Abstract
In the last decade, there has been considerable discussion and concern about the aging nurse workforce. In the near future there will be a greater demand for health care services because of our increasing population—mostly due to immigration, the number of baby boomers who are about to retire, and the rapid increase in the number of elderly citizens. This increasing need for health care services will be occurring at a time when many practicing nurses are approaching retirement age. The Health Resources Service Administration reported in 2006 that the average age of registered nurses in 2004 was 46.8 years, an increase of over a year from 2000 (Hart, 2007). In addition, only 26.6% of practicing nurses were under the age 40, and 16.6% were under age 30.
The aging work force is not limited to nurses, but also is occurring in other health care professions, teaching, and many other occupational groups. This phenomenon is also affecting the school nurse work force. In early 2007, the National Association of School Nurses (NASN) conducted a national web-based survey of its members. About 5,000 of the approximately 14,000 NASN members responded to the survey that asked questions about school nursing practice and gathered demographic data on characteristics of the participants. Data from this survey paint a portrait of the school nurse workforce and illustrate that the school nurse workforce is also aging. Table 1 shows the age distribution of those responding (the notation of “optional” was listed after this question which may have lead some respondents to leave this question unanswered). As you can see, 58% of school nurses who answered this question were over 50 years of age. This demographic characteristic affirms what is also true in the profession of nursing in general—the school nurse work force is aging—and it is very likely that the average age of school nurses is greater than nurses in general. Nationally the number of nurses under 40 years of age is 26.6%, while the number of school nurses under 40 years responding the NASN survey was 8.9%. The number of nurses under 30 years is 16.6% while the number of school nurses responding to the study age 30 and under was 1.17%.
One potential reason nurses practicing in the school setting are older than the general population of practicing nurses is that they come to school nursing later in their careers. Tables 2 and 3 show that while nearly 30% of school nurses have practiced nursing for over 30 years, only 2.5% of them have practiced in the school setting for over 30 years. On the same note, 77.1% of school nurses have had over 19 years of experience in nursing, but only 30.29% have had greater than 16 years of experience in school nursing (Note: NASN data does not have the same ranges on these two tables so comparable data is not available).
Not only do practicing nurses come to school nursing later in their careers, they come for different reasons. Many seek employment as a school nurse for a change of pace from the hospital routine; others may be burned out after working in a hospital setting with long hours, unpredictable schedules, and a stressful work environment. Some seek out school nursing because the hours are more compatible for nurses with families; others look to school nursing as an “easy” job with shorter hours. That shows you how little they know about school nursing! It is doubtful that any of them choose school nursing for the excellent salaries.
Another reason nurses may come to school nursing later in their career trajectory is the different levels of nursing education programs discussed in my August 2007 editorial (Denehy, 2007b). The NASN position on minimal educational preparation for school nurses is a baccalaureate degree (NASN, 2002). In some states, a baccalaureate degree is required for certification or licensure as a school nurse and thus employment in the school setting. In other states where there is no educational requirement, this may not be the case. However, most school nurses are now seeing the benefit of having the minimum of a baccalaureate degree in the school setting to be on par with the educational preparation of teachers and other professionals in the school setting, as well as the benefits of being able to negotiate comparable salaries with other school professionals (Denehy, 2007b). However, for the most part school nurses’ salaries cannot compete with salaries offered to nurses in the hospital setting, which has a negative effect on recruiting nurses, both young and older, to the specialty of school nursing.
One reason nurses may not be attracted to school nursing is a lack of knowledge about the specialty of school nursing. Some may view school nursing as a practice limited to band aides and tummy aches, perhaps from a childhood experience with their school nurse. Contributing to the lack of knowledge about school nursing is curriculum in nursing education programs that has considerable focus on critical care nursing in the hospital setting. As a veteran nursing educator who has taught at all levels, it is evident that most students entering nursing school see themselves working in a hospital setting during their nursing education program as well as when they graduate and begin their career in nursing. In baccalaureate programs, many students are uncomfortable when they first begin their community health experiences as they are not familiar with the autonomy, lack of structure, the focus on health promotion and disease prevention, and the lack of procedures they were accustomed to doing in the hospital. While some embrace the uniqueness of the community setting and its flexibility and variability in daily routines and will set their career goals in this area, most will seek employment in a hospital setting upon graduation.
Baccalaureate nursing programs frequently offer the option of doing some community practicum time in the school setting which is an excellent opportunity for school nurses who work with these students to explain the complexity of the school nurse role and the unique and varied student encounters they have daily. Often groups of students will plan and implement health education modules, health fairs, or screening programs for students and families. What better way to educate the next generation of nurses about school nursing than to have them work side by side with school nurses in planning and implementing such programs in the school setting. School nurses should communicate with local colleges and universities about the possibility of contracting to have students work with school nurses as part of their educational experience. They can also speak to nursing students as well as potential students in middle and high schools about school nursing as a career option.
One thing I have heard repeatedly from school nurses though the years is the belief that nurses should work a few years in the hospital setting—a pediatric, intensive care, or emergency unit—before entering school nursing. While the intention is good to insure school nurses are familiar with a wide variety of diseases, procedures, and emergencies that may occur in the school setting, there is no guarantee that such experience will prepare the nurse for the realities of school nursing practice. In fact, school nursing is a community-based specialty with its roots in public health nursing—yet, I do not hear any recommendations for prior experience in the community as a prerequisite for school nurses. Such experience would no doubt be equally beneficial for those entering school nursing.
Such beliefs, however well meaning, may erect barriers for those wishing to enter the specialty of school nursing. At a time when the school nurse workforce is aging and many are approaching retirement, school nurses need to enthusiastically encourage young nurses to consider the specialty of school nursing. School nursing needs their newly acquired knowledge, their youthful enthusiasm and new ways of seeing things, and their potential promise as our leaders of the future.
For the last decade there has been considerable concern about the shortage of nurses now and in the future, prompting a variety of strategies to recruit individuals into the nursing profession. Johnson & Johnson has promoted its Discover Nursing campaign (http://www.discovernursing.com/#;) to interest individuals in examining nursing as a career option by providing information about the various roles nurses play in today’s healthcare system, as well as opportunities outside the health care system. Their website and television spots feature a wide diversity of individuals, including males, who are studying to be or who are practicing nurses in many settings and specialty areas, including school nursing. At this time, school nurses need to think seriously about how they can attract the next generation of nurses to the specialty of school nursing. How can we make school nursing a viable, attractive, and exciting option for nurses? As schools seek to fill positions left by those who retire from or leave school nursing, school nurses must actively and enthusiastically share information about school nursing practice, its unique role in the school and community setting, and the many rewards for those who are willing to accept the opportunities and challenges school nurses will face in the years ahead.
Many who are potential candidates for school nursing positions likely have no idea about what school nurses do. The NASN website (http://www.nasn.org) is a wonderful resource for those seeking to learn more about the role of the school nurse. School nurses need to become more visible in their schools and communities—with this visibility comes more recognition of what school nurses do and their contribution to children’s health (Denehy, 2006). School nurses must also become more politically active in becoming a voice for issues that relate to the health of children and families (Denehy, 2007a). This activity is a mark of professionalism and maturity of the specialty which may well attract nurses from other practice areas to school nursing. Finally, school nurses need to attend to their educational preparation so they have the minimum preparation needed to meet the position set forth by NASN (Denehy, 2007b). Baccalaureate preparation will help school nurses not only achieve education parity with their peers in the school setting, but it is the key to improving school nursing salaries—and increased salaries will be necessary to recruit the next generation of nurses to the school setting.
The future of school nursing is in our hands today. The vision of NASN’s new president, Donna Mazyck, is to transform school communities. She listed many suggestions in her inaugural address that would promote the visibility and impact of school nursing, ideas that will challenge every school nurse in making school nursing all that it can be (Mazyck, 2007). Let us not miss the opportunity to make school nursing all it can be in our schools and communities today to insure its growth in the future—the health of children and the specialty of school nursing depends on it.
