Nelson County School Nurse Program
- Need: Low rates of immunization and a lack of knowledge about physical health among school age children in the rural areas of Nelson County, Virginia.
- Intervention: A School Nurse Program placed a registered nurse in each of the four county public schools to track and encourage immunization compliance, provide health education, and handle students' daily health issues.
- Results: School-age children are having many of their minor health concerns addressed throughout the day by registered nurses at school. Compliance for childhood immunizations is now extremely high.
In the 1990s, Blue Ridge Medical Center (BRMC) outreach
staff completed health screenings in Virginia's Nelson
County public schools. BRMC staff realized that in
addition to very low immunization rates, the children
lacked basic health knowledge. In order to address these
needs, BRMC, the school district, and the county health
department collaborated. They were awarded a 3-year
(1998-2001) Federal Office of Rural Health Policy (FORHP)
Rural Health Care Services Outreach grant to form the
Nelson County School Nurse Program.
At the program's inception, registered nurses were
positioned in the county's public schools. Now a
registered nurse and a part-time school nurse coordinator
are in each of the four county schools.
The Nelson County School Nurse Program is still
facilitated through the BRMC, and all of the nurses are
BRMC employees. A BRMC Medical Director provides
assistance and supervision. Though the nurses are BRMC
employees, they are not just located within each school,
they are very much a part of each school.
After the original grant expired, the success of the
program has continued to receive support from Nelson
County annual grants. Of note is that School Nurse
Program does not compete with funding for extracurricular
activities or other budget line item decisions within the
- Assess students' minor daily health issues such as
headaches, fevers, sprains
- Assist students with chronic disease management as
- Assist staff with minor health needs throughout the
- Administer students' prescription medications needed
during the school day
- Develop individual health plans with assistance of
school system personnel
- Track immunization compliance and encourage parents
to follow through with their child's immunizations
- Complete health screenings including those for
scoliosis, dental issues, height and weight measurements
- Make referrals on the basis of abnormal screenings
- Educate parents about Virginia's health insurance
program for children: FAMIS (Family Access to Medical
Insurance Security) and FAMIS Plus (Children's Medicaid
program) and encourage enrollment if applicable
- Provide some health education in the schools
The past five years of data that tracks the both the
numbers of student visits to the school nurse and school
nurse communications with parents by phone, email or
face-to-face reveal increased or steady numbers despite
decreasing student enrollment.
Of note is that compliance with school immunization
recommendations has ranged from 96% to 99% for the past
Specific results for fiscal year 2018 to 2019:
- 38,596 visits to the school nurses
- 29,792 contacts with parents by phone, emails,
- 97% to 98% school immunization compliance
- Finding substitute RNs when regular staff need time
away. Without this backup staffing model, the school
nurses are often working when they are ill.
- Each nurse works independently at the assigned site
which translates into a challenge based on the volume of
visits. With over 30,000 visits in a year, each nurse
sees an average of 48 students each day.
A good relationship between all the parties involved is
important to the healthy functioning of this program. The
school nurses and the BRMC have great relationships with
the county and the school system, along with the school
system principals and superintendents.
Awareness of school nursing program regulation changes
are essential. For example, school nursing programs do
not follow HIPAA (Health Insurance Portability and
Accountability Act) regulations; rather they follow FERPA
(Family Educational Rights and Privacy Act) regulations.
A software tracking program is necessary for the school
nurses in order to track students' health information and
the nurses' interventions.
Deborah Williams, Chief Operations Officer
Blue Ridge Medical Center
Children and youth
Wellness, health promotion, and disease prevention
July 14, 2005
Date updated or reviewed
April 7, 2020
Suggested citation: Rural Health Information Hub,
Nelson County School Nurse Program [online]. Rural Health Information Hub. Available at:
[Accessed 30 November 2023]
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about this program. Summaries of models and innovations are provided by RHIhub for your convenience. The
programs described are not endorsed by RHIhub or by the Federal Office of Rural Health Policy. Each rural
community should consider whether a particular project or approach is a good match for their community’s
needs and capacity. While it is sometimes possible to adapt program components to match your resources, keep
in mind that changes to the program design may impact results.