I have vague but warm memories of the nurse at my secondary school. The nurse’s station was a quiet enclave away from the tumult of the school corridors, with comfy chairs and a minimalist order to it.

Pupils could drop in when they liked. For some, the station was simply a place for time out - no nurture rooms in the 1980s. Often the “headache” a pupil complained of was just code for school being too much, with bullying or struggles in the classroom the real reason for stopping by.

The nurse herself had an easy sense of matriarchal authority: stern if necessary, but in no rush to shoo away her patients - no matter how tenuous their symptoms.

She provided valuable support: not always easily quantifiable on a spreadsheet, but different from what teachers offered. In some vulnerable pupils’ eyes, it might have felt like the only safe haven in a school.

The school nurse is one of those roles, like janitors (see box), technicians and library staff, that has long been a part of school life but that has been quietly eroded for years - or even decades - almost without anyone noticing (see statistics, below).

Now a pilot project in two local authorities - recommended for national rollout - is seeking to revitalise the service by making clear exactly what it is there to do. The scheme has had a mixed reaction, with potential benefits set against the departure of some disenchanted nurses and fears of a “straitjacket” being placed on the traditionally fluid role.

School nurses’ influence has diminished as their ranks have shrunk - by more than half in a decade - and there has been little training for them since the 1990s.

When Tes Scotland contacted the National Parent Forum of Scotland for comment, its chair, Joanna Murphy, conceded that, apart from nurses administering immunisations, she hadn’t realised that a school nurse service still existed.

Primary school leaders’ body AHDS, meanwhile, recently suggested that school nurses were a dying breed when we reported concerns that many children were unable to take medication in school because staff lacked the expertise to administer it.

‘Trusting relationships’

The pilot projects have been run under Dumfries and Galloway and Perth and Kinross NHS boards since November 2015. They tried to make the service more “focused and targeted” by defining “nine priority areas” of work, for 27 staff across the two areas’ school nurse and wider health teams.

An evaluation of the pilots’ first six months by NHS and University of Edinburgh researchers found that the nine areas had “undoubtedly” made the role more standardised and reduced inessential visits from pupils (bit.ly/NursesSchool).

Nurses and schools, meanwhile, were clearer about what was now covered and nurses had built “stronger trusting relationships” with the pupils who come to them, the report said. In addition, the introduction of a referral system was generally viewed as a positive.

One nurse said that the new approach - which involved 406 children across the two areas in the evaluation period - was less “scattergun” and empowered nurses to “say no” if they were asked to do something that was beyond their capabilities. A manager even suggested that greater clarity about the role might lead to earlier identification of pupils’ ailments. Another manager said that the old system worked best for “the one who shouts the loudest”, with highly vulnerable children sometimes missing out on help.

However, the “high level of anxiety” created among nurses by the changes was “a major concern”. Although sickness rates did not appear to change much, there were four resignations and retrials in Perth and Kinross. A number of nurses felt they were ill-equipped to deal appropriately with the referrals that came their way and that the system was “cumbersome”.

The new requirement for referrals from pupil support teachers has, in some cases, created barriers for students who feel uncomfortable talking about personal issues with teachers. Although some nurses suggested that pupils rarely showed up at drop-ins run before the pilot project, others regretted their loss because, as one said, “now it’s not a confidential service”.

‘Real gaps’ in training

There were also complaints about omissions from the nine priority areas - one nurse said it was “crazy” that sexual health was not included. School nurses’ time was dominated instead by “unprecedented” levels of “very time-consuming” immunisation programmes, which took up 75 per cent of the Perth and Kinross team’s time.

Meanwhile, there was dissatisfaction about many different types of referrals put through under “mental health” - a category accounting for 68 per cent of Perth and Kinross referrals, despite this being an area where some nurses complained of a “real gap” in their training.

Critically, although the new system was viewed to have raised the profile of school nurses among other professionals, the most important people - the pupils - had “limited knowledge of their school nurse”.

Matt McLaughlin, the Unison union’s head of health, said: “We are acutely aware of the cut in school nurses over the past two decades. Health boards and successive governments have failed to recognise the vital role school nurses play in child protection.”

He welcomed the pilot schemes’ attempt to “refocus” school nurse services but he believes there is still a need for greater recognition of their “important role … in the protection of all our children”.

George Gilchrist, a recently retired Borders primary headteacher, said school nurses had been “greatly diminished” in recent years. He used to work with one connected to three primary schools and a secondary, who was asked to take on more schools in the same hours; her frustration grew when she was told that she had to go back to university to renew a qualification. “She never came back, and after that we had a succession who never lasted very long, or were moved,” said Mr Gilchrist.

Ken Cunningham, an educational consultant and former general secretary of School Leaders Scotland, welcomed attempts to make the role clearer but said there was a danger of guidance being overly prescriptive and creating a “straitjacket”.

“One of the benefits of the old system was there was a degree of flexibility,” he said, adding that drop-in arrangements could help to identify pupils’ more “deep-seated problems” The new system seemed to expect nurses to take on more duties - and potentially more bureaucracy - with no extra resources, Cunningham said. And if the changes resulted in schools becoming more reliant on first-aiders to deal with, for example, severe allergic reactions and accidents, “there are all kinds of risks”.

Murphy said: “In these cash-starved times, it makes sense to prioritise school nurses’ duties, and the pilot seems to have made a reasonable job of this.” But any wider rollout will only work, she added, if the changes to the service are explained to pupils and parents.

A Scottish government spokesman said: “School nurses are valued members of the nursing workforce and we remain committed to their vital contribution to improving the health and wellbeing of children, young people and families.

“These pioneering pilots showed that a targeted school-nursing role added value to the service through maximising their contribution and effectiveness, by providing additional support to young people.”

@Henry_Hepburn