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School nurses spend twice as much time on paperwork than on direct work with children in schools, research by the Children’s Commissioner for England has found.

This could be reducing their ability to identify children at risk of neglect or abuse. There was also evidence that time pressures meant their role in supporting and promoting children’s health and wellbeing, their mental health, healthy relationships and sex education – was being compromised.

A survey of nearly 800 primary and secondary school nurses* revealed a concerning picture of paperwork eating into the time these important school staff had to spend with pupils – with some school nurses responsible for the health and well-being of 1000s of children.

School nurses were asked about child protection and children in need referrals they had made to Children’s Services, as well as any barriers they had faced.

When they identified children of concern, four-in-ten school nurses said they were unhappy with the response they had from Children’s Services on at least half of the referrals they make.

School nurses reported that increasingly high thresholds operated by local children’s services had meant making successful referrals about children had become more difficult. These thresholds also resulted in school nurses picking up early child protection work and developing support activities for rejected cases – work previously done by social workers.

Bureaucratic work

Many school nurses described how bureaucratic and reactive work was impacting on their ability to build relationships with children and help advise them about their health and wellbeing. This was a cause of frustration and concern among many in the profession.

One school nurse in the north-west said: “We have very little contact with children due to drop-ins being stopped.” Another working across several schools in the east of England commented: “We could be much more effective if we were able to get into schools more often and allow time with the pupils. A majority of my work is behind the scenes writing reports and following up on safeguarding issues.”

Safeguarding and child protection processes have become a substantial part of school nurses’ work. A fifth of school nurses felt that their child protection caseload was limiting their capacity to perform other activities. On average, school nurses attended one case conference a week, which (including travel and paperwork) took up around 4.5 hours of their time. However, 8% were attending four or more case conferences, indicating they were spending at least half their working week attending these meetings and completing tasks associated with them.

Ironically, this means that school nurses have less time for the preventative work to spot the signs of abuse and help prevent problems developing.

Only an estimated 1 in 8 victims of abuse are known to authorities and school nurses are one of a range of professionals who should play an important role in spotting the early signs a child could be a victim, or at risk in other ways. Time spent building trusting relationships with children in a safe place can help them disclose abuse, or talk about other problems related to their mental health or wellbeing.

Children are unaware of the service

The majority of school nurses stated that children and young people in the schools they work in were unaware of their service. This is despite the positive way school nurses were often seen by young people, and the benefits they could bring.

A 13-year-old young carer said: “School nurses are really important, I was picked up by my school nurse and they referred me to my local young carers’ project; if it wasn’t for them I wouldn’t know about my young carers group and get the support I do now.”

Recent initiatives in some areas to enhance the role of school nurses were highlighted in the Children’s Commissioner report, including the introduction of digital and texting services, which allow children and young people to get in touch with their school nurse.

Anne Longfield, Children’s Commissioner for England, said: “School nurses have a vital role to play in schools protecting children as well as promoting their well-being.

“They are one of the professionals at the front-line identifying abuse or neglect, as well as supporting children with a host of other issues – whether that’s mental health, age-appropriate relationships and sex education or healthy eating. Being available for children for face to face time is irreplaceable.”

“It is clear from this research that school nurses face significant barriers in working directly with children and young people, with paperwork getting in the way. The support they offer needs to be better promoted and new ways to enhance their engagement with children explored.”

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