Health Assessment and Screening
Screening is not diagnosis
School screening is a brief, population-level procedure that sorts students into "pass" and "refer" groups; it never establishes a diagnosis. The school nurse must know the mandated screenings in their state (vision, hearing, height/weight/BMI, scoliosis, sometimes dental and blood pressure), the required grade levels, notification and consent rules, and the rescreen/referral algorithm for each. Every screening instrument has sensitivity (correctly flagging affected students) and specificity (correctly clearing unaffected students); no screen is perfect, which is why a failed screen triggers a rescreen or confirmation step rather than a label.
Key skills
- Vision: age-appropriate chart (Lea symbols, HOTV, Snellen letters) at the correct distance; test each eye separately, with glasses if worn. Referral commonly follows a two-line difference between eyes or acuity worse than the state threshold on repeat testing.
- Hearing: pure-tone audiometry at 1000, 2000, and 4000 Hz at 20 dB in a quiet room; tympanometry when indicated; follow up on impacted cerumen or suspected effusion.
- Growth: plot height, weight, and BMI on CDC charts; crossing two major percentile lines warrants referral.
- Behavioral/mental health: use validated tools (e.g., PHQ-A) only with a clear referral pathway in place.
- Dental, scoliosis (Adams forward bend), and blood pressure per state protocol.
Traps
Questions love to blur screening with diagnosis ("the nurse diagnoses strabismus"). Others hinge on closing the loop: a referral that is never tracked is a failed screen. Know that screening results are confidential education records and that parents may decline some screenings where law allows.
Rule of thumb
Rescreen before you refer, and track every referral to a documented outcome.