Private and independent schools count on school nurses to treat illnesses and give health advice to students, parents, and staff. But their capabilities go far beyond checking temperatures and applying Band-Aids. School nurses can also play a critical role in stopping the harmful misuse of substances. 

We recently chatted with Independent School Management (ISM) to learn how nurses can help shape and strengthen a school community’s approach to substance misuse prevention.

Why Nurses? 

In addition to addressing acute health concerns, managing chronic conditions, and coordinating student care, nurses already practice preventive care. Nurses view substance misuse as a health issue based on their knowledge and clinical expertise. This perspective helps them educate others through formal training, workshops, and conversations. 

School nurses frequently have more opportunities to talk about substance misuse. Students see the health office as a safe alternative to the counseling or administration office, and feel less stigma when talking to a nurse about mental health or substance use issues. Additionally, nurses are used to discussing uncomfortable health topics and are prepared for these conversations.  

Viewing Substance Misuse Through a Health Lens 

Foundations of Prevention 

When nurses approach a substance issue, they look at the foundations of a student’s life that can protect against misuse. Students are less likely to struggle with substance use when these foundational aspects are strong. 

The foundations of prevention are: 

• Physical 
• Emotional
• Mental 
• Social 
• Spiritual  

Nurses who discuss substance use in the context of these foundations can shift the conversation. The struggle then becomes a health issue, not a personal problem.  

Balancing Risks and Protection 

Preventing substance misuse through a health lens is about balancing risks and protections. There are inherent risk factors such as age, environment, and genetics. But nurses can counter these circumstances by promoting family engagement and school connectedness. These actions demonstrate to students that adults and their peers care about them as individuals. 

Most Common Substances and Concerns 

The most common substances students misuse are alcohol, nicotine, and cannabis. When talking to students, school nurses can raise concerns about these substances from a health perspective.  

Medication Safety 

Nurses can educate students on the risks of combining alcohol and other drugs with medications.  

Mixing ADHD medications with stimulants, such as nicotine, puts an excessive toll on the heart. This strain could affect students with existing heart conditions or family histories of heart disease. 

Combining depressants like benzodiazepines and opioids with other depressants like alcohol is dangerous. This combination magnifies the effects and can suppress respiratory function, leading to coma or death. 

Drinking alcohol while on antidepressants can counteract the benefits of the medication. Mixing monoamine oxidase inhibitors (MAOIs) with alcohol can cause dangerous blood pressure spikes.  

Individual/Environmental Factors 

School nurses can help others recognize contributing factors to substance use disorders. Students in high-achieving schools are at higher risk because of ongoing academic pressure. Children with untreated or undertreated mental health issues are also prone to substance misuse. Other factors include children with neurodivergence, learning differences, and Adverse Childhood Experiences (ACEs). 

Warning Signs 

School nurses can work with students, parents, and staff to recognize potential problems with substance use. 

Here are some warning signs: 

• Frequent visits to the health office 
• Unexplained somatic complaints 

• Excessive sleepiness or energy 
• New reactions to medications 
• Change in appearance 
• Impaired coordination 
• Behavioral changes 

• Bloodshot eyes 

The earlier a school nurse acts on their concerns, the more likely a student will recognize how their actions are affecting themselves and other people. They’ll also be more likely to get help before the situation escalates. 

Early Intervention 

Nurses have clinical options they can use to intervene with substance misuse. Screenings include SBIRT (Screening, Brief Intervention, and Referral to Treatment), CRAFFT (Car, Relax, Alone, Forget, Friends, Trouble), and S2BI (Screening to Brief Intervention). These tests can help identify ways to promote healthy behaviors and reduce harmful substance use. 

If a student struggles with substance use or mental health issues, nurses can refer them to a school counselor or psychologist. They may also suggest an outside community provider or a parent consultation. Online resources like Rethinking Drinking, MyLife MyQuit, and SmokeFree Teen can help, too. These websites also support families who may not want to involve the school. 

Practicing Prevention 

Prevention approaches to substance misuse are most effective when everyone works together. The responsibility lies with parents, the community, and the school. School nurses, counselors, administration, faculty, and coaches can all play a part. 

Here are some questions nurses can ask at school: 

• Do we have a multi-disciplinary team that handles health and wellness? 
• Where are opportunities for the team to share their areas of expertise? 

• How do school leaders determine what information they should communicate? 
• Which channels are best to relay information to team members, parents, and students? 
• How do students communicate their questions and concerns to adults? 
• Do I have the necessary resources to conduct my duties and propose new approaches? 

Nurses can advocate for support to position themselves as prevention practitioners. 

Outreach is also integral to supporting a culture of substance misuse prevention at school. School nurses must be visible to students and staff to promote trust and build relationships. They may remind students about the health office’s location and the availability of confidential services. Nurses can also reduce silence and stigma by discussing mental health and substances. 

Setting up a health-promoting environment at your school makes it easier for students to discuss substance use. Nurses may display health information on posters and digital screens to promote an open forum. They can offer links to educational videos to reinforce the messaging students receive in class and at home. Nurses may also make pamphlets available around schools for those who want to read about substance use in another setting. 

Moving Forward 

School nurses can be the driving force behind substance misuse prevention, but they can’t do it alone. They must communicate their needs to their school’s administration.  

Nurses should also look for ways to partner with counselors, coaches, and advisors to advocate for education and dialogue. Their voices and perspectives can help inform, support, and care for students and their communities so they are healthy and resilient. 

Magnus Health helps nurses deliver better student care and improve communication across all departments. Our electronic health record software allows health staff to share treatment notes and vital health information with approved personnel. Get in touch to learn how we can help your school work together to prevent substance misuse.