Writing about food allergies from a pediatric allergist's perspective

Making The Case For Full-time School Nurses: We Need Food Allergy and Anaphylaxis Champions

Making The Case For Full-time School Nurses: We Need Food Allergy and Anaphylaxis Champions

Written by Michael Pistiner MD, MMSc

As we move forward with implementing policies to care for students with life-threatening allergies, it has never been more clear – school nurses are indispensable.

Stock Epinephrine Saves Lives

Food allergies are a growing national concern.  Unfortunately, food allergy related deaths can and do occur.  Recognition of anaphylaxis, severe allergic reaction, and its treatment with epinephrine can be life saving.  First time allergic reactions and first time anaphylaxis do occur in school.  Our schools must be ready to identify these reactions, and treat appropriately.  Laws establishing availability of epinephrine as well as  training to provide this medicine are imperative.  The momentum of these laws has been inspiring and a result of the wonderful advocacy efforts of so many. As we move forward with implementing policies to care for students with life-threatening allergies, it has never been more clear – school nurses are indispensable.

Stock Epinephrine AND Full-time School Nurses: The Gold Standard in Preparing for Food Allergy and Anaphylaxis

In the case of first time anaphylaxis, not only is the availability of epinephrine imperative, but so is a full time school nurse.  School nurses are trained to make assessments of their students’/patients’ medical situation. They have spent their schooling and clinical training evaluating children. No one is better positioned or trained to make the assessment of anaphylaxis and treat appropriately.  Their role in the school and their medical background also allow them to train others to recognize these reactions in the event that they are unavailable, and efficiently implement school wide policies aimed at  delivering emergency treatment and preventing these reactions before they start. While it is ABSOLUTELY NECESSARY TO HAVE STOCK EPINEPHRINE AND PEOPLE TRAINED TO GIVE IT (especially when a school nurse is unavailable), we need to remember that our goal is to have stock epinephrine AND full-time school nurses. This should be our gold standard. 

Food Allergy and Anaphylaxis Champions: School Nurses

Food Allergy Champion: School NurseAlthough food allergy and anaphylaxis management is only one of many responsibilities of the school nurse, many would stress that it is one of the most CRITICALLY important issues in a school;  children’s lives depend on it.  A school nurse’s training positions them perfectly to be our schools’ food allergy and anaphylaxis champions.  They are the coordinators, advocates, responders and educators who are leading and guiding the entire school community in food allergy and anaphylaxis management.

School Nurses CARE: Roles as Food Allergy and Anaphylaxis Champion

  • Coordinators: School nurses work with physicians, parents, school staff, administration, school nutrition services, and students. They are the food allergy and anaphylaxis team leaders and liaisons, guiding and leading their schools in the implementation of guidelines and school policies.
  • Advocates: School nurses ensure that child’s health and self esteem are protected. They serve critical roles in bridging the gap between those with and without food allergies and play key roles in bully prevention and management.
  • Responders: School nurses are trained and poised to recognize and treat anaphylaxis.
  • Educaters: School nurses are in the unique position to teach the entire school community about food allergy management.  Educating all staff, parents and students can bring an awareness and understanding that can create supportive environments for students with food allergies and other life threatening allergies.

For more on the importance of full-time school nurses in managing life threatening allergies as well as pointers on what to do if your school does not have a full-time school nurse, see Life Threatening Allergies, School Nurses, and You: The Massachusetts Experience.

Also take a look at the Kids With Food Allergy Webinars where we emphasize the importance of full-time school nurses: 1)Partnering with Your School Nurse for a Safe School Year, 2)A Review of State School Policies for Protecting Kids with Allergies and Asthma (37:30-40:55 min, 44:30-49:10 min, 57:30-61:50 min)

A School Nurse’s Role and Importance Goes Far Beyond Food Allergy and Anaphylaxis Management and Education

Diabetes, cardiac arrest, mental health issues, storage and dispensing medication – these are just some of the many health issues for which a school nurse must be responsible. These professionals perform life saving and critical work that they have chosen to pursue and have been trained to do. In the event that a full-time school nurse in unavailable, children’s health needs don’t stop. In these cases other people in the school must assume these critical responsibilities.  Teachers, administrators, secretaries and others take on the tasks that a trained and licensed professional would have otherwise performed.

A recent National Association of School Nurses (NASN) position statement, Caseload Assignments, shares national data demonstrating that 45 % of public schools have a full-time school nurse, and 30% have a part time school nurse in one or more schools. This position statement also shares that when a school nurse is unavailable their responsibilities fall to others that are not trained or prepared to take these on.  Also a recent NASN Bill Summary of the Student-to-School Nurse Ratio Improvement Act of 2013, references a 2011 study demonstrating that having a school nurse in the building can save 13 hours a day of the total time spent by other staff (including principals, administrative staff, and teachers) addressing health concerns.

For more on the importance of full-time school nurses in our schools see:

1) A Day in the Life of Your School Nurse,

2) Five Ways a School Nurse Benefits the School

Let’s Rally For And Support Full-time School Nurses

School Nurses Rock: Food Allergy ChampionsAs a food allergy community, let’s start advocating for full-time school nurses in every school where there are children with food allergies  as well as other life-threatening allergies. Let’s rally in support of the people trained to care for our children. Please support NASN, and state and local school nurse associations in efforts to improve school nurse to student ratios and to get full-time school nurses in schools with children with life threatening allergies. Please support your local school nurses (if you have them) and remind your school boards and parent teacher associations that school nurses play a critical role in your child’s health and their ability to learn.

The views written in this piece are reflections by Dr. Pistiner individually and are not representing  the organizations that he volunteers for or is affiliated with.

Please consider sharing this post as well as the below template with others within our community and others dealing with chronic medical conditions.  Our advocacy efforts can and will go a long way for our school nurse heroes.

Please feel free to use the below template. Keep in mind that there are a few active links within and if mailing, you may want to include printed copies of those.


Dear Parents,

We all rely on our schools to care for our children’s health and well being when they are not in our care.  In addition to the usual challenges that come along with being kids, some students are coping with chronic medical conditions.  With these conditions come increased healthcare needs that don’t stop when our children go to school.  Asthma, food allergies, anaphylaxis, diabetes, seizure disorders, feeding difficulties, etc.; all need to be appropriately managed at all times and in all circumstances.

School nurses are in the unique position to adequately care for the health needs of children with and without chronic medical conditions.  They have chosen a career where they are trained to recognize and manage medical emergencies.  School nurses are perfectly positioned to educate entire school communities and to help support ALL students. A recent National Association of School Nurses document, The Case for School Nursing, highlights and discusses how school nurses benefit their schools.

The Student-to-School Nurse Ratio Improvement Act of 2013 will create a pilot demonstration grant program that allows federal assistance for educational agencies at the local level to target schools with the least adequate school nurse to student ratios.  It will require the U.S. Dept. of Ed. to monitor the efficacy of the piloted grant program as it relates to academic outcomes.

Our communities can start rallying to support school nurses. Please support this bill and ask members of the House of Representatives to become co-sponsors of Representative Carolyn McCarthy’s (D-NY-4) House bill (H.R. 1857). Ask Senate Members to consider being original co-sponsors of a companion bill.

Let’s support the heroes that support our children.


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  1. Outstanding post! Completely agree that every school needs a qualified nurse. I won’t yield on that premise either. It is not a matter of what is ‘optimal’, it is a matter of what is sorely needed and necessary.This is especially critical at a time when so many more students have diagnosed chronic health conditions. Nurses are well prepared to coordinate school food allergy management and trained to prioritize health/safety needs. Thank you so much for supporting the Nursing profession and The Student-to-School Nurse Ratio Improvement Act of 2013.

  2. Of course, as a school nurse, I feel school nurses are critical for a variety of illnesses that require the ability to assess and determine the best course of action (Diabetes, Asthma, Severe Allergies) We have had 1 situation THIS YEAR that despite being trained, the classroom teacher was too nervous about giving the epi-pen. I, the school nurse was not there- ( at 2 schools daily) so I am grateful our school principal was trained, and willing to provide a prompt epi-pen injection and the student rapidly recovered. Until you are in the situation, it can be hard to know if you are ready to react and do the right thing- urge your school to have a full time nurse for your school.


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