Due to budget cuts, many schools in the state of Michigan
had to cut school nurses from their annual budgets.
Michigan now has the highest nurse to student ratio in
the nation at 1 school nurse for 6,607 students, far
national recommended ratio of 1 for 750 students. A
noticeable increase in pediatric emergency room visits
and subsequent preventable hospitalizations caught the
attention of the
Munson Healthcare Charlevoix Hospital (MHCH), a
25-bed Critical Access Hospital located in Northern
In response, MHCH leaders and the board of directors
developed a hospital-based pilot School
Nurse Program in which MHCH nurses work in 7 rural
schools in Charlevoix and Northern Antrim Counties where
access to healthcare is limited and health disparities
high. Approximately one-third of these counties' children
live in poverty. Prior to the program, these schools had
no school nurses. The goal of the MHCH School Nurse
Program was to provide direct nursing care, increase the
medical safety in the school setting, and educate and
train school staff. An unexpected result in the program
was a remarkable decrease in student absenteeism in the
schools served by the program.
The nurses offer health screenings and preventive
education while also providing basic medical care and
ongoing assessments. In many cases, the school nurse acts
as a case manager, communicating between clinics and the
child's parents and helping to create a care plan. School
nurses work full-time in the schools during the school
year and keep up their nursing skills by working at MHCH
during school vacations and in the summer.
State and local grants, together with hospital
fundraisers, initially funded the program from 2011-2013,
making the service free for the schools and families. The
program is now funded solely by the Munson Healthcare
School nurses offer a variety of services for students,
staff, and parents:
How to improve nutrition in school meals
How to appropriately update and create medical action
Sickness prevention and general health education
CPR and AED
Epipen injection training
Screening for health risk factors
Distribution of basic hygiene items and winter
clothes for students who need them
Communication about health alerts or potential health
threats in the region (such as flu or other viruses)
Hand washing program
Mandatory Hands-Only CPR Training for junior high and
high school students, a graduation requirement in the
state of Michigan.
On-site diagnosis and treatment for minor ailments,
accidents, and sicknesses
Medication management and same-day distribution
Monitoring and treatment of students with complex
health issues, including type 1 and type 2 diabetes,
seizure disorders, life threatening allergies, attention
deficit disorder, and autism
Referrals to medical specialists, therapist,
counselors, and clinicians when further care is needed
Care planning for students in conjunction with area
Consultations with parents regarding the health of
Through funding from the National Institute of Health
and the National Library of Medicine, school nurses use
iPads to help students with mental or emotional health
needs. For example, a mindfulness app helps students cope
with anxiety and post-concussion symptoms.
Kids' Cooking Classes at the Charlevoix Hospital
Wellness Workshop that teach children healthy ways of
cooking with farmers market produce and other nutritious
Referrals to Health and Human Services and other
Evaluation and improvement of school hygiene, air
quality, and cleanliness
Provision of winter clothes for students in need of
Since 2011, the School Nurse Program has brought
healthcare to over 3,200 students every year in rural
Michigan. Other positive outcomes include:
Chronic absenteeism in participating schools has
dramatically decreased (one school dropped 32%).
Medical safety has increased.
Diabetic children have improved their blood glucose
levels by carbohydrate counting.
All schools now have medical action plans for asthma,
head injuries, allergic reactions, and diabetes.
More than 250 staff and 1300 students have been
trained in CPR and the use of AEDs.
With funds from a Farm to School grant, the School
Nurse Program has helped schools improve their lunch
menus using food from local gardens and farms.
With funds from a Safe Routes to School grant, the
School Nurse Program helped to improve safe routes for
students who walk to school.
In the fall of 2017, Boyne Falls
Public School's cafeteria was recognized by Chef Alice
Walters from the Edible Schoolyard Academy project as the
only school in the nation that attained their goal of
ensuring that 20% of the fruit and vegetables served to
students came from local farmers. Read about Walters's
visit to the school in the article
Boyne Falls school hosts special lunch guest.
Below are some more indirect but related effects that the
MHCH School Nurse Program has had:
Parents are less burdened with medical problems and
lose less time from work.
Students have increased attention spans that teachers
attribute to improved nutrition, hygiene, and sleep
Parents take less time off of work to spend at
medical appointments and money is saved that would have
otherwise been spent on medical bills.
Principals, teachers, and secretaries are spending
less time on students' medical-related issues.
Hospital staff are rejuvenated by the opportunity to
utilize their skills with students in diverse ways.
Area agencies that are active in social well-being
(bullying, suicide, and childhood obesity prevention) are
getting an increase in referrals from school nurses.
Provided tangible evidence of
MHCH's intentional efforts to provide "community benefit"
in Northern Michigan.
In 2014, the School Nurse Program was named a
"Program of Promise" by the Jackson Healthcare Hospital
Charitable Services Awards. This award recognizes
innovation of new programs in addressing community needs.
In 2015, the program won the "Programs of Excellence"
award given by the Jackson Healthcare Hospital Charitable
Services Awards for their measurable outcomes.
In 2015, the program was named
one of 4 winners of the Michigan Health & Hospital
Ludwig Community Benefit Award for improving the
health and well-being of area residents.
To read more:
Jacobsen, K., Meeder, L., Voskuil, V.R. (2016).
Chronic Student Absenteeism: The Critical Role of School
Nurses. National Association of School Nurse (NASN)
School Nurse Journal. 31(3). Article
School nurses found that there was a lack of medical
record keeping and outdated student medical management
plans in most of the schools they served. School nurses
helped staff create or revise medical plans. Other
challenges for school nurses include school staff
turnover, student homelessness, poverty, and lack of
Before starting a similar program, evaluate your
resources and talk with area schools to see if there is
School nurses who are employed by a local hospital
can provide access to hospital resources and more direct
medical help for children. It can also supply more rapid
care, as same-day deliveries of medical supplies can be
made from the hospital.
For hospitals starting a school nurse program, use
your staff in innovative ways. Introduce other medical
professionals such as athletic trainers, physical
therapists, and dietitians into the school system for
Carefully track absentee rates in order to build the
case for the necessity of your school nurse program.
Initiatives like Farm to School and the Safe Routes
to School programs have seen success because they were
tailored to each school's needs. Be mindful of your
schools' cultures and cater health initiatives as
Make an effort to partner with medical and economic
community leaders to strengthen your impact and awareness
of your services.
Utilize the talents within your hospital to help out
in the schools: dietitians, physical therapists, and
respiratory therapists can help the school with complex
School nurses work in hospital
settings during the summer months or on school vacation
days to keep their skills sharp and provide relief to
Leaders of the MHCH School Nurse Program will gladly
serve as mentors and widely share their methods, actions
plans, and any or resources needed so that other
hospitals, school systems or partnerships may establish a
school nurse program in underserved "school nurse desert"
Success of the School Nurse Program was evaluated through
the following methods:
Annual surveys were distributed to
school principals, teachers, and parents
School nurse reports kept updated
record of a child's illnesses, injuries, treatment, and
School nurse reports and screening
results kept record of health risk factors
identified and intervention that was taken
School nurse and referral source
records documented necessary referrals to
other health professionals
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.