
• CDC: Checklist_15 Characteristics of Effective Health Education
• SEICUS: National Sexuality Education Standards
• SIECUS: Guidelines for Comprehensive Sexuality Education
• Planned Parenthood: Comprehensive Sexuality Education
• AMAZE: Medically Accurate and Age Appropriate Resources for Educators
• UNESCO: International Technical Guidance on Sexuality Education

Communication Skills
Strengthening communication skills positively supports the school nurse’s delivery of CSE. The NMPED identified part of a school nurse’s role was to facilitate communication between the student, family, medical provider, and the community. Thus, being able to communicate within both the healthcare and education arenas.

On an individual level, school nurses can identify their comfortability with sexual health topics and develop their skills in presenting these topics to their sexual health class or in one-on-one meetings with students as needed. In a 2018 study on the delivery of sexual health education, sexual health educators reported discomfort with sexual health terminology. Thus, it is important for school nurses to practice and develop their comfortability in delivering CSE and engaging students in discussions. Furthermore, using language that is inclusive all students is imperative. A checklist for inclusive sexual education language for educators can be found here.

Providing Services in Multiple Settings
Pavelová, et al (2016) found a positive association between a school nurse’s ability to work in multiple settings (i.e., schools, community agencies, and healthcare clinics) and the opportunity to improve sexual and reproductive health. Additionally, involving a health worker in the delivery of CSE, supported the youth’s knowledge of sexual health and risky behavior.

Resources

National Association of School Nurses: Sexual Health Toolkit
https://learn.nasn.org/courses/41997

American Nurses Association (2022) Position Statement: Sexual and Reproductive Health
https://www.nursingworld.org/~4957d2/globalassets/practiceandpolicy/nursing-excellence/ana-position-statements/social-causes-and-health-care/srh-position-statement-approved-03072022.pdf

Understanding Sexual Health in New Mexico
https://hsc.unm.edu/news/news/images/she-policy-report-dickson-e.pdf
Dickson, E., Parshall, M., & Brindis, C. (2019). Isolated voices: Perspective of teachers, school nurses, and administrators regarding implementation of sexual health education policy. Journal of School Health, https://doi.org/10.1111/josh.12853
Dickson, E., & Brindis, C. D. (2019). The double bind of school nurses and policy implementation: Intersecting the street-level bureaucracy framework and teaching sexual health education. The Journal of School Nursing, https://doi.org/10.1177/1059840519868764
New Mexico School Nurses Association
https://nmsna.net

New Mexico School Health Manual
https://schoolhealthmanual.clickhelp.co/articles/#!new-mexico-school-health-manual-publication-1/about-the-school-health-manual

NMPED (2022) New Mexico School Health Manual
Retrieved from: https://schoolhealthmanual.clickhelp.co/articles/#!new-mexico-school-health-manual-publication-1/chapter-one/a/h2__1457038237
Dickson, E., Parshall, M., & Brindis, C. (2019). Isolated voices: Perspective of teachers, school nurses, and administrators regarding implementation of sexual health education policy. Journal of School Health, https://doi.org/10.1111/josh.12853
Jackson, V. (2011). What is the role of the school nurse in sexual health education?. NASN School Nurse (Print), 26(3), 146-147. Retrieved from:
Dickson, E., Parshall, M., & Brindis, C. (2019). Isolated voices: Perspective of teachers, school nurses, and administrators regarding implementation of sexual health education policy. Journal of School Health, https://doi.org/10.1111/josh.12853
American Nurses Association (2022) Position Statement: Sexual and Reproductive Health
https://www.nursingworld.org/~4957d2/globalassets/practiceandpolicy/nursing-excellence/ana-position-statements/social-causes-and-health-care/srh-position-statement-approved-03072022.pdf
National Association of School Nurses, & National Association of School Nurses. (2016). Sexual health education in schools (Position Statement).
Pavelová, Ľ., Archalousová, A., Slezáková, Z., Zrubcová, D., Solgajová, A., Spáčilová, Z., … & Slamková, A. (2021). The need for nurse interventions in sex education in adolescents. International journal of environmental research and public health, 18(2), 492. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7827239/
NMPED (2022) New Mexico School Health Manual
Retrieved from: https://schoolhealthmanual.clickhelp.co/articles/#!new-mexico-school-health-manual-publication-1/chapter-one/a/h2__1457038237
National Association of School Nurses. (2016). National association of school nurses code of ethics. Retrieved from: https://www.nasn.org/nasn-resources/resources-by-topic/codeofethics
Rose, I. D., Boyce, L., Murray, C. C., Lesesne, C. A., Szucs, L. E., Rasberry, C. N., … & Roberts, G. (2019). Key factors influencing comfort in delivering and receiving sexual health education: Middle school student and teacher perspectives. American journal of sexuality education, 14(4), 466-489. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8064695/

Pavelová, Ľ., Archalousová, A., Slezáková, Z., Zrubcová, D., Solgajová, A., Spáčilová, Z., … & Slamková, A. (2021). The need for nurse interventions in sex education in adolescents. International journal of environmental research and public health, 18(2), 492. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7827239/
Pavelová, Ľ., Archalousová, A., Slezáková, Z., Zrubcová, D., Solgajová, A., Spáčilová, Z., … & Slamková, A. (2021). The need for nurse interventions in sex education in adolescents. International journal of environmental research and public health, 18(2), 492. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7827239/