Notes from New Zealand: School Nurses Building a Culture of Youth Health
April 28, 2014
Putting young people’s needs front and center
Tara Kennon served as HSC’s communications manager before moving about a year ago to New Zealand’s Coromandel peninsula, where she has focused on projects to promote travel in this region. Now, she’s reporting back to us on a few of her observations related to school wellness.
Working as a school nurse in New Zealand might mean screening young children for vision problems or talking with a high school student about pregnancy. It may mean working as part of a team in a school-based clinic or connecting students with mental health services. Increasingly, it means being part of a movement to develop an NZ culture of youth health that takes on the unique concerns young people face.
Terryann Clark, senior lecturer at the School of Nursing at the University of Auckland and a nurse specialist at the Centre for Youth Health in Counties Manukau, explained that over the past twenty years, she’s seen a “major change in recognition that youth health requires special skills and expertise.” In her role as principal investigator for the Youth’12 national health and well-being survey , she’s seen school leaders increasingly use health data to advocate for more nurses in schools, recognizing the unique skills they bring.
Research and school nurses’ own experience shows the health issues facing young people (in this case defined as ages 10-24) are often mental, emotional or behavioral — issues that aren’t at the core of medical education. In NZ, specialized training in school nursing and youth health therefore has a strong focus on mental and behavioral health.
Nurse practitioner Maria Kekus, clinical director for HealthWEST and the Youth Health Hub, puts this focus in action. She and her colleagues are striving to transform a tradition in which “young people are seen as children,” by instead providing services that reflect individual developmental stages. One-on-one, that means school nurses conducting youth health assessments with students. Big picture, it means moving the culture of school nursing from “Panadol and plasters” to involved evaluation of individual needs.
Maria serves as chair of the Society of Youth Health Professionals Aotearoa New Zealand (SYHPANZ), a professional organization helping lead the transformation of this field. The recently-formed group provides professional development, hosts an annual conference and is documenting the competencies needed for best practice in school nursing and youth health. It’s leading the “recognition of and professionalization of youth health in New Zealand,” said Terryann.
At the heart of this work is an effort to recognize and address the things that keep young people from getting the care they need.
New Zealand’s national healthcare system provides universal free or low-cost care (YouthLaw offers an overview of services for young people) but barriers still exist. Some of these are logistical: lack of transportation, limited hours at GP offices, lack of money for fees. Others are less concrete: for example, young people consistently cite confidentiality concerns and “not wanting to make a fuss” as reasons for not accessing care. Simon Harger-Forde of innovate change explained that many young people actually do access care but leave feeling that their needs weren’t really addressed.
School nurses with specialized knowledge of youth health are well-poised to take on all of these issues.
It’s in this context, Simon explained, that New Zealand has seen a strong movement for school-based health clinics over the past decade with most high schools now providing some form of a health clinic staffed by a nurse. These vary widely, from robust clinics with labs and prescribing power to spaces where nurses work alone one day a week. Some school nurses are employed by the health sector while others are employed directly by the school. Sometimes a local health provider (such as Maria’s organization, HealthWEST) runs clinics in schools.
It’s easy to see how the NZ health sector would be motivated to fund school-based health clinics and school nurse salaries, as these school services are generally very effective and very efficient in terms of cost. Almost all health services are ultimately funded by the same public sources, whether the care is provided by a school nurse, a neighborhood doctor or a hospital emergency department. Plus, school nurses help keep students in school — and education is just as good for health as health is for education. As Maria put it: “The number one predictor of good health is completing school.”
By building a school health culture that puts young people’s needs front and center, school nurses are making a long-term difference for education and for health.
PS: What about children younger than 10? Primary schools are served by public health nurses who are employed by District Health Boards. They focus on the preventive side of public health such as screenings and immunizations. Some schools also hire a school nurse with a clinical focus. Visiting district nurses and Plunket nurses focus on care for children under five.