Healthcare provided at school

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School nurses

School nurses are qualified and registered nurses who offer support and advice on a range of health issues. They also carry out immunisation (injections) and screening programmes. They’re often the first place pupils go to if they’re feeling unwell or need health advice while at school. The school nurse’s day-day role varies, depending on the type of school. As well as individual health advice and care, it can include supporting schools with health advice for the whole school, such as healthy eating and exercise advice.

Hazzan recalled having injections at school from the school nurse, and that teachers at his school often reminded pupils that pastoral care was available as well as a school counsellor.

Hazzan saw a practice nurse to have tetanus, measles, mumps and rubella injections. He’d also seen a school nurse for injections.

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I don’t really go to the GP that often. I think it’s only for vaccinations [injections]. But they do do that in our school sometimes, because I don’t really get ill often. But I don’t really see the GP that often, as I got older; I think that as I got older I saw the GP less.

Has it always been the same surgery like the health centre or GP’s surgery has it always been the same or has it changed over the years?

I’ve always gone to the same surgery but we have gone to the hospital sometimes if I needed to get a blood test.

So, more recently, it was more to get vaccinations. Can you remember what the vaccinations were for?

I think it was like tetanus and measles, mumps and rubella I think. That’s all I can remember, yeah.

And did you see the GP at those appointments or did you sometimes see a nurse? Who was it usually at the surgery?

It was a nurse. I went to a nurse to go and do it. And the last time I did it, it was with the school nurse. But I did it before that with the nurse at the hospital.

So some injections you had at school?

Hm mm

And was everybody having those that, you know, you all had a time that this afternoon you’re having the injection or anything like that?

Yeah, I think that was the case. I think if you’d already gotten them, you didn’t need to go again. Or if your parents didn’t want you to go within the school, you could go and do it with your GP. But I think most of the students went in school.

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Isaac recalled seeing a school nurse when he’d had nose bleeds and when he’d tripped and fallen. At college, there were first aiders available for minor injuries or illnesses. When Siobhan was feeling depressed and was self-harming, she spoke to her sociology teacher first and later the school nurse. She was good but Siobhan felt that the nurse knew more about sexual health than mental health.

It would have been helpful if the school nurse had more mental health training. She gave Siobhan coping strategies for when she felt like self-harming.

Gender Female

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How was the school nurse?

She was okay. But I think her job role, like the training she’s had, it’s more around sexual health, especially in a school environment, rather than like being in the mental health sort of area, which is quite common in schools because of exam stress and that. But she was good, she was really nice. But like she did all she could, but like, she was setting homework and stuff like that for me to do, like the CBT stuff does. It’s like, Have you done your projects? I’m like, No, of course I haven’t. I’ve got more stuff to do than bake a bloody cake.

So how could she have been better? Like knowing more about mental health issues?

I think she just needs training in how to deliver mental health therapy. Cos obviously she can’t diagnose things. She was having to say, You need to go to your GP. You could do with going to your GP like every week. But I was really scared to go about my depression and anxiety. She was the first person I went to.

Oh, before you even went to the GP?

Yeah, she was the one who like said, You need to go to the GP now. But she was like good at giving me like temporary coping strategies and things like that. But she wasn’t specifically trained in general practice. It was like how to deal with young people and sexual health in young people I think mainly.

When she like gave you some techniques —

Yeah.

— did you use them? Did they help in any way?

I tried them. Like she said, If you feel like you need to self-harm, just leave it 5 minutes, then leave it another 5 minutes. But ob-, I found that difficult cos when I’m gonna self-harm it’s obvi-, it’s normally at a point where I’m doing nothing and I’m just like in my own head. So often leaving it 5 minutes can feel like leaving it 3 hours.

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Ambeya and Rowan felt that it would be good for school nurses to play a bigger role within schools. Ambeya would like health to be a bigger part of school education, and felt that ‘talking about your health issues at school was better than talking about your health issues at the doctor or with your GP because, at the end of the day, you’re in school most of your life’. She recalled that her secondary school was ‘quite resourceful …because we kind of had every single service that a school should have’. This included a school nurse, counsellor, student support worker, and school social worker.

The school nurse’s office was next to the staff room so it was easy for pupils to find her. Ambeya still keeps in touch with the nurse.

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When I was in school, there was a school nurse and if we wanted to see her we could easily just knock on her door. And she wasthe other good thing about our school nurse was she was, you know how every department’s like got their own office and stuff, she was connected with the youth club, and she was connected with the community worker and the social worker. So they all had an office where they were altogether, and it felt like a sense of security at the same time as well.

The fact that she could move around different departments and still do her job, which I think was good. Because I think that if she was secluded into her own office, at like the top of the building or something, it wouldn’t give the same atmosphere with it if she was right next to the staff, like she was there. Yeah, her office was right next to the staff room so she would be there during the day and on her lunch as well, so she’s always in the same area, so it wasn’t even difficult to find her.

Mm so you think accessibility is really important?

Yeah, definitely.

Yeah and what was she like?

She was really good, yeah. And I think it’s just the fact that it’s good when all your brothers and sisters go to the same school as well because then she’ll getshe has a chance to see them as well if she needed to.

Mm so you feel like you’re building up a relationship with your nurse that you weren’t necessarily able to do with your GP?

Yeah, yeah.

So she knew about like family history and things?

Yeah, and it’s nice to know that you’re still in touch with them as well because the school nurse that I had back in secondary school, I’m still in contact with her now. And I still have her email address and still have her phone number and everything. So she did say if you ever need anything I am still here, like don’t think that you’vejust because you’ve left school you can’t access me. So yeah.

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Rowan felt that it could be embarrassing if other pupils knew you were seeing the school nurse but that nurses should play a bigger role in schools. Shane also felt that there was ‘a stigma attached to being seen going to’ the first aid room at college and that it would be better if it wasn’t somewhere prominent.

School nurses should be involved and approachable. Pupils should be able to contact them by email and phone so it could be more private.

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I think it’s really important that, despite only having kind of one thousand I think it’s one thousand two hundred school nurses for the nineteen thousand schools in England, that the school nurses really get involved in the schools and kind of make themselves approachable for people.

So whether that may beI think sometimes people find if they’re coming in to do like a weekly slot, then that becomes a bit stigmatised and people find it a bit difficult to go along to the school nurse. But if you’re able to kind of contact them as well, kind of by email or by phone or something in your own time.

The school nurse?

Yeah. Then they might be able to play a bigger part, but obviously are limited people and limited hours, which is always limiting in these situations.

So are you aware if there’s a school nurse at your school or?

There is, and I know her mainly because she used to be a teaching assistant at my primary school. She has come into assembly to do her kind of school nurse presentations. “I am a school nurse, this is what I do,” about three or four years ago. And of course I’ve seen her doing vaccinations and things every year. But, apart from that, there is very little support. In fact I’m not quite sure if she’s actually still there, but she used to be quite active, and she used to pop into school every now and again. But I’ve not seen her recently.

Did you know her to be approachable or?

She was hardly ever around. So, apart from doing vaccinations, and I think she was going to start a kind of school nurse surgery once a month, but I didn’t actually hear what came of that.

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Lara recalled that her school had a nurse and a quiet room where pupils could go if they felt unwell. But the nurses weren’t allowed to give them painkillers without parental permission. Kyle’s school had a sick bay and he recalled going there to see the nurse when he’d bruised his foot. He was worried that he might have broken a bone. He was given an ice-pack but would have liked the nurse to have reassured him more that he hadn’t broken anything.

Kyle waited a while before the school nurse could see him. He felt that pupils should be treated in turn unless it’s something serious.

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Have you ever used the sick-bay?

Yeah I have, but I don’t really like it because [siren] someone fell on my foot and I had like a big bruise coming out of it. And I thought it was a bone so I was like worried about that. Yeah, but I went there and they just sat me there to put an ice bag on it for an hour. I just left.

Did you feel comfortable there, or could it have been better? Could it have been easier or better in any way?

Well it could have been a lot better. Well, they didn’t really tell me what was wrong with it. Because I thought it was a bone, and I believed that, and then they’re telling me, “Oh relax, I’ve seen it before, it’s a bruise.” Which it was a bruise butsorry, I don’t really trust their medical experience. They said they’ve been in like the job thirty years or something, but that doesn’t really mean anything to me. I prefer, I much prefer doctors.

So they told you it was a bruise but you were worried that it was a bone and you didn’t feel reassured?

No, they didn’t really pay any attention to me. They just sat me there, and then theyand someone came in with a headache and they’re like, “Oh have a paracetamol or have this”

So if you were going to give some advice to school nurses or, you know staff like that all over the country in different schools, what would you saywhat would you advise them? What message would you give to them?

Well they need to make sure that they’re not prioritising the people that come in. Like one person might have a little cut and the other person might have like something serious, but you have to treat them the same. Well obviously if someone’s like bleeding out then you’ve got to treat them first, but you can’t ignore one person.

So theywhoever comes in, they should treat everybody the same as they come in?

Yeah, yeah, unless of course someone’s like obviously in a lot more pain, then you can treat them first, yeah.

Did you feel that you were sitting around before they actually came and spoke to you?

Well I had to call them over to actually pay attention to me, but they just said the same thing, yeah.

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When Sophie’s sister was having problems with anorexia, her mum suggested that Sophie should talk to the school nurse. Sophie felt that school nurses were in a good position to raise awareness of mental health and ‘make themselves known’ to students with mental health issues. Although the nurse gave her a leaflet, Sophie felt that she didn’t really know where to go for help after that. She thought that the nurse could have come across as more welcoming and understanding, and that it would be good if school nurses could help more with mental health issues.

Talks in assemblies and posters around the school would help people know who the school nurse is and what she does.

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Well I think she [school nurse] could have been much more kind of welcoming and understanding. So yeah I think that would have been the first thing really because her tone was quite like sheI don’t, I don’t know whether sheif she really meant it like it, but it felt like she was kind of just looking down on me for coming to her for that reason.

But, yeah, I think it would have helped if she knew more, or just yeah, even if she didn’t know personally information, she could have directed me on where to go because I think it’s really important that, you know, people know about these things, so…

And a few people that we’ve talked to have talked about the school nurses at school.

Yeah

Is there any message or advice you could give to school nurses all over the UK, in terms of how they can be good as school nurses for young people?

I’d probably say I guess a lot of them, their main thing that they come across as just kind of general kind of in-school health concerns, I feel ill/ I need to go home. But I think it would be really appreciated if they could do more on kind of long term mental health. And so, even if you have like a student in school, make yourself known to them if you’ve got a student in school that maybe has mental health issues. Make yourself known to them that you’re kind of a place to go if you’re feeling not right, or if you do want to go home, that kind of thing.

So yeah, like it would be really, really appreciated if they could kind of clue up on mental health especially like long term mental health.

So much more information.

Yeah.

Knowing who in the school it might be worth talking to so that they can then come and see them if they feel like it?

Yeah exactly, yeah I think that would be good.

How can they best get this information out in schools do you think it’s worth having talks in assemblies or in classes or certain lessons? How do you think the schools could do better to get this information out?

I think, yeah definitely, I know in my school it was kind of a case of you never saw the school nurse unless you were in the room with the school nurse. So I think it would be good basically if they just made their face known, and made their role known so we all kind of knew that she was available if we did want to go and speak to her and that kind of thing.

So I think that, but also just, yeah every now and then speaking to students maybe; yeah maybe through assemblies but also maybe some posters up round school saying that she’s available for anyone if anyone wants to go to chat to her.

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Some people, like Paula and Louis, had never seen the school nurse and a few, like Louis, were unsure if their school had one. Jake thought that someone in the school office was trained in first aid, though wasn’t a nurse. Gentian had been to see someone who he thought could have been the school nurse when he’d had a bad stomach ache. He felt that she often didn’t believe pupils when they said they were unwell and that he’d like her to be more understanding.

Some people had occasionally seen a school nurse and felt they would have liked them to be a bit more welcoming. Lara saw one once and felt that school nurses should be a bit more patient. Peter was unsure but felt that ‘the woman in the office doubles up as a nurse’ and can get annoyed when pupils go to see her.

The school nurse assumes you want to get out of lessons. Peter’s seen her for cuts and bruises.

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Here there’s sort of a woman who works in the office who I think doubles up as the nurse. But I wouldn’t really go to her unless necessary really because she’s working and then you come in and she can normally be quite annoyed with you. And you feel that she doesn’t want you to be there, especially since normally, like people might try and get out of lessons. And she just assumes that you’re there with bad intentions even if you are feeling genuinely sick.

So is there any message you could give to school nurses in different schools, any, anything thata message to make them, you know to improve?

Just to feel like, like just to be there a bit nice, you know a bit more welcoming for the people who are there, to make it all, you know to feel that you want to be there that kind of thing. And to feel that you can go there if you feel ill rather than feeling that you couldn’t go there even if you wanted to.

Have you ever hadbeen to see her or not…?

I’ve been there a few times mainly for cuts and bruises and that kind of thing. And they just give you a plaster and tell you to go away normally. And then once I’ve had to wait there for a few minutes, and you sort of just sit there waiting whilst they get on with whatever they’re doing in the office. So yeah you feel sometimes that you’re just brushed aside and you’re just waiting there.

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When Lucy started having panic attacks during lessons, she spoke to the school nurse but felt she was ‘never very helpful’. She preferred talking to the ‘pastoral person’ because sometimes ‘you just want someone to listen. And I think they [school nurses] need to be more open to listening instead of just, ‘Well, here, this will fix your problems’. Lucy felt that she could talk to the pastoral care manager about problems at home. One of her teachers was also very understanding and gave Lucy a pass that would allow her to leave lessons if she was feeling anxious.

It was helpful speaking to two pastoral care staff at school. One was very good because she listened and gave advice quite directly.

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I used to talk to her [pastoral care manager] anyway, just more about general things and stuff that would be going on at home. Cos I’d just be like down about it. But there wasn’t really a gap. She was sort of like, Well, what’s been going on? Why aren’t you going to lessons? And so I sort of talked to her about it and I was like, Yeah, I’ll go, I’ll go. Fine. But then I wouldn’t, yeah.

Was it helpful talking to her?

Sometimes. Because there was two. There was like the main one that you could go to, for the whole school. And then there was the ones who, particular year groups. And the one for my year group, she was really nice. I really liked her. But she was, I think she tried to relate a bit too much. Cos she’d be like, Oh, when I was your age, this would happen. And then she’d sort of turn it to be all about her. And I’m like, That’s great. I get that you get it. But I’m trying to talk. But the other one could be pretty helpful. She was, yeah.

What was the difference between the other one? Was she more, listening more rather than talking about her own experience?

Yeah, she listened more. And as well sometimes I think she was a bit like firmer. Not in a like angry, bossy, I don’t care’ kinda way. But she’d sort of be like, Look, I get you’re feeling this way, but you need to just sort of get on with it. And sometimes you just needed that. And so that was good.

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Paula, like Ambeya, felt that it would be helpful if school nurses gave more information about the range of issues that GPs can help with, and that leaflets and flyers outside the nurse’s office would be useful. Fran, like several other people we spoke to, felt that school staff, including teachers and nurses, could do more to raise awareness of mental health. She felt that teachers could also have mental health training so that they might recognise when pupils are having problems. Auberon also felt that it was important for schools to raise awareness of mental health issues, including having people who’d had problems in the past visiting schools and giving talks.

Counsellors

Counselling is usually available free of charge to students who are at college or university. But not everyone we spoke to knew whether there was a counsellor at their school. Auberon recalled that there was ‘a very good counsellor’ at his school. There was also a nurse who he felt was good at helping with physical health problems, but the counsellor was better at helping with mental health issues.

Aphra recalled having counselling at school when she was doing her GCSE’s – she was under exam pressure and also caring for her mum. She felt that the first counsellor she spoke to was ‘very weird and very airy fairy’ but the second one was ‘lovely’. Sometimes she also spoke to the pastoral care manager, who she felt should play a more obvious role within schools. She found her ‘really personable’, friendly and empathetic. The pastoral care manager also gave Aphra a card to use if she needed a break. Aphra sometimes sat and worked in the pastoral manager’s office instead of in the classroom.

The school pastoral care manager was a really lovely woman. Aphra preferred her to the two school counsellors she saw.

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For my school they had a counselling agreement with Relate. So she was only there for one afternoon a week, and to be able to go you had to go to the pastoral manager who was a really lovely woman. And I actually would say that the pastoral manager probably did more for me than the counsellor did. Because the pastoral manager had given me a card that said if I needed to go out and get some air, I could. And any time I wanted to, I could go to her even if it just meant sitting in her office and having the radio on, I didn’t necessarily need to do some work.

Sometimes I did just work in there because I found that environment was better for me. And I always remember as well that my teachers were really surprised I was going to the pastoral manager because they always associated her with the kids who were in trouble, or who were truanting and just generally the problematic people. And they kept going, “But your grades are so fine, why on earth would you end up there?” And you’re just going, “Because it’s actually not about the grades, I’m coping, but I just need the break.”

But she has been able to get me a slot with the counsellor, and I had to wait about a month before I could go. And then they did have all the normal agreements that it was entirely confidential, and they’d only break that confidentiality if they thought I was at risk. Which luckily for me I never was.

But I didn’t have a lot of confidence in her, partly because I felt that, when you’re a young carer, you act a lot older than you are anyway. Because you’re used to having to deal with things that are just more difficult and more adult. And some of her methods were very childlike.

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Nikki, who was bullied at school from a young age, had counselling at school from around the age of six, and then later at secondary school. She found it hard to open up and trust the counsellor, but felt that it helped talking to someone. When she started hearing voices, the counsellor advised her to see the GP.

Knowing that there was one person that Nikki could talk to helped. She found it hard to trust a counsellor in 12 sessions. More time would have been better.

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So when you were at school, at one point you saw a counsellor. Did that help in any way?

I think like sometimes it did because a lot of the time I felt really alone, like I had absolutely no one. So knowing that there was one person there that I could talk to once a week for a little while [coughs], that did really help because it made me feel like there was one person that wanted to listen. And that was, I think that probably helped a lot, but yeah. I can’t remember what I was going to say, sorry.

So that helped. Did you feel that you could trust this other counsellor that you were talking to?

I didn’t feel I could trust them, but just knowing that there was someone there that was listening, even if I couldn’t trust them that helped a lot, just knowing that there is someone there. Because a lot of the time people just feel so like when they’re being bullied, or there’s issues at home and stuff, they just think, ‘I’m completely on my own and no one cares about me at all. So then knowing thateven if you don’t trust them, even if you can’t talk to them just knowing that there is someone there, it can be a lifesaver.

What would have helped to build a better trust with that person, what could have helped?

I think if I had more time. Like they give you a very short time period, which is absolutely ridiculous because people are different. They have different needs that are complex. To say like twelve weeks, this is what you get, like deal with your issues, now go, like it’s ridiculous. So I think if I had more time to get to know her or something like that, then maybe it would have been more helpful.

To build that trust over time knowing that you didn’t just have a short slot.

Yeah.

And you could have as long as you needed.

Yeah.

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Sophie’s school counsellor also advised her to see the GP when, after around eight sessions, Sophie wasn’t feeling any better. She felt that it would be helpful if school counselling services were better advertised – she only found out about them through a friend.

Mental health problems affect a lot of people and shouldn’t be seen as embarrassing. It’s important to talk to someone and take time out for yourself.

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I just wasn’t really myself; just feeling kind of quite down, that I was very tired all the time and I didn’t have any motivation to go and see my friends or to do any work, or even things like I normally enjoyed I just wasn’t enjoying them anymore. And it was kind of happening for so long. My sister was getting better but it wasn’t going away.

And so that’s when I kind of realised it wasn’t primarily based on that. I think it just kind of triggered it and actually it was something a bit more than that. And so when I was feeling just really low, and yeah, just not myself, that’s when I thought, ‘I’ll go and see a counsellor.

Yeah. Did anyone suggest it or it’s something that came to your mind, or did you look on the internet or discuss anything with anyone, or you just didn’t feel like talking about it at that point?

My friends noticed I was really reluctant to talk about it with anyone, but my friends noticed I just like wasn’t really hanging out with anyone and I wasyeah I was just really reluctant to do anything.

And so like I kind of confided in one of my friends I was just saying I’m just not feeling good about myself, and she suggestedshe said, “Oh I know someone else who’s used a counsellor and maybe that will help you out.” So, yeah, it was effectively from her who suggested it.

And can you tell me how old you were at that time?

Well I must have been around thirteen/fourteen I think.

Is there any message or advice you would give to someone who’s thirteen/fourteen, feeling a bit like that, they don’t know what to do. So, you know, looking back, in hindsight, is there anything that you would suggest to them?

Yeah. I definitely would say like talk to someone about it. It’s not embarrassing, you know, and it happens to a lot more people than you think. Yeah go and talk to someone about it, and also like make sure you’re making time for yourself because I think it’s really easy, in this day and age, to kind of get wrapped up in everything else and to be kind of completely overwhelmed in work and things.

But make sure, you know, obviously try to do your work but actually make sure you take out time for yourself and you do actually give yourself a break. And try and keep yourself healthy and know that actually it’s really important to do that. And kind of recognise that and just take out time for yourself, but talk to someone about it if it’s getting bad.

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