Williams, Chelsey1; Rankin, Elizabeth2; Moyes, Anita1,3,4Author Information
JBI Evidence Synthesis 23(5):p 967-974, May 2025. | DOI: 10.11124/JBIES-24-00151
Abstract
Objective:
The objective of this review is to generate a national picture of the scope of nursing work and models of service delivery in Australian primary and secondary schools.
Introduction:
Schools are an important setting for providing health services to school-aged children and youth. Early intervention with identified health needs has the potential to improve health and educational outcomes across the life course. Additionally, many children and young people present with health issues requiring sophisticated management at school. Nurses have worked in Australian schools for more than a century, but there is a lack of clarity about the scope of nursing work and models of service delivery in Australian schools.
Inclusion criteria:
The review will include papers describing the work of registered or enrolled nurses in primary and secondary Australian schools providing education to children aged 3–18 years in urban, regional, and remote areas of all states and territories. Peer-reviewed, non-peer-reviewed, and gray literature, not limited by publication date or language, will be included.
Methods:
The review will be conducted in accordance with the JBI methodology for scoping reviews. Databases to be searched will include CINAHL, MEDLINE, PsycINFO (all via EBSCOhost), together with ERIC, Informit, and Google. Two authors will independently screen titles and abstracts, and extract data from included papers. Data will be analyzed by state/territory and by education sector (government/non-government) to generate a national picture. The findings will be reported in a narrative synthesis aligned with the review questions.
Review registration:
Open Science Framework https://osf.io/6yqrm
Introduction
Schools are an important setting for providing health services to school-aged children and youth. Education is compulsory in most countries, and Australia is no exception: children must have entered full-time schooling by the time they are 6 years of age and must continue in full-time education, training, or employment until they reach 17 years.1 Schools are, therefore, one of the few settings in which children, young people, and their families can be easily accessed and supported to address identified health needs.
While many Australian children are in robust health, a proportion will have health and developmental problems. Early intervention with these difficulties has the potential to improve both immediate and longer-term outcomes. For example, children with conditions such as obesity or speech difficulties may take these problems into adult life if these are not addressed.2,3 Poor health in early childhood may also have implications for educational outcomes. Vision or hearing difficulties can interfere with a child’s ability to engage with learning and significantly affect educational attainment and future employment prospects.4,5 In addition to health and developmental difficulties, as many as 43% of Australian children have at least one chronic health condition.6 Asthma is the primary burden of disease for children aged 5 to 14 years, followed by mental health problems.6 In adolescence and young adulthood, mental health problems, substance use disorders, and injury are the leading issues of concern.7 Additionally, the management of injury and illness presents a significant issue in Australian schools, and young people can present with conditions as varied as anaphylaxis,8 concussion,9 or self-harm.10 The case for having a nurse present in a school is therefore robust.
Australia has approximately 9000 schools1 spread across 6 states and 2 territories: New South Wales, Victoria, Queensland, Western Australia, South Australia, Tasmania, the Australian Capital Territory, and the Northern Territory. As the sixth-largest country in the world with a land mass only slightly less than that of the United States, schools are located in urban, regional, and remote areas of Australia and comprise primary schools (ages 4 to 12 approximately) and secondary schools (ages 11 to 18 approximately).1 Some schools also offer 1 year of onsite pre-school, typically for children who are turning 3 that year. The Australian education sector is complex but can be broadly divided into 2 distinct groups: government schools and non-government schools. Almost 70% of Australian schools are government schools;1 these are secular and largely publicly funded. In contrast, the smaller non-government school sector consists of fee-paying schools and includes mainly Catholic and independent schools. Some schools in both sectors provide education support for children who have diverse or additional educational needs.11 A minority of schools will also provide specialist tuition in fields as varied as agriculture, mining, science, the arts, or sports.11 National student enrollment numbers in 2022 comprised just over 4 million students: 2.6 million in government schools, and around 1.45 million in Catholic and independent schools combined.1
Nurses have worked in Australian schools for over 100 years and continue to do so in modern times,12 but a national approach to nursing work in schools is absent. Situated at the interface between health and education, national leadership and planning for nursing work in Australian schools has been overlooked. Strategic direction for Australia’s education system is outlined by the Federal Government and implemented by the states and territories,13 but this has not included the work of nurses in schools. The Australian Commission on Safety and Quality in Health Care works in partnership with the states, territories, and private sector to contribute to better health outcomes and experiences for health consumers,14 but this does not extend to the work of nurses in schools. A national professional organization might address the leadership and advocacy gap, but progress on this front has been slow. The only document purporting to provide a nationally relevant guide for nurses working in schools is the National School Nursing Standards for Practice in Australia.15 This document does not advocate for a national approach but acknowledges that nursing work in Australian schools is a highly heterogenous field of practice.
In the absence of national direction, school nursing in Australia appears to have developed on an ad hoc trajectory, influenced by the employer and local or regional circumstances. Nurses working in schools are employed by the Department of Education in some states,16 by the Department of Health in others,17 and can also be employed directly by schools.18 This approach has led to a lack of clarity about the scope of nursing work in Australian schools. A preliminary review of the literature suggests that some nurses are employed primarily to respond to acute illness or injury,18 while other nurses may be employed to promote health,19 intervene with mental health problems,20 or support children with intellectual and developmental disabilities.21 This lack of clarity may also be reflected in the diverse range of occupational titles for nurses working in Australian schools, such as “school-based youth health nurse,”22 or “community health nurse.”17 Whether different occupational titles reflect variation in the care delivered has not been investigated.
Our preliminary review of the literature also identified that models of school nursing service delivery vary. For example, some nurses are based in the school,22 while others are visitors.17 Further, in some schools, the nurse is a sole practitioner,19 other schools have a team of nurses rostered across the school day and after-school extracurricular activities,23 and some boarding schools roster nurses 24 hours a day, 7 days a week.23 While not a focus in this scoping review, a significant proportion of Australian schools may not have access to a nurse at all.
In late July 2024, the Australian federal government published the Better and Fairer Schools Agreement 2025–2034.24 This document is important because it details the proposed funding arrangement for schools and, therefore, shapes the education system in Australia. Notably, one of 3 priority areas identified in the document is well-being for learning and engagement,24 with the inclusion of nurses in schools provided as an example of a structured initiative that can support this priority area. This development presents a strong rationale for obtaining a more comprehensive picture of the existing scope of nursing work and models of service delivery in Australian primary and secondary schools. The current lack of clarity about the scope of nursing work and models of service delivery in Australian schools is highly problematic for schools that need to make decisions about the types of structured initiatives for well-being and learning that they choose to invest in. It is also problematic for a wider range of stakeholders, including children and young people who might benefit from school nursing services, parents, and nurses themselves.
An integrated picture of nursing work in Australian schools is also required to advocate for a national approach, improve equity of access to nurses at school, develop best practices, and enhance postgraduate education opportunities in school nursing work. The work of nurses in Australian schools is not reported in a dedicated scholarly journal but has been published in journals as diverse as the International Journal of Mental Health Nursing,20Public Health Nursing,22 and BMC Nursing.19 This has exacerbated difficulties in identifying the gaps in research and practice that exist. A scoping review will assist in highlighting these practice and policy gaps. A comprehensive national picture could also inform the expectations that governments, service planners, schools, and parents can reasonably have of a nurse employed in a school.
The aim of this scoping review is to collate, synthesize, and summarize the evidence to create a national picture of nursing work in Australian schools. Given the characteristics of the Australian education system already described, the findings will be stratified by state and territory, and by education sector (government/non-government). A preliminary search of CINAHL, JBI Evidence Synthesis, Open Science Framework, and Figshare failed to identify existing or in-progress scoping reviews examining the work of nurses in Australian schools. It is anticipated that the findings will provide a comprehensive understanding of nursing work in Australian schools, identify knowledge gaps, and inform future research.
Review questions
What is the scope of nursing work in Australian primary and secondary schools for children aged 3 to 18 years, and what variations exist in models of service delivery?
- Does the scope of nursing work in government schools vary by state or territory?
- Does the scope of nursing work in non-government schools vary by state or territory?
- Do models of service delivery in government schools vary by state or territory?
- Do models of service delivery in non-government schools vary by state or territory?
Inclusion criteria
Participants
The review will consider studies that report on registered and enrolled nurses who work in schools. Enrolled nurses practice under the supervision of a registered nurse and are accountable for their own practice.25 All occupational titles for registered and enrolled nurses providing services to schools will be included. Nurses based in the school or providing regular in-reach or visiting will be included. Nurses working as sole practitioners or as part of a team will be included.
Dental nurses will be excluded as dental nursing is a unique field of practice, characterized by its own scope and educational prerequisites that are distinct from those of registered and enrolled nurses.26 Dental nurses also operate within distinct professional associations and regulatory frameworks.26
Concept
The concepts for exploration are scope of nursing work and models of service delivery. Scope of nursing work includes tasks such as immunization, sports injury management, or vision screening. The model of service delivery is defined as the way nursing services are delivered; for example, whether the nurse is based in the school or visits it; and whether the nurse works autonomously or is part of a team. Where available, additional information such as the hours of nursing service availability may be included, for example, if boarding school nurses provide 24-hour care. All papers that provide insights into the scope of nursing work or models of service delivery in Australian schools will be included. Articles that advocate for nursing work in schools but do not describe current nursing work in schools will be excluded.
Context
All Australian primary and secondary schools providing education to children aged 3–18 years will be included. Government and non-government schools will be included, as will urban, regional, and remote schools in all Australian states and territories. Where preschools are on the same site as primary schools, they will be included; preschool-only settings such as community kindergartens and childcare will not be included. Post-secondary education such as universities and technical colleges will not be included. Articles describing nursing work with children where the nursing is not delivered at school will be excluded.
Types of sources
Peer-reviewed, non-peer-reviewed, and gray literature addressing the review questions will be included. All types of primary studies and reviews will be included. Protocols, editorials, conference papers, commentaries, and papers with the sole focus of advocating for nursing work in schools will be excluded. The review will consider non-peer-reviewed literature to provide insights into gaps identified in the peer-reviewed literature.
Methods
The proposed review will be conducted in accordance with the JBI methodology for scoping reviews27 and in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR).28 The review has been registered at Open Science Framework: https://osf.io/6yqrm.
Search strategy
A 3-step search process aligned to the JBI methodology will be employed.29 In the first step, an initial limited search of CINAHL and MEDLINE was undertaken to identify appropriate keywords and index terms. An analysis of the title and abstract text words from relevant articles, and index terms used to describe the articles, informed the development of the full search strategy. The strategy was subsequently also reviewed by an experienced academic librarian. The complete search strategy for CINAHL (EBSCOhost) is shown in Appendix I. In the second step, the following databases will be searched: CINAHL, MEDLINE, PsycINFO (via EBSCOhost), Informit, and ERIC. The search strategy will be adapted where necessary to accommodate the requirements of each database. The search will not be limited by publication date or language and each database will be searched from its inception. An advanced search of the first 5 pages of Google using the same search strategy will be undertaken to identify relevant gray literature. In the third step, the reference lists of all included articles will be hand-searched for additional sources.
Study selection
Database searches will be uploaded into Rayyan (Qatar Computing Research Institute, Doha, Qatar) and duplicates removed. As recommended by JBI,29 a pilot test of the title and abstract screening process and the full-text screening process will be undertaken. All authors will screen 25 randomly selected titles and abstracts, discuss discrepancies, and review the full text where appropriate to ensure a minimum 75% agreement is achieved prior to commencing screening. Subsequently, at least 2 authors will independently screen all article titles and abstracts for possible inclusion. Two authors will independently review the full text of potential articles. Inconsistencies regarding eligibility will be resolved through discussion and consensus in consultation with a third author. The results of the search will be reported in full in the final scoping review and presented in a PRISMA flow diagram.30
Data extraction
Data will be extracted from the full text of included papers using the data extraction instrument shown in Appendix II. The instrument is based on the JBI template.29 Data will be extracted by 2 authors independently. Key information for extraction will include the following information: paper title; authors; year of publication; aims of the study (for peer-reviewed papers only); study type (for peer-reviewed papers only); the Australian state or territory where the study or paper originates; whether the paper reflects an urban, regional, or remote school context; the type of school (primary/secondary/both); whether the services are provided in government schools, non-government schools, or both; the employer; the nurse’s occupational title; the scope of work; the model of service delivery; whether the study is part of a suite of papers describing the same service/program or a single study; and whether the paper was peer-reviewed. A pilot test of the data extraction tool was undertaken by 2 authors independently to confirm the tool’s feasibility and suitability to address the review questions. Further notes about the data extraction tool are provided in Appendix II.
Data analysis and presentation
The extracted data will be charted on a Microsoft Excel (Redmond, Washington, USA) spreadsheet for analysis. Extracted data will be analyzed and synthesized to address each review question. Data will be analyzedby state/territory and by education sector (government/non-government), then compared and contrasted for similarities and differences. Findings will be reported at the national level, by state and territory, and by education sector (government/non-government). Both types of literature will be presented in a narrative synthesis, supported where relevant by tables, graphs, and visual infographics that explain the findings and how these relate to the review questions. Where knowledge gaps are found, these will be reported and described.
Acknowledgments
Lisa Munro, academic librarian at Edith Cowan University, who assisted with consideration of appropriate database search terms. Dr Brent Hayward from Monash University for helpful comments on the final version of the manuscript.
Declarations
All authors have experience working as a nurse in an Australian school and contributed to shaping the study.
Author contributions
AM developed the search. CW and AM wrote the protocol. All authors provided critical feedback on the protocol, and read and approved the final manuscript.
References
1. Clark S School education in Australia: a quick guide [internet]. Commonwealth of Australia; 2023 [cited 2024 Mar 23]. Available from: https://parlinfo.aph.gov.au/parlInfo/download/library/prspub/9147739/upload_binary/9147739.pdf.
2. Weihrauch-Bluher S, Wiegand S. Risk factors and implications of childhood obesity. Curr Obes Rep 2018;7(4):254–259.
3. Langbecker D, Snoswell CL, Smith AC, Verboom J, Caffery LJ. Long-term effects of childhood speech and language disorders: a scoping review. SAJCE 2020;10(1):1–13.
4. Lieu J, Kenna M, Anne S, Davidson L. Hearing loss in children: a review. JAMA 2020;324(21):2195–2205.
5. White SLJ, Wood JM, Black AA, Hopkins S. Vision screening outcomes of grade 3 children in Australia: differences in academic achievement. Int J Educ Res 2017;83:154–159.
6. Australian Institute of Health and Welfare. Australian’s children [internet]. Australian Government; 2022 [cited 2024 Mar 23]. Available from: https://www.aihw.gov.au/reports/children-youth/australias-children/contents/health/chronic-conditions-burden-disease.
7. Australian Institute of Health and Welfare. Health of young people [internet]. Australian Government; 2023 [cited 2024 Mar 23]. Available from: https://www.aihw.gov.au/reports/children-youth/health-of-young-people.
8. Vale S, Netting MJ, Ford LS, Tyquin B, McWilliam V, Campbell DE. Anaphylaxis management in Australian schools: review of guidelines and adrenaline autoinjector use. J Paediatr Child Health 2019;55(2):143–151.
9. Lystad RP, McMaugh A, Herkes G, Browne G, Badgery-Parker T, Cameron CM, et al. Risk of impaired school performance in children hospitalized with concussion: a population-based matched cohort study. Concussion 2023;8(3):CNC105.
10. Crowe R, Townsend ML, Miller CE, Grenyer BFS. Incidence, severity and responses to reportable student self-harm and suicidal behaviours in schools: a one-year population-based study. School Mental Health 2020;12(4):841–851.
11. Government of Western Australia. Learning programs: Department of Education [internet]. Government of Western Australia; 2024 [cited 2024 Aug 6]. Available from: https://www.education.wa.edu.au/learning-programs.
12. Moyes A, McGough S, Wynaden D. An untenable burden: exploring experiences of secondary school nurses who encounter young people with mental health problems. J School Nurs 2022. 10598405221088957.
13. Australian Government Department of Education. About the department [internet]. Australian Government; 2024 [cited 2024 May 29]. Available from: https://www.education.gov.au/about-department.
14. Australian Commission on Safety and Quality in Health Care. About us [internet]. Australian Government; 2024 [cited 2024 May 22]. Available from: https://www.safetyandquality.gov.au/about-us.
15. Australian Nursing and Midwifery Federation. National school nursing standards for practice: registered nurse [internet]. Australian Nursing and Midwifery Federation Federal Office; 2019. [cited 2024 Aug 15]. Available from: https://www.anmf.org.au/media/x1gaxvbj/anmf_national_school_nursing_standards_for_practice_rn_2019.pdf.
16. Queensland Government. State schools nursing service practice guidelines [internet]. Queensland Government; 2021 [cited 2024 Mar 23]. Available from: https://education.qld.gov.au/student/Documents/state-schools-nursing-service-practice-guideline.pdf.
17. Child and Adolescent Health Service. School-aged health services policy [internet]. Government of Western Australia; 2023 [cited 2024 Mar 23]. Available from: https://www.cahs.health.wa.gov.au/-/media/HSPs/CAHS/Documents/Community-Health/CHM/School-aged-health-services.
18. School nurses do it all. Nurs Aus. 2000;1(3):12-13.
19. Banfield M, McGorm K, Sargent G. Health promotion in schools: a multi-method evaluation of an Australian School Youth Health Nurse Program. BMC Nurs 2015;14(1):1–11.
20. Moyes A, McGough S, Wynaden D. Hidden and unacknowledged: the mental health and psychosocial interventions delivered by school nurses in Western Australia. Int J Ment Health Nurs 2023;33(2):463–472.
21. Hayward BA. A job analysis of mental health nursing in a school for students with intellectual and developmental disabilities. Int J Ment Health Nurs 2024;33(4):957–966.
22. Barnes M, Courtney MD, Pratt J, Walsh AM. School-based youth health nurses: roles, responsibilities, challenges, and rewards. Public Health Nurs 2004;21(4):316–322.
23. Chapman M. A class of their own. Nurs Rev 2011:20–21.
24. Australian Government Department of Education. Better and Fairer Schools Agreement 2025–2034 [internet]. Australian Government; 2024 [cited 2024 Aug 6]. Available from: https://www.education.gov.au/recurrent-funding-schools/resources/heads-agreement.
25. Australian Nursing and Midwifery Accreditation Council. Glossary [internet]. Australian Nursing and Midwifery Accreditation Council; 2016 [cited 2024 Mar 24]. Available from: https://www.anmac.org.au/glossary/e.
26. Australian Health Professionals Regulation Agency. Dental Board of Australia – policies, codes, guidelines and FAQ [internet]. Australian Government; 2024 [cited 2024 May 29]. Available from: https://www.dentalboard.gov.au/Codes-Guidelines.aspx.
27. Peters MDJ, Marnie C, Tricco AC, Pollock D, Munn Z, Alexander L, et al. Updated methodological guidance for the conduct of scoping reviews. JBI Evid Synth 2020;18(10):2119–2126.
28. Tricco AC, Lillie E, Zarin W, O’Brien KK, Colquhoun H, Levac D, et al. PRISMA extension for Scoping Reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med 2018;169(7):467–473.
29. Peters MDJ, Godfrey C, McInerney P, Munn Z, Tricco AC, Khalil H, et al. Chapter 11: Scoping Reviews. In: Aromataris E, Munn Z, editors. JBI Manual for Evidence Synthesis [internet]. JBI; 2020 [cited 2024 Mar 23]. Available from: https://synthesismanual.jbi.global.
30. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Goffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021;372:N71.
Appendix I: Search strategy
CINAHL (EBSCOhost)
Search conducted: June 7, 2024
Search not limited by date or language.
–
| Search | Query | Records retrieved |
|---|---|---|
| #1 | TI school* OR AB school* OR TI school-based OR AB school-based | 173,486 |
| #2 | TI nurs* OR AB nurs* | 611,321 |
| #3 | TI Australia* OR TI Queensland* OR TI New South Wales OR TI Australian Capital Territory OR TI Victoria* OR TI Tasmania* OR TI South Australia* OR TI West* Australia* OR TI Northern Territory | 50,480 |
| #4 | AB Australia* OR AB Queensland* OR AB New South Wales OR AB Australian Capital Territory OR AB Victoria* OR AB Tasmania* OR AB South Australia* OR AB West* Australia* OR AB Northern Territory | 70,306 |
| #5 | S3 OR S4 | 97,255 |
| #6 | S1 AND S2 AND S5 | 406 |
| #7 | ((MH “School Nursing”) OR (MH “School Nurses”)) | 10,362 |
| #8 | (MH Australia OR MH Queensland OR MH New South Wales OR MH Australian Capital Territory OR MH Victoria OR MH Tasmania OR MH South Australia OR MH Western Australia OR MH Northern Territory) | 132,086 |
| #9 | S7 AND S8 | 93 |
| #10 | S6 OR S9 | 472 |
Appendix II: Draft data extraction instrument
–
| Items | Description |
|---|---|
| Title | The title of the article |
| Authors | The listed authors of the article |
| Year | Year of publication |
| Aims | The aim of study, as stated by the authors (peer-reviewed literature only) |
| Study type | The study design, methodology, or methods, as described by the authors (peer-reviewed literature only) |
| State | The Australian state or territory in which the study was conducted |
| Urban/regional/remote | Whether the paper reflects an urban, regional, or remote school setting |
| Primary/secondary/other school type | Whether the paper relates to primary school students, secondary school students, or a mixed cohort of students |
| Government/non-government school | Whether the paper describes school nursing services provided in government schools, non-government schools, or both |
| Nurse employer | Whether the entity employing the nurse is the government or the school; where the employer is the government, whether the employer is the Department of Health or the Department of Education |
| Occupational title | The occupational title for the nurse working in a school, as stated by the authors |
| Scope of work | The scope of nursing work described |
| Model of service delivery | How nursing services are delivered, including whether the nurse is based in the school or visits the school; whether the nurse works autonomously or as part of a team; where available, additional information, such as the hours of nursing service availability, may be included |
| Service/program identifier | Identifies whether the paper is part of a suite of papers describing the same service/program, or whether the paper is a single study |
| Peer-reviewed (Y/N) | The findings will be stratified by peer-reviewed and non-peer-reviewed literature |
Keywords:
Australia; children; nursing; schools; scoping review
