Schools Need Universal Nursing Coverage.

To the editor:

In August, as the New York City School District prepared to re-open, mayor Bill DeBlasio guaranteed that every public school building would have a school nurse. Universal nursing coverage is undoubtedly needed to ensure a safe return to school amidst the COVID-19 pandemic, but it is also long overdue. A registered nurse should have already been present daily in every school to optimize student wellness, promote safety, and foster a healthy learning environment. Universal nursing coverage in schools is needed to combat an epidemic that will persist long after COVID-19 is a memory. That epidemic is childhood obesity.

Obesity affects nearly 1 in 5 school age children and the consequences are severe (Hales, Carroll, Fryar, & Ogden, 2017). Children with obesity are developing serious chronic conditions, like cardiovascular disease and type 2 diabetes before they reach adulthood (Güngör, 2014). A comprehensive approach to childhood obesity must include schools, where students spend over 900 h per year (Desilver, 2014). School nurses have been providing healthcare in schools for over 100 years. School nursing was founded as a community based practice and is grounded in public health. School nurses are trained to address social determinants of health, thus they are well-prepared to tackle the complex problem of childhood obesity.

School nurses can lead efforts to prevent and reduce childhood obesity through education, assessment, and advocacy.

Nurses are highly skilled at conveying health information. They can educate students, teachers, and parents about behaviors that promote a healthy lifestyle. Nurses can address weight bias and stigma in their schools by setting an example for how to discuss nutrition, physical activity, and weight status appropriately and sensitively.

Nurses can conduct health assessments to identify students with or at risk for developing obesity and coordinate care with the child's primary care provider.

School nurses are powerful advocates and should be involved in the development and implementation of school wellness policies. Nearly all children eat lunch, either purchased in school or brought from home, at school. School nurses can advocate for policies that promote healthy eating habits. For example, about half of school districts in the United States do not have a policy that provides students with at least 20 min to consume their lunch (Centers for Disease Control and Prevention, 2019). Short lunches cause students to eat rapidly or eat an incomplete lunch. Eating rapidly is associated with excess weight gain (Berkowitz et al., 2010). Eating an incomplete lunch can lead to increased hunger in the late afternoon and binge eating snacks before dinner. Requiring a minimum of 20 min to consume meals once the child is seated is just one example of a district level policy that school nurses can champion that will foster the development of healthier eating habits. Nurses can also support physical activity initiatives like “walk to school” programs.

The National Association of School Nurses takes the position that “the registered professional school nurse has the knowledge, expertise, and skills to promote the prevention and reduction of overweight and obesity among children and adolescents in schools”(National Association of School Nurses, 2018). There is also evidence that school-based interventions that engage school nurses result in significant reductions in body measures like body mass index (Schroeder, Travers, & Smaldone, 2016). However, time is a barrier and in many districts, the school nurse covers multiple buildings and hundreds of students. Staffing a registered nurse in every school building is a critical first step in ensuring that school nurses have the time to engage in obesity prevention and reduction strategies. We must fight for universal nursing coverage to continue after the COVID-19 pandemic passes, because the childhood obesity epidemic is not going anywhere.