NASN Position Statement: Safe, Supportive, Equitable Schools.

Poverty, racism, homelessness, access to health care, food insecurity, and other social determinants of health can have a significant impact on the health and wellbeing of students and school communities (Centers for Disease Control and Prevention [CDC], 2021a; NASN, 2020). The Future of Nursing Report emphasizes the positive impact of school nurses on students’ clinical and social needs and highlights the urgent need to expand, strengthen, and diversify school nursing practice as a means to advance health equity for students (National Academies of Sciences, Engineering, and Medicine, 2021). Learning is best achieved when the student’s physical, social, and emotional development are addressed in the school setting (CDC, 2018). All students have a right to learn in a safe environment. Structural and systemic barriers, both within and outside of schools, have created environments in which students may feel disconnected and unsafe. Issues related to safety, racism, and violence affect all students; however, they may disproportionately affect racial, ethnic, and gender-sexual minority students (Brookings Institute, 2020). Students who do not feel safe are unable to learn; therefore, they may be chronically absent, may not actively engage in learning, or may drop out of school. Students struggling with mental health issues, including isolation, stress, anxiety, depression, and the effects of bullying, may avoid school if they do not feel a sense of safety and belonging (Baek et al., 2019; Eugene et al., 2021). Thirty-six percent of U.S. high school students identified being treated unfairly or badly due to their race or ethnicity, with those who indicated poorer mental health and less school connectedness reporting the highest incidence of racism (Mpofu et al., 2022). Minority stress also places students at additional risk for depression and suicidal ideation or attempts (Kosciw et al., 2020). Furthermore, safe and supportive school environments provide opportunities for LGBTQ+ (lesbian, gay, bisexual, transgender, queer/questioning) youth to socialize and build positive, identityaffirming relationships that are pivotal in improving their mental health and physical well-being (McCabe et al., 2021). School connectedness is a protective factor that supports youth physical, mental, and emotional well-being; fosters resilience; and is a significant predictor of healthy behaviors (Eugene et al., 2021; Osher et al., 2021; Steiner et al., 2019) and academic success (Reynolds et al., 2017). School nurses promote connectedness through communication, advocacy, and by establishing trusting and caring relationships with all youth, including youth from marginalized groups (McCabe et al., 2021). A schoolwide approach to connectedness also involves the integration of trauma sensitive schools and social emotional learning (Osher et al., 2021). Adverse childhood experiences have been linked to long-term impact on physical, social, and mental health (CDC, 2021b). This is more prevalent in Black and Brown communities and escalated during the COVID-19 pandemic (Martin et al., 2022). Issues of structural racism, intentional or unintentional, must be eradicated. For example, it is well known that school discipline policies related to expulsion and suspension have been unevenly applied toward ethnic minority and special education students (Steinberg & Lacoe, 2018). School nurses are well-positioned to address systemic inequities and to influence school policies and practices, working in concert with other school support personnel. These include disciplinary and other practices involved in treatment of racial, ethnic, and gender-sexual minority students (Willgerodt et al., 2021). Youth violence is a public health concern. Half of U.S. students have experienced violence in the school setting (David-Ferdon et al., 2021). Black, Indigenous, and people of color and LGBTQ+ teens are at a greater risk of experiencing violence than their peers (CDC, 2021c, 2022). A majority of U.S. children and teens worry that a school shooting may occur at their school (Cogan et al., 2019; Graf, 2020.). Teens who experience violence in and out of the school environment may be at risk for: