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Rural Health Information Hub

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 school district.

Services offered

  • Assess students' minor daily health issues such as headaches, fevers, sprains
  • Assist students with chronic disease management as needed
  • Assist staff with minor health needs throughout the school day
  • 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 five years.

Specific results for fiscal year 2018 to 2019:

  • 38,596 visits to the school nurses
  • 29,792 contacts with parents by phone, emails, face-to-face visits
  • 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.

Contact Information

Deborah Williams, Chief Operations Officer
Blue Ridge Medical Center

Children and youth
Health screening
Wellness, health promotion, and disease prevention

States served

Date added
July 14, 2005

Date updated or reviewed
April 7, 2020

Suggested citation: Rural Health Information Hub, 2020. Nelson County School Nurse Program [online]. Rural Health Information Hub. Available at: [Accessed 19 May 2024]

Please contact the models and innovations contact directly for the most complete and current information 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.