School Nurses and School-Based Health Centers: A Conversation with Paula Fields

Paula and her granddaughter at a concert, enjoying sugar-free icy slushes

Paula Fields, MSN, BSN, RN is a senior program manager at the School-Based Health Alliance. 

First, tell us about yourself!

I am a nurse, a mom, a MiMi of a Type 1 diabetic grandchild, and a fierce advocate for children and school-based health care! I’ve worked to establish and grow school-based health centers for over 20 years in my home state of West Virginia.

It’s easy to confuse the roles of school nurses and school-based health centers (SBHCs), though we know that both are critical parts to improve student health outcomes. Can you shed some light on the differences between school nurses and school-based health centers?

To answer that question, I first have to smile. You see, when I first started my life’s work of establishing and growing SBHCs many years ago, even I didn’t understand the role of school nurses and vice versa! We tried to figure out each other’s respective roles as we worked together—all while  keeping the students as our focus. What we learned? The importance of the three “C’s”: cooperation, coordination, and collaboration. Since that time I’ve had the pleasure of interacting both personally and professionally with a host of school nurses. As I’ve worked with school nurses more and more, I’ve come to add a few other words to the three “C’s”: appreciation, courtesy, and respect.

First things first: school nurses are responsible for managing the daily health needs of ALL students. Terms such as Free Appropriate Public Education, IEPs, 504s, care plans, immunization compliance, and health promotion come to mind. As I mentioned, I have a granddaughter with Type I diabetes and it’s challenging for me to care for her, even with my nursing background. She has an insulin pump, continuous glucose monitor, and more alarms and needed interventions than I could ever have imagined. She’s the only child I provide care for—and believe me, it’s hard! If it’s so difficult to provide care to only one little girl, you can imagine the difficulty and scope of the work that school nurses do by serving ALL students… including those with health conditions like my granddaughter. For students needing medical care, school nurses can refer them to a school-based health center.

School-based health centers serve over 3,000 schools across the nation. Located in or on school grounds, SBHCs provide primary health care among other things. SBHC providers differ from school nurses in that they can diagnose and treat illnesses, prescribe medications, and may also provide oral, behavioral, and vision care. SBHCs work cooperatively with the school, school nurses, and parents. They also work with—but don’t replace—a student’s primary care provider.

As working parents, we were fortunate that our children attended a middle and high school with an SBHC. The SBHC worked with us and our children’s pediatrician to ensure our children received the care they needed.

One time, I remember I was working in another state (championing SBHCs) and their dad was working in an underground coal mine. I received a call. “Mom, I have pink eye.” I responded, “Ok, what can I do for you? I’m in another state, Dad can’t leave work, and your pediatrication is an hour away.” My child responded, “I’ll go to the SBHC!”

I could not help but feel proud. You see, this is a prime example of how having access to services at school teaches students how to navigate the health care system, take ownership of their well-being, and become independent. My child visited the SBHC and was diagnosed with conjunctivitis. But the care didn’t even stop here! The SBHC contacted his pediatrician and  called in a prescription to the pharmacy. The prescription needed to be paid for and picked up, but neither my husband nor I could leave work. And here’s the incredible part: the SBHC and school nurse worked together, paid for, and picked up the prescription. Ultimately, my child saw a provider, was prescribed medication, and received treatment before either of us as parents could have secured care. I’m telling you—our children win when we work together!

It sounds like both school nurses and school-based health centers have the same goal in mind: making sure students are healthy and ready to learn. What does having a school-based health center in addition to a school nurse make possible?

The bottom line is that students benefit when SBHCs and school nurses work together. This collaboration enhances continuity of care through information sharing and even saves the school dollars as students progress toward graduation. Working together yields multiple benefits: improving access to care, reducing student absences, increasing classroom seat time, decreasing parent/guardian missed work time for visits, and improving students’ health and academic outcomes, to name a few.

Research shows that school nurses and SBHCs lead to improvements in education and health outcomes for our nation’s children, and it’s important to know that one does not replace the other.

I wholeheartedly believe that healthy students are better learners, that it takes a village, and we’re stronger together.


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