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Rural Health Information Hub

Munson Healthcare Charlevoix Hospital School Nurse Program

  • Need: School nurses to assess and care for students in rural Michigan schools who have limited access to healthcare.
  • Intervention: Munson Healthcare Charlevoix, a CAH in Northern Michigan, created the School Nurse Program to provide medical care and education to students, school staff, and families.
  • Results: The School Nurse Program brings healthcare to over 3,400 students in 8 schools every year and chronic absenteeism in participating schools has dramatically decreased.


Promising (About evidence-level criteria)


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 below the 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 Michigan.

Munson Healthcare Charlevoix Hospital logo

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.

Participating schools include:

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 Charlevoix Hospital.

Munson Healthcare Charlevoix Hospital School Nurse Program Cooking Class
Cooking class taught by a MHCH school nurse.

Services offered

School nurses offer a variety of services for students, staff, and parents:

Staff Education

  • How to improve nutrition in school meals
  • How to appropriately update and create medical action plans
  • Sickness prevention and general health education
  • CPR and AED
  • Epipen injection training
  • Narcan training

Sickness Prevention

  • 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)
  • Flu clinics
  • Hand washing program

Medical Treatment

  • 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 clinics
  • Consultations with parents regarding the health of their children

Wellness Programming

  • 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.
  • Suicide prevention task forces, Farm to School, Safe Routes to School, and other programs related to student health and wellness
  • Kids' Cooking Classes at the Charlevoix Hospital Wellness Workshop that teach children healthy ways of cooking with farmers market produce and other nutritious ingredients

Social Services

  • Referrals to Health and Human Services and other community agency
  • Evaluation and improvement of school hygiene, air quality, and cleanliness
  • Provision of winter clothes for students in need of them
Charlevoix Public School students
Students of Charlevoix Public School attend a CPR class as a part of a Friday morning Wellness Workshop.


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 habits.
  • 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.


MHCH school nurse award recipients
MHCH School Nurse Program Creator Kathy Jacobsen (right) and School Nurse Chris Signs-Warstler (left) receiving the 2015 Jackson Healthcare "Program of Excellence" award in Atlanta, Georgia.
  • 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 Association's Ludwig Community Benefit Award for improving the health and well-being of area residents.

To read more:


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 affordable housing.


  • Before starting a similar program, evaluate your resources and talk with area schools to see if there is interest.
  • 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 further support.
  • 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 appropriate.
  • 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 504 plans.
  • School nurses work in hospital settings during the summer months or on school vacation days to keep their skills sharp and provide relief to hospital nurses.
Munson Healthcare Charlevoix Hospital school nurses
MHCH School Nurses (left to right): Sue Coen, Chris Signs-Warstler, Kristie Fichtner, and Alice Thumser.

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" areas.

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 referrals
  • 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

Contact Information

Kathleen Jacobsen RN, MPA, Director of Community Health Education
Munson Healthcare Charlevoix Hospital

Children and youth
Wellness, health promotion, and disease prevention

States served

Date added
February 27, 2017

Date updated or reviewed
April 17, 2019

Suggested citation: Rural Health Information Hub, 2019. Munson Healthcare Charlevoix Hospital School Nurse Program [online]. Rural Health Information Hub. Available at: [Accessed 6 February 2023]

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.