Ensam i sin profession i skolans värld : skolsköterskans upplevelser av förutsättningar att utöva och utveckla yrket

Sammanfattning: School health care is stipulated in Swedish law. The Swedish National Board of Health and Welfare is the institution which has the overall responsibility for school health care in Swedish primary and secondary schools. The municipalities are responsible for providing school health care. In several areas in Sweden, a head of school nursing has the overall responsibility for school health care within a defined area. Most of the school nurses are employed by schools, with a head teacher as their line manager. Their competence is based on training as a district nurse or a paediatric nurse. Studies have shown that the school nurse s role is unclear and that there is limited support for their work. Subsidiary study 1. The purpose of this article was to gain a deeper understanding of school nurses perceptions of their opportunities for practicing and handling health support work within the educational system. The study was based on data collected through focus group interviews with 24 school nurses from areas in Sweden with different geographical locations, socioeconomic status and cultural background. The questions concerned the school nurses views of various aspects of their work situation. The results described the conditions for practicing health supporting work within the educational system. The school nurses expressed concern about practicing individual health supporting work due to poor legitimacy and space within the educational context. Being the link between the school and the medical service in individual health related cases, i.e. transferring the needs of these children from the medical to the school setting provided a more clear position and legitimacy of school health personnel. All participants viewed their availability, individual support and giving time for pupils as one of the most important functions in practicing school health care. Being available was considered as a prerequisite for their supporting role. The participants experienced their work positively related to their autonomy but negatively as regards their experienced isolation from colleagues. Lone working could entail a sense of uncertainty and vulnerability when faced with difficult decisions. Limited opportunities for further professional development were also described. In most cases, the school nurses relied on their previous medical experience and experience gained during their working life. The clear and explicit need to be accessible and flexible was central in almost all interviews and could at times be experienced as a dilemma. The participants discussed the dilemma of how to increase the school health work s profile. To make their work more evident and with a clearer profile was viewed by most as important in order to argue for the importance of the school nurse s profession in the future. Subsidiary study 2. The purpose of this article was to gain a deeper understanding of how Swedish head school nurses perceive their leadership in developing school health care and school nurses work. The study was based on 11 individual interviews with nine head school nurses. For verification one more interview was held by telephone. The questions focused on the way in which they coordinated school health care and the strategies they used to implement it within the educational system and schools. The results described how head school nurses experienced their leadership in developing school health care and school nurses work. Overall school health care, stipulated by law, was described by the head school nurses as a formalised part and an important arena for promoting the health of children and young people. Limited opportunities and restricted conditions and regulations, as well as lack of interest and knowledge about school health care, made it difficult for the head school nurse to inform political and organisational leaders about the contribution of school health care as well as the work done by school nurses. The restricted conditions experienced by the head school nurses were described and understood in the sense of background and perspectives in school health care differing from those of the educational organisation. The head school nurses specific position was experienced as a pioneering job, working alone and in isolation, but also with some autonomy in interpreting school health care, and some freedom in creating their own goals for school health care,given some set frameworks and financial restrictions. The head school nurses described that there were no clear goals for their competence development. Knowledge and experience as a local school nurse was seen as an important qualification on which to base working as a head school nurse. To strengthen the school nurses in their lone working situation, the head school nurses stressed the importance of giving individual support to school nurses. Sometimes these practical tasks were described as taking too large a part of the head school nurse s time, which had an impact on developing school health care for the future.