School Health Office Facilities

Since The Journal of School Nursing (JOSN) published“Promoting the Construction of an Optimal Nurse’s Office Facility: One School District’s Experience” in 1997, many school nurses across the nation have had the opportunity to be involved with school renovation and new construction projects in their districts. As school districts work to meet the challenges of growing and changing student enrollment, so do the nurses who serve the health needs of those students.

According to the National Center for Educational Statistics (2004), there were approximately 78,300 public schools in the United States in 1999. At that time, one fourth of all public schools reported having at least one building feature in less than adequate condition. Approximately 51 percent of schools planned major repairs, renovations or upgrades to at least one building feature in the subsequent two years. Total school construction costs were $20 billion in 2003, and $11.2 billion was spent on upgrading existing structures. These figures include changes needed to comply with the Americans with Disabilities Act (ADA); new heating, ventilating and air conditioning systems; roofs and windows.

Considerations in Planning

Many school nurses find themselves working in facilities slated for renovation or replacement. Other school nurses anticipate working in schools that are being planned or are currently under construction. One role of the school nurse — advocacy — includes working with school officials to plan up-to-date health office facilities in schools to meet the health needs of students during the school day. School nurses need to be aware of the planning process that occurs in school districts so they can participate early on in the design of facility renovation or new construction.

Providing health care may not be an academic priority, therefore space assigned to school nurses is often inadequate. School health offices may have been designed originally for other uses, or in other instances, the space is gradually taken away from the nurse as pressing academic needs arise. It is not unusual for nurses to find themselves practicing in cramped quarters away from basic needs, such as telephones or running water, or sharing space with a variety of other school personnel.

Renovation and new construction projects allow school nurses the opportunity to work with facilities planners, school officials and architects to design school health office facilities that enhance delivery of health services and accommodate all student health needs. By working with design professionals early in the process, school nurses will be able to use their expertise in planning a work space that assures optimal care, comfort and privacy for students requiring health services during the school day.

With school construction being so wide spread, what advice do the experts have for school nurses? Robert Hayes, of Robert Ehmet Hayes & Associates, an architectural firm in northern Kentucky specializing in school construction, says the design process has changed dramatically through the last few years.“In the past, the architect would arrive for meetings with plans in hand. Now, the architect has a laptop computer and meets with groups of school personnel who talk about how they will be using the space. The design process literally takes place during those meetings.” Hayes suggests that school nurses participate in the design planning meetings and come prepared to answer the following questions: What is the purpose of the space? What activities will be performed in the space? How many people will be using the space?

During the spring of 2004, JOSN editor, Janice Denehy, asked school nurses who had been involved in school construction or renovation to send her their comments or suggestions. Projects ranged from newly constructed elementary, middle and high schools to renovations in a variety of facilities, including one residential school for deaf and hearing-impaired children. In addition to the online responses, nurses sent photographs, CD-ROMs, drawings and blueprints. The respondents had advice and suggestions on everything from working with administrators and architects to lists of equipment, as well as many wonderful ideas that often began with the words, “I wish I had though of...” Respondents were pleased to have been involved in the design process and were eager to share their experiences with other school nurses.

In anticipation of renovation or new construction, several school nurses talked about how impressed the architect or school administrators were when they came to planning meetings with lists of items they believed would be essential in their new facilities.

When Dede Meidinger learned that her school, Fargo North High School in Fargo, N.D., was going to be renovated, she asked the principal to consider the school nurse office needs in the design. As planning began, she was given appointed times to meet with the architects and school administrators to talk about her ideas. She attended the meetings armed with sketches and lists. “These visits allowed a very valuable exchange of information and discussion, and was a positive experience for all. We learned much from each other.”

Gail Blaesing, the nurse at James B. Morris Elementary School in Des Moines, Iowa, agrees that it is important to be involved early in the process. She recommends doing research to determine what is necessary for a safe and efficient office. “Request to be on the planning committee and be involved in planning the design. Visit other schools for ideas. Find out how much space will be available for the nurse’s office. Talk to other nurses to find out what works and what doesn’t in the design. Make a wish list of everything you would desire and prioritize the immediate needs.”

Understanding what works and doesn’t is essential to good design. So is traffic flow. How will students and the nursing staff move around in the office space? Barb Allen, the nurse at Johnston Community School District in Johnston, Iowa, recommends two entrances into the health office — one from the main office area and one from the hallway. This helps relieve congestion and allows the nurse easy access to both areas for consultations and emergencies. This was a major consideration as she examined her practice and how she would use the new space. “In the 13 years I have been the school nurse in this middle school, the number of student visits to the nurse’s office have steadily increased, not only in number but also in complexity. I currently see an average of 710 students each month in the health office. This does not include the students who come in for daily medication or routine OTC medications.” As stated previously, sometimes the exchange of ideas leads to learning during the design process. A priority for Anne Biddle, school nurse at Newark Charter School in Newark, Del., was to have a 20-ft., unobstructed space to use for vision screening. “This was not a popular request with the architect or the principal since it cut out some work space in the administration areas and prompted multiple revisions in the blueprints.”

It may be necessary to explain why certain items are needed and how the work will be carried out in the office. When it is time to compromise, and that will happen, it helps tremendously if the nurse has prioritized the list of needs according to their degree of necessity. As the architect gains a better understanding of the work that takes place in the health office, he or she will be able to offer suggestions. Becky Munson, a school nurse at a state school for deaf children in Vancouver, Wash., offers this advice, “Don’t ask for less thinking it will be easier to get, (the state) always gives you less than you ask for, so ask for more.” She also advises being specific in making requests. “If one brand is better than another, explain why.” Finally, she advocates using language that educators value. Explain requests in terms of enhancing the education process, student safety and complying with federal mandates such as OSHA, FERPA, or HIPAA.

Visiting other facilities will be very helpful, particularly if the current workspace is older, cramped and the nurse has to adapt his or her practice to the space available. Don’t confine visits just to schools. Visit newer health facilities, such as hospitals or primary care offices, as well. It helps spark creativity and may give ideas that might not occur otherwise. For example, Dede Meidinger recommends having a swivel gooseneck faucet and deep sink in the treatment area. This is useful for rinsing tubing and bags as well as for students to wash their own wounds, such as scraped elbows. Janet Terrill, a school nurse in Summersville, Mo., recommends a sprayer attached to the toilet that can be pulled down to clean messy pants. Finally, recognize the needs in your setting that are unique. In addressing privacy issues in her setting, Becky Munson, who works with deaf and hearing-impaired students, kept in mind that sign language can be “overheard” across a room. She had to be sure that the design for her office included privacy that blocked views, as well as sounds, so that all “chats” with students could be confidential.

Like many other projects school nurses are involved with, the planning of the health office may be just as time-consuming as the actual construction of the facility. It may be difficult to envision the “final” result just from looking at two-dimensional plans. Hayes uses a virtual three-dimensional program on a laptop computer during design planning meetings to aid in visualization of the “finished product.” The process may be frustrating when budget or space restraints require compromises. Gail Blaesing found that she did not have a good perspective of her new office until it was near completion, and she discovered she did not have enough storage space. Because hers was the first building being remodeled in the school district, she did not have an opportunity to visit other buildings with new facilities. She later had to add file cabinets and find storage in other parts of the building for items not frequently used. She has since hosted tours for other school personnel throughout her district and has been a resource for them as they plan renovations in their buildings.

Most of the school nurses who participated in the planning process for renovation or new construction of health offices reported positive experiences. They believe that they learned a lot, not just about construction, but also about communication and compromise. In the end, they were very pleased to have modern, accessible facilities in which to serve their students.

Leslie Cooper, RN, MSN, FNP-BC is an assistant professor of Clinical Nursing at the University of Cincinnati, College of Nursing. She can be reached at Leslie.cooper@uc.edu.

This article is reprinted with permission from the Journal of School Nursing, official publication of the National Association of School Nurses and the Alliance Communications Group.

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