Q&A: Why School Nurses Should Get a Seat at the School Safety Table
Many nursing environments present similar obstacles and opportunities, regardless of where the hospital is or the specialty of the medical practice.
But school nurses face different challenges. Instead of a doctor’s office or hospital, these nurses practice at a junction point of education and healthcare, and they must be prepared to respond to public health emergencies and individual severe health conditions.
Both preventative and reactive, school nurses deal with the physical, emotional, and mental aspects that are deeply intertwined with security risks. They are often in a position to identify an issue with a student (i.e., trauma, mental illness, signs of abuse) and are expected to treat or guide anyone who has been harmed, whether by a medical condition, attack, or other disaster.
Terri Hinkley is the CEO for the National Association of School Nurses (NASN). The organization, which was established in 1968 through the National Education Association, represents U.S. school nurses and a handful of international members, including nurses practicing in schools on U.S. military bases abroad. Hinkley has a background in nursing and nonprofit associations.
The conversation below has been lightly edited for clarity.
Security Management (SM). What are some of the areas that NASN focuses on to try to improve school and student safety?
Terri Hinkley. Like many professional associations, we focus on advocacy and education. There are educational products or resources that we have for school nurses in dealing with students who might be experiencing a health issue, like a student dealing with dangerous blood sugar levels from their diabetes, for example.
What I think is of interest in this conversation are some of those bigger, broader community-based issues where we’re looking at safety in the school. We’re involved in initiatives related to safe gun storage as a nonpartisan organization, so we focus on what the evidence says is best for a child’s well-being—making sure that children are safe from guns, unsecured guns in the home, making sure that we’re having those conversations with students, as well as parents and families, about appropriate storage of firearms.
But then also just thinking about things like emergency preparedness and mass casualty events, and those can take many forms. Severe weather events, a car accident, or a bus accident in the parking lot, for example, and emergency preparedness and readiness for those events. We have an emergency triage program for nurses who find themselves in situations where there are emergencies on site and how to manage that emergency, how to triage students, how to deal with emergency personnel and the administration, and much more.
It runs the gamut from individual students up to the entire student and school body, because school nurses—and many people might be surprised to hear this—provide care to other staff members that need it during the school day. It is not unheard of for a teacher or another person within the school to need to see the school nurse. We’ve had instances where the school nurse has correctly identified that someone was having a heart attack and provided necessary emergency services.
SM. You touched on a number of situations or risks that nurses might deal with. From your perspective within the association, how have these threats or risks to student or staff safety evolved in recent years?
Hinkley. That’s such a great question, and I think it is certainly multifactorial. First of all, we’re trying to make sure that all students have access to schools. You’re seeing students with sometimes profound health issues being in school when they never would have previously. So, I think it’s important to recognize our student body has changed. The school nurse should be a critical part of the conversations on what happens if we have to evacuate the school. We have individual student safety concerns—clinical practice guidelines on managing students with epilepsy, diabetes, special needs. How do we make sure that the students that have special needs get the support to also safely evacuate?
We’re also seeing effects from more significant severe weather—look at how damaging and the strength of some of the severe weather that we’re seeing in terms of tornadoes, hurricanes, and the wildfires. The wildfires in more and more areas of the country are certainly a significant factor. So, severe weather is certainly increasing across the country, and we’re seeing increased effects from that.
And then we’re seeing more mental health issues and increased violence. I’m not referring to any one type of violence but just increased concerns in our student population and in our surrounding communities.
It’s almost like everything’s just been amplified over the last 20, 25 years—that’s what makes these conversations so incredibly important because you can never stop considering what those safety and security risks are. It takes all of us to be thinking what those risks are and how to mitigate and manage them. There’s only so much brain space that any person can afford, and it helps when you can at least spread that out. So, if somebody misses something, then someone else might catch it for sure—and that’s how we can support each other in that.
SM. You’ve mentioned these kind of primary pain points when it comes to school safety today. Out of these, which ones keep you up at night?
Hinkley. Making sure that our school nurses are appropriately trained and ready to respond at a moment’s notice to any one of those sorts of emergencies. Having a clear disaster prevention, recovery, and management plan is critical. And making sure that not only do we have plans in place, but that everyone understands the role that they play, that no one’s left out of the conversation because we all have a role to play.
I can say with certainty, because I’ve had these conversations with school nurses, that emergency response and preparation plans are typically developed by either the school or possibly the district. The school nurse was never involved in those conversations, doesn’t even know where the emergency plan rests, doesn’t have a role identified in that emergency plan—and that’s just such a missed opportunity.
First of all, in any sort of emergency, you’re likely going to need health services, so making sure that a school nurse is involved in the triage and the appropriate emergency treatment is critical.
But also, just some of those considerations I mentioned before, like how to get students with disabilities or special needs out of the school? What about students that need medication—how are we getting their medication out of their school in case they need it? Especially for our students with diabetes, epilepsy, or asthma. For example, if there are wildfires and you need to evacuate the school, the likelihood that your student with asthma is going to need their rescue medication just is so high. But if you haven’t thought through those things in building the emergency plan, then you’re going to find failures that you can’t test for, that you can’t identify before you’re actually in a situation.
Making sure that your school nurse is part of the planning is also incredibly valuable because they’ve got that experience they can draw upon, especially if they come from a hospital setting.
So, what keeps me up at night is just making sure that we have a holistic and team-based approach to the development of our emergency procedures, the actual management of an emergency situation, and then the debrief and revisions to those plans afterwards. What worked? What didn’t? What did we miss? What can we do better next time? What didn’t we anticipate?
I work with a school nurse who was in the military, and her expertise is emergency preparation response and mitigation. She says time and time and time again that the emergency plan will say that parents of students are going to be routed to somewhere else, right, because the last thing you need is an entire number of parents. There’s going to be a specific point set up for the parents to go to. And she will make the point in every single conversation that she has that it’s all fine and good that you’ve said that in your emergency plan. But the parents don’t know it, and they don’t care. So, what are you doing about that? You have to prepare for an absolute crush of parents. Who’s going to be responsible for managing that crowd, and ultimately getting them reunited with their children?
That’s why having those voices around the table is so important—we all have different experiences and perspectives that we can bring.
I will also say that school nurses, like some of the other professionals, probably have come from a hospital setting that has incredibly detailed and tested emergency procedures. If there’s any sort of bus accident, massive car accident, events at a sporting event, whatever it might be, the hospital is where all of those patients are brought, and there’s an emergency response system. So, making sure that your school nurse is part of the planning is also incredibly valuable because they’ve got that experience they can draw upon, especially if they come from a hospital setting.
SM. Which policies or practices do you think have helped improve safety in schools without generating fear or disruption?
Hinkley. I love that schools are locked, that you can’t just walk into a school anymore in the middle of the day, that you have to report to the office, you have to have a visitor’s badge. I just think that that’s the smartest thing that we’ve done to protect schools and students from a security perspective.
I’m going to give another funny answer: taking the doors off bathrooms. Sometimes the threats are from within the school—bullying, for example. So, when you take off the doors, opting instead for an entrance where you have to turn a corner and can’t look right into the bathroom, like the area is almost like a cul-de-sac. Or what’s actually also working really well to protect gender- and sexually diverse students is just individual bathrooms and not having communal bathrooms at all. That also provides safety and security for students.
SM. What measures do you think are ineffective, outdated, or overly hyped?
Hinkley. Addressing safety and security as only the physical structure of school is an outdated practice. Safety needs to be considered and addressed separately from security. Students may not feel safe knowing they have to go through metal detectors, etcetera, just to learn —not to mention the trauma and anxiety from lockdown drills or similar measures.
As I mentioned, I also believe that approaching the topic without an interdisciplinary team with a holistic focus on everything from prevention to recovery is outdated and not supported by current evidence.
SM. If you could implement one change in every school’s safety policies, specific from that nursing perspective, what would it be and why?
Hinkley. It would be to make sure the school nurse has a seat at that table, is involved in those conversations, and is a critical part of that team. It all starts with just making sure the right people are around the table when you’re discussing safety and security and making the plans. And if we bring them and empower them to actively participate in those discussions, we’re going to develop better plans, just period. It’s that simple. Just make sure they’re at the table.
School safety and security efforts are as multifaceted and complex as the students, staff, and families that make up a school and its community. For this series on K-12 security and operations, Security Management spoke with different stakeholders and professionals that are invested in making schools safer and vying to create a learning environment where students and educators can focus on learning. Read more perspectives on the topic here.
Sara Mosqueda is associate editor for Security Management. Connect with her on LinkedIn or send her an email at [email protected].
