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Role of school nurses threatened by endless paperwork

Time pressures curb health and wellbeing promotion

Jo Carlowe

Monday, 12 September 2016

School nurses spend twice as much time on paperwork than on direct work with children in schools, research by the Children’s Commissioner for England has found.

The report,* published today, suggests this may be reducing the nurses' ability to identify children at risk of neglect or abuse. There was also evidence that time pressures meant their role in supporting and promoting children’s health and wellbeing, their mental health, healthy relationships and sex education – was being compromised.

A survey of nearly 800 primary and secondary school nurses revealed a picture in which paperwork ate into the time nurses had to spend with pupils – with some school nurses responsible for the health and well-being of 1,000s of children.

School nurses were asked about child protection and children in need referrals they had made to Children’s Services, as well as any barriers they had faced.

When they identified children of concern, four in ten school nurses said they were unhappy with the response they had from Children’s Services on at least half of the referrals they make.

School nurses reported that increasingly high thresholds operated by local children’s services had meant making successful referrals about children had become more difficult. These thresholds also resulted in school nurses picking up early child protection work and developing support activities for rejected cases – work previously done by social workers.

Many school nurses described how bureaucratic and reactive work was impacting on their ability to build relationships with children and help advise them about their health and wellbeing. This was a cause of frustration and concern among many in the profession.

Safeguarding and child protection processes have become a substantial part of school nurses’ work. A fifth of school nurses felt that their child protection caseload was limiting their capacity to perform other activities. On average, school nurses attended one case conference a week, which (including travel and paperwork) took up around 4.5 hours of their time. However, 8% were attending four or more case conferences, indicating they were spending at least half their working week attending these meetings and completing tasks associated with them.

This means they had less time for the preventative work to spot the signs of abuse and help prevent problems developing.

The majority of school nurses stated that children and young people in the schools they work in were unaware of their service. This is despite the positive way school nurses were often seen by young people, and the benefits they could bring.

Recent initiatives in some areas to enhance the role of school nurses were highlighted in the Children’s Commissioner report, including the introduction of digital and texting services, which allow children and young people to get in touch with their school nurse.

Anne Longfield, Children’s Commissioner for England, said: “School nurses have a vital role to play in schools protecting children as well as promoting their well-being.  

“They are one of the professionals at the front-line identifying abuse or neglect, as well as supporting children with a host of other issues – whether that’s mental health, age-appropriate relationships and sex education or healthy eating. Being available for children for face to face time is irreplaceable.”

“It is clear from this research that school nurses face significant barriers in working directly with children and young people, with paperwork getting in the way. The support they offer needs to be better promoted and new ways to enhance their engagement with children explored.” 

Responding to the report, Fiona Smith, Royal College of Nursing Professional Lead for Children and Young People’s Nursing, said: “School nurses have the skills and the experience to provide a wide range of health support, from counselling to promoting healthy lifestyles.

“Despite the importance of the role, this report echoes what many RCN members have been telling us for some time – school nurses do not have the time or resources to carry out their roles as effectively as they would like to. 

“A major part of the problem is that the number of school nurses is dropping all the time - despite the vital importance of what they do. Children and young people are bearing the brunt of these public sector funding cuts with potentially serious consequences for the future.

“Capacity is key and these roles should not be under threat when they are so badly needed. Prioritising and valuing school nurses’ expertise would go a long way towards helping the Government fulfil its obesity and mental health aims as well as protecting the health and wellbeing of the generations to come.” 

* Lightning Review: Children's access to school nurses to improve wellbeing and protect them from harm. Children’s Commissioner for England, September 2016.

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