In the U.S., 65.7% of public schools have access to a full-time school nurse. For students, teachers, and administrators, school nurses are critical in keeping everyone healthy and safe.
They’re also commonly the first line of medical defense in emergencies and active shooter incidents, treating injuries and supporting students. But school nurse roles go beyond just physical care — especially in the aftermath of traumatic events.
A Surgeon General’s Advisory has declared gun violence a public health crisis, and recent incidents like the one at Apalachee High School in Winder, Georgia, happen with unfortunate regularity.
It's important to recognize the role that school nurses play in both preparing for and responding to such incidents.
Let’s explore ways to support school nurses in preparing for an active shooter event and examine the emotional and mental health impact such events have on these healthcare professionals.
Preparing for active shooter situations
Nurses are often called upon to act as emergency responders in active shooter events. This requires specific training that many school nurses might not have received during their standard education.
Schools should invest in ongoing education programs to ensure nurses have the necessary skills to handle a mass casualty event. This might include:
- Stop the Bleed programs: Offered by organizations like the American Red Cross, these programs teach individuals how to control severe bleeding, which is common in injuries seen in active shooter situations.
- First-aid training for gunshot wounds: While all school nurses are trained in first aid, dealing with gunshot wounds requires a specific skill set. Nurses should have access to advanced first aid courses that cover this kind of trauma response.
- Triage training: In a mass casualty event, victims might need to be triaged to determine the order of care. Nurses should understand how to assess injuries rapidly and direct students and staff to the appropriate care.
These training programs are not only essential for nurses’ preparedness but also to help teachers and other staff understand what to do in these situations. Nurses can lead drills, helping to create an environment in which everyone in the school knows what to do during an emergency.
Stocking medical supplies
Another proactive step in supporting school nurses is ensuring that they have the necessary medical supplies to handle an emergency. Often, school clinics may only be equipped with basic supplies, which are insufficient for a mass casualty situation. Nurses should have access to:
- Tourniquets and trauma kits: These resources help manage severe bleeding.
- Automated external defibrillators (AEDs): Stressful and traumatic situations like these can cause severe panic and shock, sometimes leading to cardiac events. AEDs can be lifesaving in these moments.
- Communication tools: A school nurse must be able to communicate with local hospitals, emergency responders, and school administration during a crisis. Having a reliable communication system in place, such as walkie-talkies or dedicated medical communication devices, is a must.
These supplies should be regularly inventoried and replaced as needed, with administrators working closely with the school nurse to ensure everything is up to date.
Mental preparedness and psychological first aid
There’s no doubt that physical preparation is critical during events like these, but mental preparedness and an understanding of psychological first aid (PFA) is also imperative. And for school nurses, they also need support for their mental well-being during these events and in the long term.
Engaging in ongoing discussions and training around stress management, crisis intervention, and PFA helps prepare nurses for the emotional toll of a shooting.
The American Psychological Association (APA) highlights using PFA training amid disastrous or traumatic events. This helps provide those affected with immediate mental health support during these situations. Nurses trained in PFA can offer much-needed emotional support to students and staff, identifying those in acute distress and providing early intervention until mental health professionals arrive.
One study highlighted the effectiveness of psychological first aid after trauma, showing that it reduced anxiety and helped facilitate adaptive functioning in the short term. Proactively preparing school nurses in this way empowers them to act as confident first responders while also safeguarding their mental health.
Supporting students and staff post-incident
After the immediate danger has passed, the school nurse's role shifts to helping students and staff begin to heal. Many students may be in shock or experiencing trauma reactions. According to the National Center for PTSD, these can include:
- Nightmares or trouble sleeping
- Trouble eating or an upset stomach
- Increased anxiety, fear, or depression
- Self-blame, guilt, or shame
- Physical symptoms like headaches
Nurses are often the first point of contact for these children. While school nurses aren’t mental health professionals, they’re trained to recognize signs of emotional distress. They can refer students to counselors or therapists and provide a safe, nurturing environment for students to express their fears.
Moreover, nurses provide essential support to teachers and administrators. Just like students, school staff may experience post-traumatic stress or struggle with feelings of guilt and grief. Nurses can help facilitate conversations around self-care, stress management, and even direct staff to resources for mental health support.
The emotional toll on a school nurse
The aftermath of an active shooter situation is overwhelming, not only for students and teachers but also for school nurses. In addition to providing immediate medical assistance, school nurses are often responsible for comforting students, speaking with families, and acting as a calming presence. The emotional burden can take a significant toll on their mental health.
During the event, a school nurse is thrust into the chaos of triage, often seeing severe injuries or death up close. While most nurses are accustomed to handling stressful medical situations, active shooter incidents are unique in their intensity, and witnessing such violence can be deeply traumatic. Nurses must also work under extreme pressure, knowing that their decisions may be the difference between life and death for students and colleagues.
The emotional impact of being involved in these situations can be distressing for school nurses. They may experience secondary traumatic stress (STS), which occurs when a caregiver is exposed to the trauma of others. Witnessing the pain and suffering of students and staff during and after a mass shooting can lead to emotional exhaustion, depression, or even post-traumatic stress disorder (PTSD).
In one study, school nurses anonymously shared their perspectives on gun violence, highlighting the impacts and need for change.
“Things have changed in our building, ‘the new normal’ we are told, but there is nothing normal about gun violence taking the life of a student,” said one nurse in the study. “A family, school, and community suffering the loss of a member. Their lives forever changed.”
After an event like this, nurses need access to trauma-informed care themselves. This includes:
- Debriefing sessions: Immediately after the event, nurses should participate in debriefing sessions with mental health professionals who can help them process what happened.
- Long-term counseling support: Access to ongoing therapy or support groups can help nurses work through their feelings in the weeks and months following.
- Peer support networks: Connecting with other school nurses who have experienced similar situations can be incredibly validating and help reduce feelings of isolation.
Administrators should prioritize these mental health resources and ensure that school nurses feel empowered to seek help without stigma.
Burnout prevention and workload management
In the aftermath of a traumatic event, school nurses may face an increased workload as students, teachers, and parents seek medical and emotional support. While they may be eager to help, this can lead to burnout if they don’t receive adequate assistance. Schools should consider hiring temporary support staff or redistributing some responsibilities to ensure that the school nurse isn’t overwhelmed.
Additionally, nurses need to be encouraged to take time off to rest and recharge, preventing long-term burnout.
Supporting school nurses before and after an active shooter situation is essential for the safety and well-being of everyone involved. Providing training, mental health resources, and medical supplies equips nurses to handle these emergencies. In the aftermath, emotional and psychological support ensures they can continue caring for students and staff without neglecting their own mental health.
