School Nursing

The Relentless School Nurse: Athletic Trainers are our Partners

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School nurses and Athletic Trainers (ATs) can be tremendous partners in providing supportive care to student-athletes. The collaboration can only work if we are intentional in creating clear and open channels of communication that are FERPA and HIPAA compliant. We must understand our unique, but collaborative roles and the intersection of our specialties to meet the needs of students, especially after injuries.

Through the magic of Twitter, I met Anthony Breitbach, Ph.D., ATC, FASAHP (Tony),  when he commented about the lack of access to evidence-based journals for ATs who are working and no longer affiliated with a university system. I have to admit, I have never worked with an AT in my school nursing experience. They function in high school programs and that is the one age group that I have had the least experience.

After viewing Tony’s tweet, I answered him and was intrigued to hear more about how school nurses and ATs can collaborate. I invited him to write a guest blog post, which he graciously agreed to do.

Here are some interesting facts about sports injuries that I found surprising when I did my own search for the role of ATs. I think the readers of this blog will find Tony’s guest post as interesting as I did. If you are a high school nurse and work with an AT, please share your comments!

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Anthony Breitbach PhD, ATC, FASAHP

Interprofessional Collaboration Between Athletic Trainers and School Nurses – A Value-added Approach to School Health

By: Anthony Breitbach Ph.D., ATC, FASAHP; Associate Professor/Director, Athletic Training Program; Saint Louis University, St. Louis, MO

Interprofessional Collaborative Health Care can improve quality, increase access and decrease costs for underserved patient populations who currently have inconsistent and poorly coordinated care.1 Comprehensive health care for children is especially important because many chronic diseases start early in life and athletic participation increases the risk of traumatic injuries.2,3  Additionally, management of potentially life-threatening issues such as traumatic brain injury, asthma or anaphylaxis also requires coordinated care that responds quickly to patient needs.4-6

Schools are a logical place to provide this care for young persons.6,7 They can be an effective conduit for human services because they: (a) have contact with a large segment of the population, (b) have a physical facility in every neighborhood; (c) have a stable source of funding, and (d) are committed to standards and professionalism. The 2014 report “For the Sake of All” recommended that communities “Invest in coordinated school health programs for all students”.  The report states that health activities in schools need to be better integrated and coordinated and bringing the main parts of school health together through an organized approach can help schools improve service delivery, build partnerships, and develop healthy behaviors in students and staff.7 School nurses provide a vital role in these schools promoting health and caring for the student body, however integration of services is essential to provide effective, school-based health care.8

Through their unique role and specific professional preparation for this role, athletic trainers (ATs) have been working interprofessionally for decades.  The most common employment setting has one or more ATs working with a consulting physician to provide primary care to a school-based or professional sports organization. The traditional athletic training facility functions as a patient-centered medical home for the athlete.  In this setting, the AT is the point of first contact in the health care of the athlete where a triage decision may include:  something as simple as managing the condition on-site with standing orders, referral off-site to a consulting health professional, or activation of the emergency medical system to manage a life-threatening condition. However, Pryor and colleagues reported in 2015 that, even though 70% of high schools report having access to some athletic training services, only 48% have daily access to an athletic trainer and 37% have a full-time AT at the school.9

Interprofessional collaboration between school nurses and ATs presents an outstanding opportunity for both professions co-create a better model to impact the health of school-aged persons.  Access and quality of health care could be improved by a value-added medical model that provides comprehensive on-site primary care and decreases medical errors through improved communication.  Costs can be decreased by providing more appropriate wellness services, treatment and referral.  School nurses and athletic trainers can work together to coordinate health care and provide wellness services at a school using:  complementary collaborative roles, common physical facility and shared medical documentation.  This model may improve health outcomes by efficiently meeting the needs of the school community.

Adapted from:

Breitbach, A. Improving School-Based Health Care through a Truly Interprofessional Approach. Jacobs J. Community Med. 2015, 1, 4.

1. Berwick DM, Nolan TW, Whittington J. The triple aim: care, health, and cost. Health Aff (Millwood). 2008;27(3):759-769.
2. Fletcher EN, McKenzie LB, Comstock RD. Epidemiologic Comparison of Injured High School Basketball Athletes Reporting to Emergency Departments and the Athletic Training Setting. J Athl Train. 2014;49(3):381-388.
3. School Based Health Alliance. About the School-Based Health Alliance. 2009; Accessed March 25, 2015.
4. School Access to Emergency Epinephrine Act. In: Congress tUS, ed. H.R. 2094. Washington, DC2013.
5. Jones SE, Wheeler L. Asthma Inhalers in Schools: Rights of Students with Asthma to a Free Appropriate Education. Am J Public Health. 2004;94(7):1102-1108.
6. Weber ML, Welch CE, Parsons JT, McLeod TC. School nurses' familiarity and perceptions of academic accommodations for student-athletes following sport-related concussion. J Sch Nurs. 2015;31(2):146-154.
7. For the Sake of All. A report on the health and well-being of African Americans in St. Louis and why it matters for everyone. 2014.
8. American Academy of Pediatrics Council on School Health, Magalnick H, Mazyck D. Role of the school nurse in providing school health services. Pediatrics. 2008;121(5):1052-1056.
9. Pryor RR, Casa DJ, Vandermark LW, et al. Athletic Training Services in Public Secondary Schools: A Benchmark Study. J Athl Train. 2015;50(2):156-162.

Bio: Dr. Anthony Breitbach is an Associate Professor and serves as the Director of the Athletic Training (AT) Program in the Doisy College of Health Sciences at Saint Louis University (SLU).  A native of Dubuque, Iowa; Dr. Breitbach received a BS from the University of Iowa (1985), Master’s degree from the University of Florida (1987) and a Ph.D. from SLU (2007). He served on the National Athletic Trainers’ Association (NATA) Executive Committee for Education, where he played an active role in the development of the “Future Directions of Athletic Training Education” recommendations which were approved by the NATA Board of Directors in 2012. Dr. Breitbach served as a coordinator for the Interprofessional Education and Practice in Athletic Training Work Group for the NATA; where he was first author of “Interprofessional Education and Practice in Athletic Training”; which was awarded the Athletic Training Education Journal’s Outstanding Manuscript for Advancing Educational Practice Award in 2015. Tony is the NATA’s liaison to the Association of Schools of Allied Health Professions (ASAHP); where he also serves as Chair of ASAHP’s Interprofessional subcommittee as well as is their representative on the Interprofessional Education Collaborative (IPEC) council. In 2018 was named an ASAHP Fellow and also received their “Outstanding Member” Award. He is Co-Chair of the Program Committee for the American Interprofessional Health Collaborative (AIHC) and is an Associate Editor for the Journal of Interprofessional Care.


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