School nurses play critical role in HPV vaccination promotion and compliance

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Each year, an estimated 13 million Americans are infected with human papillomavirus (HPV). The Centers for Disease Control and Prevention (CDC) estimates that the HPV vaccine can prevent over 90% of cancers caused by HPV. The CDC recommends children ages 11–12 years should get two doses of HPV vaccine, given 6 to 12 months apart before contact with the HPV virus, yet fewer than 60% of adolescents have been vaccinated against HPV. School nurses are uniquely situated to be at the forefront of preventing HPV-related cancers through promoting timely vaccination among children and adolescents.  

Kim McNally

Kim McNally, a PhD in Public Health student, is a school nurse and knows first-hand the vital role school nurses play in adolescent HPV vaccination efforts.  

School nurses are on the front lines promoting the health of children, educating and encouraging both children and parents on the benefits of immunizations. Given their proximity to adolescents, school nurses are in the prime position to administer vaccinations and ensure proper adherence to vaccine series schedules, including the HPV vaccine. Understanding how to best support school nurses allows them to incorporate other evidence-based strategies to increase HPV vaccine uptake.  

In a novel systematic literature review of school nurses' experiences and attitudes, McNally used evidence-based models to understand and analyze the factors that influence school nurses’ ability to promote the HPV vaccine. “There is limited knowledge about the vital role that school nurses play in HPV vaccinations. Improving awareness and supporting our efforts can have a significant impact on increasing vaccination rates,” said McNally.  

Amira Roess, professor of global health and epidemiology in the College of Public Health, is Kim’s thesis committee advisor and stated that “having school nurses engage in high-quality research like what Kim has done, is crucial to identifying realistic solutions to improve vaccine coverage.”   

McNally synthesized findings from 28 global research articles, comprising observational and descriptive studies, surveys, and interviews and focus groups. Results found that nurses experience complex challenges to facilitate conversations and implementation of HPV vaccination.  

“There are several complex factors that impact nursing practice. Nurses have good vaccine knowledge and positive attitudes, but poor workflow processes, competing demands, and difficulties communicating about vaccines challenge school nurses' ability to do their job fully,” McNally said. 

Other nurses identified challenges like their students’ fear of needles and nurses’ limited ability to create relationships with families. Broader barriers such as inconsistent school-based health interventions, disproportionate HPV vaccination promotion for females over males, and varying vaccine laws were also forces outside of nurses’ control.  

Using findings from the literature review, McNally offers practical implications for how practitioners, researchers, and policymakers can advance public health efforts to reduce HPV-related cancers by supporting school nurses. McNally recommends training nurses on vaccine safety and efficacy, teaching strategies to engage with parents and guardians, providing schools with the necessary resources to administer vaccines, and advocating for policies that support accessible vaccinations as actionable steps to support nurses and increase HPV vaccination.  

School Nurses’ Experiences and Roles in Promoting and Administering the HPV Vaccine: A Systematic Review Using the Socioecological Framework was first published online in The Journal of School Nursing in October 2023. Ali Weinstein, professor in the Department of Global and Community Health and a Senior Scholar in the Center for the Advancement of Well-Being, was also a contributing author. Additional co-authors are Lisa Lindley, an associate professor in the Department of Community and Population Health at Leigh University’s College of Health, and Robin Wallin, School Health Services Coordinator in the Department of Student Services within the Arlington Public Schools.