The position of school nurse was created at the turn of the 20th century. The idea was that nurses placed in primary schools could help treat and prevent communicable diseases so that children could stay in school and receive an education. In 1902, pediatric nurse Lina Rogers became New York’s—and our nation’s—first school nurse. Funded by the Henry Street Settlement, Rogers set up clinics in four schools to care for the district’s students, all of whom lived in poverty with their families in the tenements of Manhattan’s Lower East Side.
Drawn there by the promise of opportunity, large numbers of immigrants faced health and hygiene challenges in this densely populated area. Living conditions were overcrowded, unsanitary, and full of contagious diseases, which children then spread throughout classrooms. Before school nursing, instead of being treated, sick children were simply excluded from school. And since most parents couldn’t afford or couldn't access care, many students never returned.
Rogers’ impact was immediate. By the end of her first month, Rogers treated 829 cases, including 93 excluded students who were then able to return to school. The results were so impressive that the New York Board of Health immediately funded 12 more school nurses, each responsible for approximately 10,000 students. Between September 1902 and 1903, the combined work of these school nurses caused the number of students missing school for medical reasons to plummet from 10,567 students to 1,101. Over the next five years, health officials in other major cities, including Los Angeles, Philadelphia, Baltimore, San Francisco, and Chicago, followed suit.
During the next few decades, the school nurse model was replicated throughout the country. By 1911, over 100 cities employed school nurses. Historical databases highlight the positive influence of school nursing during the 1918 influenza pandemic as far reaching as Wisconsin, Minnesota, and North Dakota. By the years after World War II, healthcare delivery was shifting from home-based to hospital. This, combined with the discovery of multiple classes of antibiotics to treat bacterial infections, shifted the school nurse role to focus more on health education over treatment, with emphasis on cleanliness, good nutrition, dental care, and sleep—the beginnings of the Coordinated School Health Program model used today.
Then came widespread vaccination thanks to the 1962 Vaccination Assistance Act, which led to the practical eradication of diphtheria, tetanus, pertussis, polio, smallpox, and measles. By 1980, every U.S. state required children to be vaccinated to enroll in school. Through the use of state registries to maintain records, facilitate vaccine compliance, and identify at-risk unvaccinated students during disease outbreaks, school nurses were and are at the very heart of this progress in communicable disease prevention.