Respondents were asked which, if any, of the activities listed they would like to add to their role or spend more time on, and conversely, which they would like to spend less time on. Overall, there were more responses to the question regarding expanding the role than contracting/reducing activities. In total 1,004 individuals responded to the question asking which activities they would like to add or spend more time on, although 60 of these replied saying that they did not want to add anything—in total 73% suggested activities they would like to increase. Whereas 755 respondents answered the question on activities they would like to reduce, again a significant number (164) reported that they did not want to reduce any activities. Hence, overall 45% of respondents made suggestions for areas they would like to spend less time on.
Table 4.5 Activities respondents would like to spend more or less time on
increase decrease
r. Health promotion 37 1
y. Providing class education/PSHE 19 8 b. Available for pupil/student drop-in 13 1 l. Pupil/student counselling 13 2
x. Family support 12 <1
d. Running specialised clinics 12 1
g. Providing sex education 12 1
i. Addressing obesity 11 <1
a. Appointments with individual pupils/students 9 <1 k. Developing health policies for schools 6 2 c. Educating school staff 5 <1 w. Development of personal/social skills 5 <1 h. Providing substance abuse advice 4 <1
j. Home visits 4 1
v. Addressing bullying issues 3 1
z. Other 3 2
e. Attending child protection case conferences 3 7 m. Special educational needs service 2 1 u. Screening/monitoring health/development 2 9
o. Attending to injuries <1 1
p. Providing in patient care (sickbay) <1 1
s. Managing other staff 1 1
q. Providing medication 1 2 t. Budget management 1 2 f. Doing immunisations 1 20 n. Undertaking screening 1 25 Other 5 13 N= Cases 1004 755 Responses 1921 948 S ource:Employment Research Ltd, 2005
More than a third of all respondents (37%) said they would like to be able to spend more time on health promotion and 19% wanted to increase the amount of class education/PSHE that they do as part of their role. Amongst state sector respondents, the activities most frequently cited for spending more time on are:
• health promotion (41%)
• providing class education/PSHE (17%) • drop-in sessions for pupils (16%) • family support (15%)
• running specialised clinics (13%) • addressing obesity (12%)
• pupil counselling (12%) • providing sex education (11%). Those they would like to reduce are:
• screening (30%) • immunisations (24%)
• monitoring health development (10%).
In half the cases, the other activity which respondents would like to reduce from their role was administration and ‘paperwork’. Slightly larger proportions of those working in independent schools reported they would like to reduce the paperwork; 12% compared with 7% in state schools. In general independent sector nurses have less desire to reduce the activities in their role; only 22% suggested activities they would like to reduce from their role compared with 54% of respondents form state schools.
Independent school nurses’ views about PSHE/class education are mixed. Some would like to do more class education/PSHE (28%). Other activities independent sector nurses would like to increase were health promotion (23%), pupil counselling (18%), and providing sex education (15%). Paperwork was the main activity independent school nurses would like to reduce from their role. But one in ten of those who wanted to reduce some activities from their role, referred to class education/PSHE.
Respondents were asked what is preventing them from doing their chosen activities to the extent that they would like. Their reasons have been coded (up to six per person) and are presented in Table 4.6.
Table 4.6 Factors preventing respondents from developing their role
% of cases
a 1 Lack of time 53
a 16 Too much time spent on other activities (such as child protection,
immunisations), activity not viewed as priority 25 a 2 Caseload/area covered too big (stretched too thinly) 21 a 14 Under staffed; staff numbers/cover/lack of skilled staff; working alone 20
b 5 Resources/funding 14
b 12 Lack admin/clerical support; too much paperwork 9 b 9 Post only part-time (not enough designated hours) 4
b 15 Term-time contract only 1
c 4 Not able to undertake training needed 1 c 3 Not had training/qualification 3 d 6 Not seen by others (e.g. mgt) as part of role/not asked to do as part of role 2 d 17 Role is too generic, not able to concentrate on specialty; ‘Jack of all trades’ 2 e 8 Attitude/lack of support of NHS/PCT prevents 1 e 18 Lack of management support/poor management 3 e 7 Attitude/lack of support of school or LEA prevents; e.g. poor access to school 4 f 11 National policy restricts 1 f 10 Other members of staff already carrying out these activities 2 g 13 Lack financial reward/grade 1 h 19 Pupil resistance/reluctance >1 i 20 Poor communication so don’t get information 1
88 Other >1 Responses Cases 1703 1018 S ource:Employment Research Ltd, 2005
The biggest single factor preventing school nurses from expanding or developing their roles is lack of time. If the themes raised concerning time (category a) are merged, we find that 71% of respondents gave time/caseload/staffing as the reason they cannot develop their role. This reinforces the data on caseloads and workloads; time restrictions are a major constraint for school nurses.
A similar survey of RCN members, conducted by Employment Research Ltd, looked at the nurses in specialist/advanced roles more generally. For these respondents too, time (or lack of it) was the main reason they were not able to expand or develop the role in the way they would like. But even larger proportions of school nurses responded in this way—71% of school nurses refer to lack of time and poor staffing levels compared with 57% of advanced/specialist nurses. The particular difference is the proportion of school nurses who refer to the fact that too much of their time is spent on certain activities that dominate their role and prevent them from providing the service they feel is required. This issue, about balance within the role, was not identified as a theme in the responses from the survey of advanced/specialist nurses working across all fields of practice but was cited by 25% of school nurses.
Also note the large proportions of school nurses that responded to this question—78%. Thus across 1,296 respondents, time/staffing is reported to be preventing school nurses from doing some activities to the extent they would like.