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Complementary Collaborators: School Counselors and School Nurses

By Robin Cogan, RN, and Jeanne Kiefner, RN, NJ-CSN | October 2020

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When students suffer from anxiety and stress at school, they often head directly to the school nurse’s office to address physical symptoms. However, this addresses only part of the issue. When school counselors and school nurses collaborate in an intentional way, students – and the school community – reap the benefits.

School counselors and school nurses are at the epicenter of the concerns students bring to school every day, from increasing gun violence in schools and communities, threats to undocumented families, the opioid crisis, homelessness, hunger, racism, transportation barriers, chronic absenteeism and academic struggles to mental health crises and adverse childhood experiences (ACEs). School counselors and school nurses function in a hidden behavioral health care system that has been widely misunderstood. Mental health concerns occupy up to 35 percent of school nurses’ time and are often masked as physical complaints such as headaches and stomachaches, according to a 2015 article in Psychology in the Schools. As students struggle with anxiety, depression, ACEs and toxic stress, school nurses are perfectly positioned to support overloaded school counselors. Nurses often know exactly who those struggling students are because they see them on a regular basis for multiple complaints and concerns. Why not be more intentional about creating connections between specialties to support both the students and staff?

Just like school counselors, school nurses have expert assessment skills but also have few tools and limited resources, and they often operate under unrealistic school-nurse-to-student ratios. According to the Psychology in the Schools article, school nurses spend up to 35 percent of their time addressing mental health issues in children and adolescents because up to 20 percent of students suffer from bullying, anxiety, stress, depression and similar concerns.

The roles of the school counselor and school nurse are complementary, and we function concurrently to support a student’s ability to optimize learning.

Creating a Safety Net

Building a coalition between school counselors and school nurses would create a safety net for our most complex and challenging students, while benefiting the whole school community. The collaboration between school counselors and school nurses, who neither discipline nor grade students, creates safe spaces for students at school. Both are guided by the principles of confidentiality and work within the Whole School, Whole Community, Whole Child (WSCC) model from the Centers for Disease Control and Prevention and the Association for Supervision and Curriculum.

Healthy students are better learners, and this includes physical and social/ emotional health. School counselors and school nurses can jointly manage students’ burgeoning needs by creating a built-in referral system for care coordination. Our roles may overlap at times, but open lines of communication can smooth out any confusion.

One overarching goal is promoting student success in growing toward independence. Collaborating within the WSCC model, school counselors and school nurses can support youth and adolescent growth and development. Early intervention can identify issues and trends that may affect students’ ability to learn and flourish. A trauma-informed approach opens communication by asking students to reflect on “What’s happened to you?” versus “What’s wrong with you?” Using this inquiry with a calm and soothing tone can open a discussion that may have been previously blocked or denied.

Collaborative Opportunities

How can school counselors and school nurses work best together? How can we support each other’s overburdened caseloads? In a perfect school day, how would it feel to be on the same team? What would a seamless referral system look like if we could design our own that met the FERPA/HIPAA requirements?

When looking to collaborate as a school counselor/school nurse team, many typical scenarios in students’ lives bear consideration. For example:
  • Family transitions can affect students – divorce, separation, death of a parent or caregiver and pet
  • Parent unemployment
  • Homelessness
  • New sibling
  • Food insecurity, hunger on the weekends
  • Co-parenting, student living between several households
  • Abandonment
  • School phobia
  • School violence/fear of school shootings
  • Bullying, including cyberbullying
  • Loneliness and/or new to the school
Schools must be safe havens for our students, families and communities. School counselors and school nurses can work together to help guide school districts that are grappling with how to address school violence and care for the students with the most challenging health and social needs. Building connections and promoting healthy relationships and communities is the link between home and school with the child at the center.

Robin Cogan, RN, is a Nationally Certified School Nurse with the Camden City School District in New Jersey and serves as faculty in the school nurse specialty program at Rutgers University – Camden School of Nursing. Contact her at Jeanne Kiefner, RN, NJ-CSN, is a retired school nurse and current faculty member at Rowan University in the post-baccalaureate school nurse certificate program.