School Health Nursing

Disclaimer: long post ahead!

As I've mentioned, I spent my first clinical week following a public health nurse at two different elementary schools, Normaalikoulu and Kellarpellon koulu.

See this unassuming field?
They teach the kids how to ski and ice skate starting in 1st grade!

Public health nurses have additional education beyond a nurse and work somewhat independently in this healthcare system. They make their own appointments and manage the health of school age children, looking out for diseases such as diabetes type 1, eyesight problems, hearing, or vaccination needs.

In this public system, nobody falls through cracks. From the time the child is born, they are part of the child clinic that follows up until school age, then the school health care, then student university healthcare, then occupational care, and if needed, maternity care. As the people move up in age, their "primary care" is offered at these clinics. For the school age children, this clinic is at school.  Some of those primary healthcare services that are provided include yearly health checks by nurses, and physical exams by physicians every few years. Public health nurses manage these clinics and perform a lot of services for families. When the family goes to the doctor for a physical, they see their nurse, who remains the same, but they cannot pick their physician. The nurse may spend 40-60minutes doing a health check and interview, the doctor usually only gets 20 if it's a healthy child. In these elementary schools, the doctor visits once a week, and that's when the school nurse can discuss any concerns about specific children needing appointments or referrals to a specialist.

In this system, public health nurses are very well respected and needed. Parents call them first for child illnesses, and in school health, she is the most visible healthcare provider. If they feel ill at home (and it's non emergent) they call the school health nurse. She then assesses and advises them on what to do, and if needed, makes an appointment with the school physician. Those appointments take place usually at school. Basically, the healthcare for the school age child is provided at the elementary school level.

The office...

This week at school, I helped the nurse perform health checks. In grades 1,5, and 9, they have a physical with the doctor as well. Our health checks included interviewing them about their stage in life, their hobbies, interests, family life, and stressors. We took height, weight, hearing, vision, BP, and hemoglobin levels. We talked about alcohol and tobacco use and eating healthy. For these kids, I was able to talk to them on a basic level in english. The nurse translated for me for other times. We also gave vaccinations as needed (many of those are free to students through their healthcare) and washed out many ears :) A useful skill. Of course, there were kids that got hurt at gym or felt ill. We assessed them as needed. We also checked blood sugars and were watching out for symptoms of diabetes. We had meetings to attend with the interdisciplinary team: principal, teachers, social worker, special education teacher, and school psychologist if needed. The school health nurse provides teaching as needed for these members about different illnesses and is the person responsible for catching changes in health and promoting it.


I think that having health care in the schools makes the public health nurse visible to students. I noticed that the kids all knew her by name and came to her with their concerns. Because anytime they are sick or for their yearly health checks they come to her, they know her and trust her. When I think back to the school nurses I had, I don't remember them. Because they weren't really visible. Yes, they performed eye or ear checks. They check for scoliosis.  But these school nurses are part of the primary health care system, and do the work we would think of in our doctor's offices.

Sirkku, the nurse I worked with was so kind and compassionate to these kids. She has a gentle voice and a calm demeanor that puts the kids to ease at once. I was nervous, too, haha but she made me feel so welcome! She answered my millions of questions so patiently. She is a gem :)

I'm also a giant when you compare height!