School Nurse Perceptions of Student Anxiety

Student summary

Why This Research Matters

Anxiety disorders are among the most common mental health conditions in children and adolescents, and one of their hallmark features is somatic (physical) complaints such as stomachaches, headaches, and fatigue. Because these symptoms bring anxious students to the school health office again and again, school nurses are in a unique position to notice patterns other adults might miss. This 2019 study by Michela Muggeo and Golda Ginsburg, published in The Journal of School Nursing, asked a simple but important question: what do school nurses themselves think about student anxiety, and how equipped do they feel to respond to it?

The researchers surveyed a large sample of 93 school nurses. The survey asked nurses about how often they encounter students with anxiety, whether they use any structured tools to identify or manage it, and what they feel they need to do their jobs better. The results were striking in their consistency. The majority of nurses identified anxiety as the single most prevalent mental health issue among the students they see, ahead of other common concerns. Despite recognizing anxiety this often, most nurses reported that they were not using any formal screening tool (a standardized questionnaire that helps flag students who may be struggling) or any structured intervention protocol (a defined, step-by-step approach for helping a student cope). Instead, nurses appeared to be relying on informal judgment and improvised strategies built from experience rather than a validated method.

The same nurses who described handling anxiety informally also said, in large numbers, that they wanted more training in anxiety intervention. In other words, this was not a case of nurses feeling confident and simply choosing not to use formal tools. The pattern the authors describe is a gap: school nurses are on the front line of student mental health, they recognize anxiety as a top concern, but they do not feel they have received the preparation needed to address it with confidence and consistency.

Why does this matter for nursing students and future school nurses? First, it reframes the school nurse's office as a mental health touchpoint, not just a place for band-aids and temperature checks. A student who visits the nurse three times a week with a stomachache may be showing a physical sign of an anxiety disorder rather than (or in addition to) a physical illness. Second, it highlights a real training gap in nursing education broadly: if school nurses are not receiving structured preparation in anxiety identification and brief intervention during their professional development, that is a curriculum and continuing-education problem worth addressing directly, not something to leave to individual initiative. Third, the study models good practice in appraisal: the authors surveyed practitioners directly, rather than assuming what school nurses know or do, which is a useful reminder that assessing actual practice (not just guidelines on paper) is essential before recommending fixes.

It is worth being precise about what this study does and does not show. It is a survey of self-reported perceptions and practices among 93 nurses; it does not test whether a particular training program or screening tool actually improves outcomes for anxious students, and the abstract available for this article does not specify the states, school levels, or exact response rate involved. Readers should treat the 93-nurse sample as the population studied and avoid assuming these findings automatically describe every school nurse everywhere. Even with that caution, the message is clear and actionable: closing the gap between how often school nurses see anxiety and how prepared they feel to respond to it is a meaningful target for nursing education, professional development programs, and school health policy. For nursing students heading toward school health or pediatric-adjacent practice, this study is a useful case for why ongoing training in mental health screening and brief intervention deserves the same seriousness as training in physical first aid.

Faculty notes

Educational Relevance

This 2019 survey study by Muggeo and Ginsburg, published in The Journal of School Nursing (35(3), 163-168; DOI 10.1177/1059840517752457), examines how school nurses perceive and respond to student anxiety. The premise is grounded in a well-established clinical observation: anxiety disorders are common in youth, and somatic complaints are a hallmark presenting feature, meaning anxious students disproportionately present at the school health office. This positions the school nurse as a plausible first-contact point for identification, well before referral to specialty mental health services.

The authors surveyed a sample of 93 school nurses to characterize current practice and perceived need. Three findings anchor the paper. First, a majority of nurses perceived anxiety as the most prevalent mental health issue among their students, ahead of other conditions competing for attention in a busy health office. Second, despite this frequency, a majority of nurses reported using no formal screening tool and no structured intervention protocol when anxiety was suspected or identified. Third, a majority of nurses expressed a desire for expanded training in anxiety intervention. Read together, these findings describe a practice gap rather than a knowledge gap in motivation: nurses are not undervaluing anxiety as a concern, nor are they satisfied with ad hoc management; they are asking for structured tools they do not currently have.

For classroom discussion, this paper is well suited to two threads. The first is instrument and protocol design: what would a feasible, brief, school-nurse-administered screening and intervention protocol look like, given the setting's time constraints, non-mental-health-specialist workforce, and gatekeeping role? Related work by this research group (e.g., task-shifting brief cognitive-behavioral intervention models delivered by school nurses) is a useful comparison point for students, though it should be introduced explicitly as separate, related research and not folded into this survey's own findings. The second thread is workforce and curriculum: this study is best used as an argument for embedding structured mental-health screening and brief-intervention content into school nursing continuing education and into undergraduate community/pediatric health curricula, rather than assuming exposure to general mental health content transfers automatically to the school health office context.

Methodologically, faculty should flag for students that this is a self-report, cross-sectional survey design: it establishes prevalence of perception and stated practice, not observed practice or patient outcomes, and cannot establish causal claims about training effects. The publicly available abstract does not specify the sampling frame, response rate, geographic distribution, or school levels represented, which limits generalizability claims that can responsibly be made in class. It also reports each headline result as a response from a "majority" of nurses without exact percentages, so the magnitude of each finding should be presented cautiously. The article is correctly cited as The Journal of School Nursing, 35(3), 163-168 (DOI 10.1177/1059840517752457; PMID 29316831); note that ERIC indexes it under accession number EJ1214531, which is not a PubMed ID, a useful reminder for students to confirm identifiers against the primary database when building a reference list. Because this is a US study conducted in a system of dedicated school nurses, faculty in Canadian programs should help students translate it to Canadian delivery models, where school health is frequently provided by public health nurses covering many schools rather than a nurse based in a single building. Suggested discussion angles: comparing this study's self-report design against outcome-based intervention trials, and mapping specific screening tools (e.g., brief anxiety scales suitable for school settings) onto the training gap the authors describe.