The role of the school nurse is essential in primary healthcare – it gives students access to a health professional specialised in engaging with their age group.

School nurses also support educational outcomes by supporting health and wellness during these critical years.

When I was a public health nurse working in both primary and secondary schools in Rotorua, I was fortunate to have an experienced team of expert public health nurses, teachers, Māori health professionals, social workers and psychologists as mentors and advisors. We were provided with a structured professional development pathway and regular connections with nursing peers. We were able to discuss our schools – and the many diverse issues needing consideration – with colleagues clinically, ethically and professionally.

Delivering care within schools is a specialised role requiring a high level of autonomy and expertise, together with the confidence to engage and collaborate with the wider health professional groups working in this area. It requires an understanding of child and adolescent health, health promotion, mental health issues, sexual health, Māori and Pasifika, refugee, and acute and chronic health issues.

The role’s comprehensive nature means it is imperative that all school nurses are provided with a well-structured professional development plan. This ensures they are safe as registered nurses to meet best care practice standards and the Nursing Council requirements. Critical to professional development is support and funding by employers.
Currently, school nurses’ employment conditions and access to professional development can be variable depending on their employer. For school nurses employed by DHBs, there is generally a link with professional development recognition programmes (PDRPs) and DHB support pathways. This allows for a structured professional development plan, access to mentorship and supervision and access to HWNZ postgraduate education funding.

In contrast, for nurses employed by schools (funded via Vote Education, not Vote Health), there is no such link and they can lack professional nursing support to strengthen their student services.

The College of Nurses is regularly contacted by a steady number of Vote Education-employed school nurses voicing risks including:

  • having to navigate their own professional development; for example, sexual health is a requirement but anecdotally some schools are not aware or are not supporting nurses in this area
  • salary variations – some are paid a minimum salary that doesn’t reflect their experience and are not paid in the school holidays
  • work conditions, expectations and boundaries are not clearly understood by employers and/or nurses, creating professional and ethical dilemmas confusion about patient confidentiality, with school principals assuming nurses should share information provided by young patients.

An excellent foundation guideline for employers is the Guide to employing a registered nurse within a secondary school setting. It is a well-developed guide – for both employee and employer – on the employment requirements of secondary school registered nurses.
Another useful resource is Youth health care in secondary schools: A framework for continuous quality improvement, which provides self-assessment checklists of youth health quality indicators, as well as practical strategies.

It is essential that schools are well-informed and school nurses are supported to remain current and competent through well-planned professional development. Also important is the need to integrate care across health services. Ideally, school nurses are part of a broader, community-based primary health team ensuring no fragmentation between the various NGO, general practice, secondary and other services. This should be of interest to the Mental Health and Addictions Inquiry team as an area in which youth health in particular can be improved.

It is timely to consider equity for nurses employed by schools – not only supporting salaries that match their expertise, but also recognising the importance of our rangatahi and their right to quality care to support their future wellness.

Ngaira Harker is co-chair of the College of Nurses Aotearoa and Nurse Director Māori Health at the Hawke’s Bay District Health Board.

References for this article are available in the online version at


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