School nurses often feel overwhelmed, under-appreciated and caught in tricky ethical situations, a new study reveals.
It shows that they are frequently disturbed by pupils' stories, particularly those involving abuse, and find it difficult to leave their work behind them.
Relatively few pupils visit in-school clinics to discuss medical conditions. Instead, the vast majority use them to unburden their worries about their emotional health and well-being, particularly relationship problems, stress, depression, self-harm and eating disorders.
"Children come out with things that are quite devastating," said one of the nurses interviewed.
Several nurses said they sometimes felt uncomfortable about working with pupils without their parents' knowledge, particularly when providing them with emergency contraception.
"It can feel dangerous, very uncomfortable," one said. "There's a moral feeling that I should speak to parents about this, that they should be involved."
Another nurse said that she did not have any difficulties working confidentially with children, but that she sometimes felt strange doing her job in a school environment.
"Giving a 14-year-old emergency contraception in school, in school uniform feels different from giving it to them in a family planning clinic," she said. "Parents expect them to be in school receiving an education, but they're in here getting sexual health advice."
The report says such ethical dilemmas "feed into a more general experience of often feeling overwhelmed, unprepared for the work and anxious about what a young person might say and how they deal with it".
Written by Betsy Allen, a school nurse in Exeter, the study is based on interviews and focus groups with 28 other drop-in clinic nurses.
The findings come as the Government tries to expand the number of nurses and drop-in clinics in schools as part of its moves to create joined-up services for children and teenagers.
Other problems which the nurses reported included a lack of funding and poorly-located clinics, which they complained could sometimes be little more than cupboards.
Most felt that teachers and parents did not understand the breadth of their roles and that they were looked on simply as "nit nurses".
Mrs Allen suggested that one solution might be to change the title of school nurses to "health adviser", "school nurse practitioner" or "youth health nurse".
The ratio of school nurses to pupils in the UK is estimated to range between one to 3,000 to one to 8,000. However, the ratio that is needed for a comprehensive drop-in service is around one to 1,500.
The Department for Education and Skills said it was working with the Department of Health to explore the options for expanding the number of school nurses.
Drop-in clinics in secondary schools: the perceptions and experiences of school nurses is in volume 22 number 3 of the journal Education and Health