The Journal of School Nursing2022, Vol. 38(2) 126–137© The Author(s) 2020Article reuse guidelines:sagepub.com/journals-permissionsDOI: 10.1177/1059840520930075journals.sagepub.com/home/jsn
The complexity and demands of the school nurse role have changed greatly over time. Our aims included determining tasks and knowledge relevant to modern school nursing in the United States, identifying continuing education needs of school nurses, and describing anticipated changes to the professional role. A secondary analysis of a cross-sectional web-based survey of 750 school nurses was performed. The study team evaluated calculations of mean importance and frequency for school nursing task and knowledge statements. Conventional content analysis was used to analyze open-ended responses. School nurses rated most tasks and knowledge as relevant to practice, underscoring the great depth and breadth of education and training school nurses need to meet the demands of students today. The results of this secondary analysis may be leveraged to accurately describe the school nurse role, advocate for nursing services, and support school nurses as they strive to better the health of school communities.
administration/management, leadership, school nurse characteristics, school nurse knowledge/perceptions/self-efficacy, school nurse education
School nursing was born out of legislative mandates in the late 19th century that supported student success through identification of communicable diseases and other health problems affecting attendance and learning. School nurses have stood at the intersection of health and education for over 120 years, working to keep children healthy and ready to learn (Johnson, 2017). However, over the past century, the role of the school nurse has evolved in response to social, cultural, and political influences. This has led to a change of the ways in which school nurses must carry out their work to meet the goal of keeping children healthy, safe, and ready to learn.
The school-based care of students has increased the complexity and demands of the school nurse role (Davis et al., 2019). School nursing duties have both maintained consistency, as in the arena of disease surveillance and improving student attendance, and progressed as school nurses now address complex physical and emotional needs of students. Today, school nurses are the only providers that most of the nation’s public schoolchildren may access for health care without barriers such as insurance, transportation, appointments, and fees (Fleming, 2011). As such, school nurses are strategically placed and uniquely qualified to provide care to schoolchildren and other members of the school community in support of student health and academic success (Butler & Diaz, 2016; Leroy et al., 2017).
Student needs are evolving quickly: Researchers recently identified a 35% increase in the number of students receiving case management services for conditions such as asthma, diabetes, and seizures over only 1 academic year (Daughtry & Engelke, 2018). This increase in care need was in part due to improved school nurse staffing, which allowed students to actually receive the care. Although, in some regions, increases in the complexity of student needs have been followed by decreases in school nurse student caseload through support of additional school nurse positions (Best et al., 2020), this is not widespread practice. Care for some students is complex enough to require care coordination, which is typically more complex than case management and involves school nurses leading communication among families, teachers, health care providers, and other individuals responsible for students’ medical and academic needs (McClanahan & Weismuller, 2015).
As school nurses and other stakeholders have realized that the bulk of the work done in health offices is not necessarily direct care, leaders of the specialty have called for a focus on workload over caseload (Jameson et al., 2018). Student caseload reflects the number of students, and at times, the clinical acuity of student needs. Workload, on the other hand, may describe the work of school nurses today in a more comprehensive manner (Endsley, 2017). In addition to direct care provision, factors such as documentation, reporting, and leading communication with the interprofessional team are included in school nurse workload (Combe et al., 2015; Davis et al., 2019). Further, inequities in access to care as well as the increase in both evidence and awareness of social determinants of health and social injustices have contributed to increases in school nurse workload. School nurses must spend more time caring for families without resources for optimal care or adequate community supports in order to help these families be healthy (Daughtry & Engelke, 2018).
Despite evidence of student health needs increasing, a misunderstanding of the school nurse role continues to create barriers to funding and availability of school nursing positions in communities across the United States (Houlahan & Deveneau, 2019). This is ultimately harmful to populations at large, as students, families, and other members of the school community need to access a school nurse who can support physical, emotional, and academic well-being. There is a critical need for school nurses to identify and publicize what we do, what we need, and where we are going. To that end, the purpose of our study was to determine tasks and knowledge relevant to modern school nursing in the United States, identify continuing education (CE) needs of school nurses, and describe anticipated changes to the professional role.
The present study is a secondary analysis of a job analysis (also known as a practice analysis or role delineation study). A job analysis identifies specific key responsibilities, knowledge, and competencies required for effective performance in a job (Prometric, 2019). The primary study was conducted as market research to validate concepts for the National Board for Certification of School Nurses (NBCSN) voluntary exam and was not externally published. The University of Massachusetts Lowell Institutional Review Board deemed the study exempt from full review.
A national cross-sectional job analysis survey conducted in April 2018 was developed and implemented according to certification industry standards (Chinn & Hertz, 2010) and in accordance with regulations set forth by the Accreditation Board for Specialty Nursing Certification (2019). The survey was developed with input from subject matter experts who volunteered their time during focus groups, cognitive interviews, and pilot tests. Subject matter experts also served as volunteers for the review and confirmation of results during the primary study. Figure 1 displays a flow diagram of survey development activities and results verification. A review of respondent subgroups was also conducted for each demographic group of the primary study (e.g., practice setting) holding at least 30 respondents. Indices of agreement (IOA) were calculated from each subgroup’s ratings of the task and knowledge statements. IOA values were then compared to identify any differences in how subgroups rated statements. A threshold of 0.80 was selected to indicate strong agreement between subgroups. All calculated values for the primary study were above the threshold, indicating agreement among nurses with different personal and professional characteristics.
As the survey was lengthy and the credentialing organization national, the questionnaire was sent to large groups of practitioners representative of the professional community (Chinn & Hertz, 2010). A total of 4,070 nationally certified school nurses and approximately 16,000 members of the National Association of School Nurses who were not included in the mailing to certified school nurses received the survey by email.
The survey instrument included a total of 684 quantitative items, which prompted participants to rate the importance and frequency of school nursing tasks and the importance of school nursing knowledge. Participants rated the importance of task and knowledge statements on 5-point scales, with 0 representing of no importance and 4 representing very important. Participants rated the frequency of performing each task on a 5-point scale, with 0 representing never and 4 representing very often. In addition to task and knowledge statement rating opportunities, the survey contained two open-response opportunities: (1) what additional professional development and/or CE could you use to improve your performance in your current work role? and (2) how do you expect your role to change over the next few years? Further, what tasks will be performed and what knowledge will be needed to meet changing job demands?
For the primary analysis, mean importance ratings were calculated for each task and knowledge statement, as well as median frequencies for task statements, using SPSS statistical software (IBM Corp, 2017, version 25). The study team evaluated these calculations for the secondary analysis. Responses to open-ended survey items were provided in unanalyzed form. We exported these responses to NVIVO (QSR International [Americas], 2015) for a descriptive content analysis adapted from Hsieh and Shannon (2005). Analysis of the open-ended responses used an iterative process to develop themes, categories, and codes. Coding and analysis of the data were done by one researcher and themes were confirmed by four study team members.
The primary study included 750 complete responses from school nurse participants. These complete responses represented a 3.73% response rate. Most respondents were White (93%) females (98%) who practiced as nurses for over 21 years (69%) and school nurses for 11–20 years (34%) in elementary schools (31%) serving between 501 and 750 students (19.5%). Table 1 displays characteristics of the survey respondents.
Of all of the tasks school nurses are charged with, select activities were rated as more important than others. School nurses considered maintaining privacy in accordance with HIPAA/FERPA (3.91), practicing according to state and national guidelines, policy, licensure (3.88), documenting medication administration (3.87), protecting student (personal/body) privacy (3.87), and communicating with parents/guardians (3.86) as job tasks with the highest importance. School nurses rated administering fluoride treatments (1.61), administering immunizations to staff (1.82), serving as advisor for student activities (2.06), conducting home visits (2.21), and leading support groups (2.21) as least important to their role.
Job tasks were performed with varying frequency. School nurses reported performing 124 specific tasks very often, 6 tasks often, 33 tasks occasionally, 19 tasks seldom, and never performing 60 tasks. Table 2 displays the three tasks rated as most important across each professional practice category with frequencies.
School nurse participants rated all included job knowledge components as important or very important. Knowledge components rated on the higher end of importance included knowledge of anaphylaxis (3.93), prescription administration (3.92), medical authorization for prescriptions (3.92), head trauma (3.91), and documentation (3.91). Although respondents did not indicate that any knowledge components were irrelevant to their job, some areas scored on the lower end of importance. These components include health education of communities/stakeholders (3.1), assistive technology (3.15), gender identity (3.19), special health needs assistive care (3.2), and pregnancy/parenting (3.2). Table 3 displays the three most important knowledge items across each knowledge domain. A complete listing of ratings of the school nursing knowledge areas is available as an Online Supplement.
Respondents were asked to identify CE topics that would be helpful in improving their work as a school nurse. Following analysis of 277 responses, three themes were identified: course topics, no time to learn, and anything.
Course topics. Participants reported a need for CE topics specific to care delivery, such as individualized health plan (IHP) development. Even when respondents felt confident in developing IHPs, they called for education on how to increase efficiencies around the work, noting “students are enrolling with more complicated issues ... [I am] spending more and more time coordinating and implementing plans.”
Participants want to know how to best support students experiencing mental illness or adverse childhood experiences (ACEs), including training specific to fostering collaboration between school nurses, clinical specialists, administrators, educators, and outside providers to adequately address mental health concerns. One participant reported,
due to the increase in incidences of students with complex health needs and concerns such as violence, bullying, human trafficking, homelessness, drug and substance abuse, school nurses need interdisciplinary collaboration with school social workers, school counselors, and school psychologists as well as community health care providers to enhance the ability of students, families, classroom teachers, and school personnel to recognize and respond appropriately to the physical and mental health of students.
School nurses would like to learn about leadership topics, such as how to best work with nonnursing administrators, and best practices to employ when working with a student or family who may be seen as challenging, defiant, or noncompliant. One nurse reported, “so many times educational goals and medical goals are not in tandem and can lead to confusion, miscommunication, or frustration on the part of the parents.”
School nurses are calling for CE regarding legal issues in school health. New school nurses as well as those with many years of experience seek such opportunities, stating
I wish there was one place to find all the laws and rules for school nursing . . . . I fell into my position 9 years ago and am still trying to learn all the things that need to be done beyond nursing care.
Courses including information on legal issues surrounding delegation to unlicensed staff members would be helpful to school nurses, as many participants shared statements such as “professional development surrounding efficient delegation would be helpful.”
While online CE courses are convenient, respondents are seeking opportunities for hands-on skills training. Participants reported, “there are lots of lectures and online courses, but it is really hard to get hands-on skills performance and training.” Participants cited tracheostomy appliance care, accessing ports, head-to-toe assessment, and use of continuous glucose monitors as specific skills they would like to practice.
No time to learn. Many respondents reported having little or no time to participate in CE. Sentiments such as “when you are caring for students all day and we are hourly employees, how are we supposed to do [CE]” and “time is limited during work hours, so it is always done on my own time [and with] no pay” were common. Respondents reported feeling overwhelmed by their workload, travel between school buildings, and that the hours needed to thoroughly complete their work exceeded their paid hours without considering CE time.
Anything. Despite limited time available to engage in professional development activities, a common response to this survey prompt was “anything.” Respondents stated “any CE is welcome and important” and “I’m interested in learning as much as I can” especially if the course was held after work hours and for low or no cost. Such responses were commonly entered enthusiastically, as evidenced by the use of capital letters and exclamation marks.
Following analysis of 338 responses to a survey item prompting respondents to share expectations of how the professional role will change in the future, three themes were identified: student complexity, staffing, and technology.
Student complexity. Respondents reported caring for a greater number of students with complex medical issues over time. Participants commented on needs requiring technical skill intervention (such as managing implanted devices) as well as student mental health needs. Regarding the acuity of student needs, one respondent said, “the needs of our students are becoming more and more complex with each year, both physically and emotionally.” Many respondents expected to spend more time identifying and addressing socioeconomic factors, often circling back to the need for specific training, such as
a school nurse almost needs to have a social work degree, not a nursing degree in order to meet the demands these days. I have very few [visits that are] first-aid issues. The problems [I] see are related more to breakdown of family structure, absent parents, and [emotional/behavioral] issues.
Staffing. Despite an increase in student caseloads and acuity, school nurses noted a decrease in supports (e.g., school nurse hours, wages, clinic assistants). Sentiments such as “we seem to be an expendable position that often is asked to cover and do much more than is feasible and we are stretched and asked to do more with less” were common across responses. Respondents remained cautiously optimistic about the future, hoping for support and respect:
I would hope that as the general public realizes school nurses are becoming an area of nursing that needs very skilled nurses [with] extremely high responsibility levels . . . . [school nurses] will be adequately compensated so the high turnover rate will stabilize.
Technology. Respondents forecast that the use of technology will grow in health offices beyond the use of electronic documentation systems, such as communication with providers using video chat and other telehealth applications. Respondents again linked the role changes to a need for education, stating “technology will be more and more part of our role. Many school nurses have basic computer and technology skills and will need to know much more.”
Changes to student well-being have broadened both the scope and practice of school nursing (Combe et al., 2015; Daughtry & Engelke, 2018; Davis et al., 2019; Houlahan, 2018; Jameson et al., 2018). Through a secondary analysis of a nationwide school nursing job analysis, we have determined tasks and knowledge relevant to modern school nursing in the United States, identified CE needs of school nurses, and may describe key anticipated changes to the professional role.
While some tasks, such as following laws and regulations, were identified as more important than others, school nurses identified 130 tasks they perform very often or often. These tasks crossed all areas within the school nursing scope (i.e., direct care, health promotion, management and leadership, public and community health). Similarly, school nurses did not rate any areas of knowledge that were not relevant to the job today. This is consistent with the finding of another research team that determined school nurses thought practice activities across all five categories of the Framework for 21st-Century School Nursing Practice were important to the role and were performed frequently (Davis et al., 2019; Maughan et al., 2016). With the great deal of knowledge and skills school nurses are responsible for, it is important to remember that no single professional—even a seasoned expert—knows everything. School nurses can learn from, delegate to, and collaborate with interprofessional colleagues to strengthen their own skills and ameliorate feelings of being overextended. Given the broad scope of tasks and knowledge school nurse respondents considered essential, combining efforts with other school professionals is crucial to fulfilling the modern school nursing role.
Interprofessional collaborations among school teams is one way to address barriers to student health (Bates et al., 2019). Working as an effective member of an interprofessional group is an important skill for all members of a student team. To the same degree that teachers can provide valuable input to school nurses about student health (Quinn & Serna, 2019), school nurses can make valuable contributions as school teams create student accommodation plans. School nurse respondents reported that collaboration on interprofessional teams for at-risk students was important (importance rating 3.46) and performed often (frequency rating 3.0). Unfortunately, school nurses are often overlooked as both a resource and intervention even when student challenges are rooted in physical health. For example, only 61% of students with persistent pain had a school accommodation plan that included access to the nurse (Logan et al., 2008). While school nurses frequently address student mental health concerns, teams do not always consider consultation or partnership with school nurses when making student plans related to mental illness (Bohnenkamp et al., 2015; Shannon et al., 2010). Even when there are legal directives mandating school nurse participation, nurses have been excluded from student teams (Yonkaitis & Shannon, 2017).
School nurse participants reported frustration surrounding the mismatch of educational and health-related goals for students, especially those with complex social and health problems. This finding builds on other reports of school nurses expressing frustration surrounding the misunderstandings of their professional role (E. D. Maughan et al., 2017). School nursing involvement on interprofessional student teams can positively impact all students, including those with disabilities (Pufpaff et al., 2015), concussions (Weber et al., 2015), pain (Quinn & Serna, 2017), or who are bullied (Kub & Feldman, 2015) and can even impact the value parents and teachers place on school nurses (E. Maughan & Adams, 2011). Whereas misunderstandings surrounding the role of the school nurse may hinder interprofessional collaboration (Fleming & Willgerodt, 2017), school nurses should make clear their scope of practice, professional role, knowledge of the problem at hand, and tasks in which they are skilled that may contribute to student success when joining an interdisciplinary team. In doing so, assigned tasks may be more meaningful in terms of the role of the school nurse and responsibilities they may take on (Reuterswärd & Hylander, 2017).
Ultimately, the onus is on school nurses to inform school administrators, teachers, parents, and other community members of the knowledge and skills they may contribute to a student team. School nurses must advocate for their own seat at the table when other colleagues are developing a plan to meet student needs, even when the needs are not of an obvious medical nature. Research teams conducting future job analysis surveys or other studies of school nurse responsibilities and workload should consider adding items regarding self-advocacy. Research on nurses’ professional self-advocacy is limited; study teams have previously explored nursing political advocacy (Taylor, 2016) and advocacy skill building among student nurses (Doherty et al., 2016). Leaders of our specialty field should aim to determine how nurses are self-advocating, which methods are most effective, and what skills school nurses may need to better perform self-advocacy.
School nurses called for education regarding working with interprofessional teams, as discussed in the previous section. Understanding the importance and frequency of school nursing tasks may help nurse educators and conference planners select professional development topics that will improve nursing competencies and therefore student outcomes. School nurses may also leverage results of this study to advocate for the presence of certain topics on conference itineraries. Specific areas for CE development include courses introducing nurses new to school health to some of the common student concerns and promoting the specialty role. Course planners should also consider a balance of broad accessibility (e.g., web-based education and sessions for large audiences) and the need for hands-on skills training.
Transition to school health primer. Nurses may begin practicing in the specialty of school nursing after finishing prelicensure generalist training or following years of experience in another setting. While generalist preparation and experience years in other settings are certainly valuable to practice, contemporary school nursing necessitates a change in the job onboarding training as well as educational opportunities for school nurses. Nurses often enter school health without adequate training on critical student health issues such as allergies and anaphylaxis (Tsuang et al., 2019). Additionally, the inclusion of students with significant complex special health care needs has increased the depth and breadth of knowledge and skills school nurses must have to meet the needs of these students (Singer, 2013).
Similarly, school nurses need education regarding approaches to addressing the mental illness of students and care of students with ACEs. The need for such training is especially pertinent when considering school nurses indicate mental illness as the most prevalent health issue among students but also report that they do not have enough training to adequately address it in school (Higson et al., 2017; Muggeo & Ginsburg, 2019; Pryjmachuk et al., 2012). School nurses should also receive training on how to facilitate some of the community factors that can ameliorate the impact of mental illness and ACEs on school outcomes, such as safe communities, supportive neighbors, and consistent meals with family (Robles et al., 2019).
Promotion of the specialty role. School nurses felt they were asked to do more with less, even feeling expendable to the school community. Such expendability places the nurse in a position where they are not able to meet their professional and ethical obligations to ensure health and safety of the school community. This is especially problematic in light of the secondary analysis finding that the tasks school nurses find most important to their work center around legal and ethical principles. While state laws direct the scope of nursing practice, few states have laws mandating the availability of nurses (E. Maughan, 2009). As discussed previously, school nurses are ultimately responsible for advocating for their involvement on student teams and for the funding and availability of school nurse positions. Educating parents, educators, other nurses, and the general public on the role and responsibilities of school nurses and needs of schoolchildren is one way to ameliorate expendability, as well as solidify job positions for school nurses.
Given the increasing medical complexity and influence of social determinants of health that school nurses must address so students are healthy and ready to learn, school nurses must work to change the misguided public perception that school nurses are present for minor direct care needs only. Survey respondents did not find it particularly important to communicate with the media or policy makers (importance ratings 2.24 and 2.99, respectively). In fact, respondents denied communicating with the media and only occasionally communicating with policy makers (frequency ratings 0.0 and 2.0, respectively). School nurses must prepare and disseminate data to administrators, colleagues, parents, and other stakeholders demonstrating the care needs of their school community. CE opportunities with a focus on media and policy training can provide school nurses with knowledge and skills needed to carry out such public advocacy effectively. Efforts in this area will help promote the professional role through providing transparency regarding the responsibilities the school nurse holds, as well as informing the public of the essential role a school nurse plays in the well-being of the entire community.
Earning specialty certification may be another method for school nurses to inform the school community and general public of the importance of school nursing. Across other nursing areas, researchers have identified relations between specialty certification and improved patient outcomes (Boyle et al., 2014, 2015). School nurses should consider pursuing certification as a nationally certified school nurse and are encouraged to publicize their professional achievements across the school community.
CE accessibility. Despite an eagerness to learn and improve their own practices, participants noted barriers to accessing CE opportunities. Unfortunately, even when school nurses are able to further their learning, they do not have time or adequate resources to implement practice changes (Quinn & Smolinski, 2018). Therefore, school districts must commit to meeting the health needs of all students through appropriate CE support. Such support should include time to complete CE and registration fees.
Additionally, school nurses are seeking hands-on learning opportunities. With access to anatomical models, highfidelity simulators, and interdisciplinary expert instructors, one group of college educators provided training to school nurses on tracheostomy care, carbohydrate counting and insulin pumps, vision screening, otoscopy, catheterization, feeding tubes, and emergency seizure medication administration (McClanahan et al., 2016). Simulation and practice laboratories in nursing schools may go unused over weekends and college breaks. School nurses or professional nursing organizations (such as state-level associations) may consider partnering with universities for hands-on training programs when the practical labs are not in use.
Despite all that is already required to effectively meet the needs of students, school nurse respondents predicted that the needs of future schoolchildren will increase in complexity and that staffing issues will continue to be a threat to providing adequate care. Increases in student complexity will necessitate interprofessional collaboration, and the adequacy of staffing may be addressed through professional advocacy efforts: Both of these anticipated role changes are addressed in earlier discussion sections. School nurse respondents also reported that technology has the potential to change the specialty. Additionally, we have identified increasing diversity among school nurses as a priority following analysis of respondent and workforce demographics.
Utilization of available and emerging technologies. Capitalizing on all that technological advances have to offer can create a work environment in which technology is a useful, productive, and collaborative tool used to improve student health, safety, and access to care. Two specific areas that have great potential to improve school nursing practice are telehealth and electronic record-keeping. Given a geographic misdistribution of pediatric specialists, access to telemedicine can have a great impact in rural and medically underserved areas (Marcin et al., 2016). In some states, school nurses may initiate a mental health services telehealth referral (North, 2020), which further removes barriers to accessing care. An emerging model of telehealth involves school nurses as the service provider for students who do not have a school nurse during the entirety of the school day (Cogan, 2020; Johnson, 2020). Researchers and leaders in this field must ensure school nurses not only have access to telehealth services but also are involved in developments and planning for implementation of telehealth. Electronic health records provide school nurses with the power of data to tell the story of the work they do each day to support student health and academic success. School nurses must thoroughly document care in order to track their own health office data and contribute to national school health data sets. With access to electronic recordkeeping, school nurses may harness the power of data to create systems-level change.
Diversifying the school nursing workforce. While school nurses may contribute to public health through immunization administration and tracking, monitoring and reporting communicable diseases, and leading school communities in emergency preparedness, addressing a lack of diversity among the school nursing workforce is a clear priority emerging from review of participant demographics. Respondents were nearly homogenous in terms of gender and race (98% female, 93% White) and resemble the gender and racial makeup of school nurses in the United States (Willgerodt et al., 2018). Such demographics do not reflect the communities school nurses serve.
The lack of diversity within nursing as a discipline contributes to health disparities and decreases access to care and care quality (Spetz, 2016). Additionally, many respondents of the survey were nurses for over 21 years (69%). Diversifying the workforce should include efforts to recruit nurses who are earlier in their career trajectories. This may seem challenging considering that promoting school nursing as a specialty is not without barriers, given comparatively low pay (Willgerodt et al., 2018) and misperceptions about the importance and scope of school nursing work. However, increasing diversity within the workforce is essential to ensuring school communities can realize improvements in care access and quality and a narrowing of the health care disparities gap (Institute of Medicine, 2011). By welcoming team members from underrepresented backgrounds, we will gain unique ideas and perspectives to meet the needs of diverse populations and decrease health inequities and barriers to wellness rooted in racism and a lack of worker diversity.
Respondents of this survey provided a self-report of professional opinions and may have answered survey items based on perceived best practices or socially desirable responses. With a lengthy survey, there was also potential for survey fatigue. Researchers of the primary study mitigated fatigue by allowing respondents to close the survey and return at a later time to complete the survey.
The data used in this secondary analysis were not collected to address the aims of the present study. Therefore, some variables that would have been helpful addressing the study aims were not available. For example, the primary study included very few survey items related to quality improvement, population health, and policy work. While the response rate for the primary survey was low and personal characteristics relatively homogeneous, the respondents shared professional experiences from all corners of the United States, from different school levels and school sizes. Respondent experiences and personal characteristics may differ from nonrespondents.
Finally, the range of mean and medians across school nursing knowledge and task statements was narrow. A narrow range of ratings speaks to the breadth and depth of school nursing responsibilities and perceived importance of many parts of the job. However, our ability to draw conclusions about tasks and knowledge items that are most important or more important than others is limited.
While central tenets of school nursing practice are still important in the present day, 21st-century school nursing requires a different and continually evolving knowledge base and skill set. Given the need to maintain competence in a wide variety of knowledge and skills and anticipated increasing complexity of the job, school nurses are seeking professional development opportunities to better their professional practices in support of student health. School nurses, leaders, and other stakeholders may leverage the results of this study to accurately describe the modern school nurse role, advocate for nursing services, and support school nurses as they strive to better the health and well-being of school communities.
The data that support the findings of this study are available from the NBCSN, but restrictions apply to the availability of this data set, and it is not publicly available. Data are available from the NBCSN upon reasonable request with permission of the executive director of the NBCSN. A table displaying ratings of the importance and frequency of all school nursing tasks is available as an Online Supplement.
All authors contributed to the conception of the manuscript as well as prepared the drafts. B. Morse and C. Homme contributed to the acquisition, analysis, and interpretation of the data, while B. Morse and L. Anderson were involved in the subsequent revisions of the manuscript. All authors gave final approvals and agreed to be accountable for all aspects of work ensuring integrity and accuracy.
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
The author(s) received no financial support for the research, authorship, and/or publication of this article.
Brenna L. Morse, PhD, RN-BC, NCSN, CNE https://orcid.org/0000-0001-9876-4700
Lori Anderson, PhD, RN, CPN-PC, NCSN https://orcid.org/0000-0002-0248-6580
Laurie G. Combe, MN, RN, NCSN https://orcid.org/0000-0002-0796-3390
Supplemental material for this article is available online.
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Brenna L. Morse, PhD, RN-BC, NCSN, CNE, is an assistant professor at Solomont School of Nursing, University of Massachusetts Lowell, Lowell, MA.
Lori Anderson, PhD, RN, CPN-PC, NCSN, is a clinical professor at School of Nursing in University of Wisconsin–Madison.
Laurie G. Combe, MN, RN, NCSN, is a health services coordinator at Klein Independent School District, Houston, TX.
Sandi Delack, MEd, RN, NCSN, FNASN, is a health services coordinator at Johnston Public Schools, Johnston, RI.
Lynnette Ondeck, MEd, RN, NCSN, is a district nurse at Nooksack Valley School District, Everson, Washington.
Carissa Homme, PhD, is a manager of Test Development and Certification at Competency and Credentialing Institute, Denver, CO.
1 Solomont School of Nursing, University of Massachusetts Lowell, MA, USA
2 School of Nursing, University of Wisconsin–Madison, WI, USA
3 Klein Independent School District, Houston, TX, USA
4 Johnston Public Schools (Retired), RI, USA
5 Nooksack Valley School District, Everson, Washington, DC, USA
6 Competency and Credentialing Institute, Denver, CO, USA
Corresponding Author:Brenna L. Morse, PhD, RN-BC, NCSN, CNE, Solomont School of Nursing, University of Massachusetts Lowell, 113 Wilder Street, Suite 200, Lowell, MA 01824, USA.Email: brenna_morse@uml.edu
