Refocused school nurse role: early adopter evaluation

7. Conclusions

What worked well?

1. The nine priority areas have undoubtedly made the school nurse role more focused and standardised. It has added value to the service by providing clear priority areas and pathways to school nurses.

2. The referral system formalises practice and ensures that school nurses receive mainly relevant referrals.

3. The role is now clearer to the nurses themselves and to all relevant agencies, including education.

4. Other agencies are increasingly aware of the contribution school nurses make to children's assessment and support process.

5. The priority areas have extended working relationships with agencies ( e.g. youth justice) that school nurses did not previously engaged with.

6. Extensive and mandatory training appears helpful for delivering the pathways.

What did not work so well and may require further consideration?

1. The nine selected priority areas generated divided opinions amongst both managers and nurses, especially in terms of what qualifies to be included or excluded.

2. The mental health and wellbeing pathway was the most frequently used pathway. Whereas nurses referred complex mental health cases to CAMHS, they felt less equipped to deal with low to moderate cases. As there are currently no nationally agreed guidelines on the assessment and treatment of mental health issues in young people, it is difficult to know what kind of training would be most appropriate for school nurses.

3. Some members of the wider school health team felt alienated and excluded from the refocusing of the SN role. Whilst the development of the priority areas and the pathways gave increased clarity and structure to the SN role, the role of the wider school health team still needs further clarity.

4. Accessing the service through pupil support teachers was considered as a barrier in some cases.

5. Although school nurses perceived that they are now in a position to build stronger trusting relationships with the limited number of children who access their services, it was generally recognised that they are now less visible to the wider school population.

6. Targeted skill-based training would be required to equip nurses on some specific pathways e.g. mental health and wellbeing.

Recommendations for school nurse training and further implementation

1. There needs to be a greater clarity around the pathways. It may be beneficial to amend some e.g. the substance misuse pathway could be widened to include all risk taking behaviour.

2. Health Boards should be encouraged to adopt the nine priority areas but develop their own pathways as referral mechanisms and resources differ locally.

3. Additional training on the mental health and wellbeing pathway is required. It might be useful to involve CAMHS in any such training.

Training

1. Nurses would benefit from training approaches that seek to build practical skills within the parameters of the priority areas. This would ensure that aside from identifying risks, nurses would also be equipped with skills to deliver interventions or support where necessary.

2. When training school nurses, the rationale for the selected nine priority areas may need to be clarified and the reasons for omitting some of the obvious ones, for instance sexual health (if it is to be omitted) need to be clearly articulated. This would promote consistency across the workforce regarding the rationale for the selected priority areas.

3. Whilst it is encouraging to see staff taking up opportunities for full time training backfilling their posts is necessary. This will be particularly pertinent over the next 5 years or so whilst most staff are receiving training.

Referral

1. The current referral procedure through the pupil support teachers may exclude some groups of children who may find it uncomfortable to approach such teachers with their issues. Exploration of other means of accessing school nurses ( e.g. text message service) without going through pupil support teachers would be useful.

2. Clarification is needed around whether the School Nurses use referrals or Requests for Assistance and the role of the HPI.

Wider School Health Team

1. The role of the Band fives should be consistent and clear career development/progression opportunities could be incorporated within the role.

2. Clearly articulating the specific role within the priority areas of members of the wider school health team would be useful.

3. A dedicated immunisation team is required if school nurses are to focus on the priority areas.

Recording and Record Keeping

1. Data needs to be consistently gathered using an agreed format. This data should be analysed nationally and fed back to school nurse teams for management purposes as well as being used to show the patterns of usage across Scotland.

2. The evaluation of the pilot was unable to measure any kind of impact. It is recommended that if the refocused school nurse role is rolled out nationally that some sort of outcome/impact study is undertaken.