The Journal of School Nursing
2025, Vol. 41(2) 226–236
© The Author(s) 2024
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DOI: 10.1177/10598405241226805
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Abstract
School nurses encountered many workplace struggles while providing care during the COVID-19 pandemic. Several struggles involved organizational support, including having sufficient time, resources, compensation, and school leadership support. The purpose of this mixed methods study was to explore the experiences of school nurses working during the COVID-19 pandemic as they related to sufficient time to complete COVID-related activities, sufficient COVID-19 resources, compensation, and perceived organizational (school leadership) support. We obtained data from 1,564 National Association of School Nurses members regarding respondent characteristics, school characteristics, measures of organizational support, and qualitative perceived organizational support using a 17-question survey. Perceptions of having sufficient time to complete COVID-related tasks and infringement of these tasks on routine activities were worse for those with greater years of experience and education. Compensation for additional COVID-related work was more favorable for LPNs. School leaders should be aware of their role in bolstering organizational support and its impact.
Keywordsschool nursing, organizational support, compensation, resources, school nurse responsibilities, COVID-19 pandemic
As frontline care providers during the COVID-19 pandemic, school nurses endured the moral distress and mental health aftermath also experienced by hospital-based nurses and public health nurses/workers around the world (Bergren, 2021; Chen et al., 2023; Silverman et al., 2021). Mental health and well-being suffered for providers in the public health sector, with greater symptoms experienced by those who worked more than 40 hours a week and who perceived inadequate compensation or unappreciation (Bryant-Genevier et al., 2021). School nurses’ mental health and well-being also suffered, with mental health symptoms correlating with hours worked, feeling underpaid, and feeling underappreciated (Merkle et al., 2023).
During the COVID-19 pandemic, school nurses encountered workplace struggles similar to those experienced in those working in healthcare settings. While many of these struggles, such as feeling under-compensated and unappreciated, were present prior to the pandemic (Lineberry et al., 2018; Maughan, 2019), they were intensified and highlighted through the pandemic. For example, among school nurses who participated in a 2022 Centers for Disease Control and Prevention (CDC) survey, 82% felt inadequately compensated and 64% felt unappreciated at work (Merkle et al., 2023). Those reporting negative perceptions of organizational supports (staffing, compensation, support from colleagues and school leadership, and appreciation) were more likely to report symptoms of anxiety, depression, post-traumatic stress disorder (PTSD), and suicidal ideation (CDC & National Association of School Nurses [NASN], 2022; Merkle et al., 2023). Conversely, feeling supported by supervisors and school district leadership served as protective factors against poor mental health for school nurses (CDC & NASN, 2022; Merkle et al., 2023).
Perceived organizational support among school nurses is an important construct to explore because school nurses are often staffed, compensated, supported, and evaluated by the education sector, rather than the healthcare sector (Willgerodt et al., 2018). However, less is known about the unique challenges for school nurses who are removed from healthcare-oriented organizational leadership, mission, funding, and commiserate pay (Willgerodt et al., 2018). Currently there is no evidence regarding the work and compensation experiences of school nurses during COVID-19 and any association between these experiences and perceived organizational support. The purpose of this study was to explore the experiences of school nurses working during the COVID-19 pandemic especially as it related to having sufficient time to complete COVID-related activities, having sufficient COVID-19 resources, compensation, and perceived organizational (school leadership) support. We conducted a nationwide survey to achieve the following aims:
Aim 1: Identify school nurse and school characteristics associated with measured organizational support during the COVID-19 response in schools.
Aim 2: Examine relationships between school nurse/school characteristics, measured organizational supports, and perceived organizational support (expressed in descriptions of the role school leadership played in COVID-related conflicts). See Figure 1 for conceptual framework of explored relationships.
We used a descriptive, mixed method study design. Mixed methods use both quantitative and qualitative data to better understand and validate multiple perspectives and give context to the findings. This study used a convergent parallel design, where both quantitative and qualitative data collection and analyses occurred simultaneously, and findings were interpreted using both types of data (Creswell & Creswell, 2018).
We recruited a convenience sample of all school nurse members of National Association of School Nurses (NASN) who work in the United States and receive emails from NASN. The NASN has email access to about 17,000 school nurses.
After receiving exempt determination from the Advarra Institutional Review Board (IRB; Pro00058972), subjects were recruited through NASN’s membership directory in November 2021. A personal email was sent to all NASN members practicing in the United States, and an announcement was posted in NASN’s weekly electronic newsletter. A reminder email was sent 1 week after the initial email. Additionally, we asked NASN’s state affiliate leaders to send the survey information via their state listservs. Email, electronic newsletter, and listserv messages to potential participants provided a link to a Qualtrics survey, which included study information, an opportunity for informed consent (provided by clicking an arrow to begin survey), and instructions for completing the survey. Within the study information and consent statement, school nurses learned they may experience distress in sharing experiences with work-related trauma due to COVID-19 responsibilities and that they may opt out of replying to any survey questions that they were not comfortable answering. Anonymous school nurse responses were stored in Qualtrics following security and privacy safeguards. Only the research team had access to the survey results.
The author-created survey included 17 survey questions based on current literature regarding the COVID-19 impact on school nurse workload and were designed by school nurse experts. Survey questions were edited for clarity and content validity by school nurse experts and school nurse researchers. The survey included six demographic multiple-choice questions (professional licensure, level of education, primary role, years as school health provider, region, and grade levels served) used to understand the context of responses, determine if the sample was representative of school nurses across the country, and achieve Aims 1 and 2. Four quantitative questions assessed school nurses’ workload, resources, and compensation and were included in the analysis to achieve Aims 1 and 2. We operationally defined organizational support as perceptions of sufficient time for COVID-19 activities, sufficient resources, infringement of COVID-19 on routine activities, and employer compensation for extra time worked to complete COVID-related activities. Items used to measure perceptions of sufficient time, sufficient resources, and infringement of COVID-19 on routine activities included 4-point Likert-like responses ranging from “all of the time” to “never.” The item used to measure compensation included the following response options: (a) no compensation for extra time worked (but work expected to be completed), (b) not allowed to work overtime (some activities left incomplete), (c) overtime pay at usual pay rate, or (d) overtime pay at a higher rate. One open-ended question elicited qualitative responses about school nurses’ experiences related to COVID-19 conflicts.
Quantitative data were uploaded and analyzed using SPSS version 28.0 (IBM Corp. Released 2022. IBM SPSS Statistics for Windows, Version 28.0. Armonk, NY: IBM Corp). We calculated frequencies for each question. We examined cross-tabulations to determine if dependent variables (sufficient time, sufficient resources, COVID-19 infringement on routine activities, and compensation) were associated with demographic variables (school nurse professional licensure, education level, role, years of experience, school location, or grade levels). We conducted Pearson chi square tests to test statistical significance of associations, with p-values less than or equal to 0.05 considered statistically significant. However, when more than 20% of cells had counts less than 5, we used the likelihood ratio chi square for testing statistical significance. Also, because of the number of tests being conducted at one time, we used Bonferroni’s correction to avoid type 1 errors, and therefore considered any p-values less than or equal to 0.002 (0.05/24) as significant for organizational support variables and 0.005 (0.05/10) for perceptions of organizational support.
Qualitative responses were analyzed using content analysis (Schreier, 2013). Codes derived during the analysis were checked for agreement among the research team, with any divergent code selections being discussed among the team until consensus was reached. The elicited codes were reviewed for relevance to school leadership’s role in COVID-19 conflicts, with those deemed relevant divided into positive and negative school leadership responses. Finally, each school nurses’ response was rated as all positive, all negative, positive and negative, or neutral in relation to school leadership’s role in COVID-19 conflicts using magnitude coding techniques (Saldana, 2012). This final rating score was used for quantitative analyses to achieve Aim 2.
A total of 1,920 people opened the survey, but 356 answered none of the questions. A total of 1,564 NASN members (81.5%) completed the survey in November 2021. The following sections describe the results organized by each study aim.
School Nurse Characteristics. Characteristics of the survey respondents are summarized in Table 1. Most respondents (93.1%) were registered nurses (RNs). The most common education level was a Bachelor of Science in Nursing (BSN; 56.7%) followed by a master’s degree (24.9%). Most respondents indicated their primary role in the school setting was school nurse. The respondents ranged from new to a school health role to quite experienced; more than 1/3 (36.3%) had been in school health for 5 years or less while nearly 1/3 (29.7%) had 16 or more years of experience in school health.
School Characteristics. Characteristics of schools where respondents worked are summarized in Table 2. Most of the respondents (51.0%) worked in suburban schools, followed by rural schools (28.9%). All regions of the United States were represented: Northeast (33.6%), South (26.6%), Midwest (24.0%), and West (15.8%). Over 1/3 of respondents worked solely in the PreK – elementary setting and almost 1/4 were spread between PreK or kindergarten through high school.
School Nurse Characteristics and Organizational Support. Supplemental Table 1 represents how often respondents felt they had sufficient time to complete COVID-related activities at work. Responses varied by respondents’ licensure, education level, primary role in the school setting, and number of years worked in school health. Overall, only about 5% of respondents consistently had sufficient time to complete COVID-related activities, while about 20% never felt they had sufficient time. A statistically significant relationship existed between perceptions of sufficient time for COVID-related activities and education level X2 (9, N = 1,553) = 27.95, p < .001 and number of years worked in school health X2 (12, N = 1,551) = 41.11, p < .001. The greater the level of education or number of years worked in school health, the greater the likelihood that the respondent reported not having enough time to complete COVID-related activities. Most respondents, no matter the licensure level, had sufficient time for COVID-related activities only some of the time or never (Licensed Practical Nurse [LPN]/Licensed Vocational Nurse [LVN] 68.9%, RN 69.4%, Advanced Practice Registered Nurse [APRN] 74.0%, and other 81.8%). Similar patterns were noted for the various levels of education when asked about having sufficient time for COVID-related activities, with most having sufficient time for COVID-related activities some or none of the time (Associate Degree in Nursing [ADN] 66.4%, BSN 69.1%, Master’s 73.4%, and Doctorate 75.1%). No matter the primary role within the school setting, the majority within in each group did not have sufficient time for COVID-related activities (school nurse 68.7%, nurse administrator 78.3%, dual role of school nurse and nurse administrator 83.3%, nurse consultant 66.7%, and other 77.7%). As years of experience in school health increased, the perception of having insufficient time for COVID-related activities grew (0–1 year 53.2%, 2–5 years 68%, 6–10 years 72.5%, 11–15 years 73.3%, and 16 + years 73.3%).
We asked respondents about how often they had sufficient resources for COVID-related activities (see Supplemental Table 2). No statistically significant relationships existed between having sufficient resources and licensure, level of education, primary role, or years of experience in school health. The majority reported having sufficient resources for COVID-related activities all or most of the time. When considered by licensure level, 65.5% of LPN/LPNs, 60.4% of RNs, 51.8% of APRNs, and 54.6% in the “other” licensure category reported having sufficient resources all or most of the time. When categorized by education level, a similar pattern was noted (65.5% ADN, 61.2% BSN, 54.4% Masters, and 56.3% Doctorate). Depending on the primary role of the respondent, having sufficient resources all or some of the time varied, with the majority of those serving dual roles as school nurse and administrator reporting only having sufficient resources some of the time (60.9% school nurse, 56.5% nurse administrator, 33.3% dual role of school nurse and nurse administrator, 50% nurse consultant, and 66.6% other). Only slight variations in having sufficient resources were noted based upon years of experience in school health (0–1 year 64.5%, 2–5 years 60.9%, 6–10 years 58.3%, 11–15 years 60.7%, and 16 + years 60.2%).
More than 80% of respondents reported COVID-19 activities infringed upon their usual school nursing activities (see Supplemental Table 3). Similar to reports of having sufficient time for COVID-related activities, there were statistically significant associations with education level X2 (9, N = 1,536) = 26.732, p = .002 and years of experience in school health X2 (12, N = 1,553) = 40.002, p < .001. When examined by licensure level, 72.4% of LPN/LVNs, 81.2% of RNs, 74% of APRNs, and 81% in the “other” licensure category considered COVID-19 activities an infringement on usual school nursing activities. The greater the level of education, the greater the likelihood of the respondent reporting COVID-19 activities infringing upon routine school nurse activities (72.0% of ADNs, 82.6% of BSNs, 83.7% of masters-prepared, and 87.5% of doctorally prepared respondents reported an infringement all or most of the time). School nurse administrators and consultants reported being the most impacted by the infringement of COVID-19 on their routine activities (79.8% school nurse, 89.9% nurse administrator, 75.0% dual role of school nurse and nurse administrator, 83.4% nurse consultant, and 77.8% other). Those with 6 or more years of school health experience reported more infringement upon their routine activities (0–1 year 67.9%, 2–5 years 77.7%, 6–10 years 85.0%, 11–15 years 80.4%, and 16 + years 84.4%).
The last organizational support construct considered in this study was the financial compensation respondents received for working over their typical or contractual work schedule to complete COVID-related activities (see Supplemental Table 4). A statistically significant relationship between compensation methods was noted by licensure level X2 (9, N = 1,523) = 25.804, p = .002, with LPN/LVNs most likely to receive overtime pay at a higher rate than their normal pay rate (13.8%). Only 4.5% of RNs, 0.0% of APRNS, and 9.5% of others received overtime pay at a higher rate, rather than receiving overtime pay at their normal rate, not being allowed to work beyond their normal work schedule or being required to work beyond the normal work schedule without any additional pay at all. A slight association was noted by education level, with 8.4% of ADNs, 4.0% of BSNs, 4.8% of masters-prepared, and 0.0% of doctorally prepared respondents receiving overtime pay at a higher rate. Those with the role categorized as “other” were most likely to receive overtime pay at a higher rate, while 4.6% of school nurses, 7.4% of nurse administrators, 8.3% of dual school nurse and nurse administrators, and 8.3% of nurse consultants received overtime pay at a higher rate. A near statistically significant association was noted for school health experience, with those with less experience more likely to receive overtime pay at a higher rate (0–1 year 6.7%, 2–5 years 5.0%, 6–10 years 6.4%, 11–15 years 4.7%, and 16 + years 3.8%).
School Characteristics and Organizational Support. We evaluated the same organizational support constructs (sufficient time, sufficient resources, infringement of COVID-19 on routine activities, and compensation) according to the urbanicity and region of respondents’ school(s). The results of these evaluations are found within Supplemental Tables 5–8. Only one statistically significant association was found, and that was between method of compensation for COVID-related work done outside of the normal work schedule by region X2 (9, N = 1,518) = 62.586, p < .001. The association between compensation at a higher rate by regions was not drastic, but associations were evident by regions for no compensation for extra hours worked (Northeast 58.7%, South 71.7%, Midwest 57.3%, and West 43.2%) and overtime pay at usual rate (Northeast 27.8%, South 15.0%, Midwest 29.6%, and West 36.6%).
Within the survey, respondents were asked an open-ended question about their experiences working with school leadership to address COVID-related conflicts. Some responses reflected only positive sentiments (expressions) toward their experience (n = 309), while some only reflected negative sentiments (n = 396). Others made a combination of statements, some of which were positive and some negative in nature (n = 73). Finally, some made statements of fact that did not indicate positive or negative perceptions (n = 169). Responses were coded as “at least one positive, no negative,” “at least one negative, no positive,”“at least one positive and one negative,” or “no positive or negative.” In general, respondents expressed more negative perceptions (41.8%) of organizational support from school leadership than positive (32.6%), mixed (7.8%), or neutral (17.8%) expressions. Table 3 provides exemplars of respondents’ positive and negative expressions related to perceived organizational support during COVID-related conflicts, a description of codes used to categorize the expressions, and the number of expressions representing each code.
School Nurse/School Characteristics and Expressions of Perceived Organizational Support. No statistically significant differences in perceptions existed among respondents based upon licensure, education, primary role, or years of experience working in school health (see Supplemental Table 9). Furthermore, differences in responses did not reach statistical significance for urbanicity or region. While not significant, a trend was noted for region; the Northeast (37.5%) had more positive responses than the South (32.9%), West (29.1%), or Midwest (27.8%). The Midwest not only had the lowest percentage of positive responses, but also the highest percentage of negative responses (47.3%), followed by the West (43.2%), South (42.8%), and Northeast (36.8%). See Supplemental Table 10 for more details.
Measured Organizational Support Variables (quantitative) and Perceived Organizational Support (coded qualitative responses). No statistically significant differences of perceived organizational support existed among ordinal responses for measured organizational support variables of sufficient time for COVID-related activities, COVID-infringement upon routine school nurse activities, and employer compensation for time worked beyond the normal work schedule. However, a statistically significant difference in perceived organizational support was noted for the varied reports of having sufficient resources to complete COVID-related activities X2 (9, N = 946) = 38.289, p < .001. For those who reported having sufficient resources all of the time, 48.4% provided only positive expressions of perceived organizational support through COVID-19 conflicts while 29.1% responded with negative expressions. However, for those who reported never having sufficient resources, only 17.4% provided only positive expressions of perceived support and 63% responded only negatively to the open-ended question. While not statistically significant, we identified similar trends of alignment with quantitative and qualitative responses for COVID-19 infringement upon routine activities and employer compensation (see Supplemental Table 11).
Many school nurses, school nurse administrators, and school nurse consultants working during the COVID-19 pandemic did so with increased workload, less than ideal resources, and inadequate compensation. Prior to this study, it was unclear if these well-reported job changes and struggles (Lowe et al., 2023) affected all school nurses similarly and if there was any relationship between these work experiences and perceived organizational support from school leadership. Perceived organizational support has historically been described as employees’ perceptions about the extent to which an organization cares about their well-being and appreciates their work contributions (Rhoades & Eisenberger, 2002). Examining school nurses’ experiences during the COVID-19 pandemic through this lens of organizational support reveals key areas of concern for the school nursing specialty and opportunities for school leaders.
School nurses’ workload and work activities, already challenging prior to the COVID-19 pandemic (Powell et al., 2018), changed drastically due to the COVID-19 pandemic. A Cochrane review of 38 studies worldwide detailed a broad range of strategies implemented in the school setting, often led by school nurses, to allow schools to safely reopen or stay open during the COVID-19 pandemic (Krishnaratne et al., 2022). Strategies included reducing contact and transmission; making in-person learning safer through wearing masks, improving ventilation, and handwashing; and surveillance and screening for symptoms, testing, and isolating sick or potentially sick students/school personnel. These strategies positively impacted control of transmission and healthcare utilization, but not without consequences. The findings from our study of a national sample of school nurses support that most felt they had insufficient time to complete these additional responsibilities, and this impacted their ability to meet their other school nurse activities.
School nurses in our study reported additional consequences from the lack of time to complete both COVID-19 mitigation strategies and their other school nurse responsibilities. These included infringement on their usual role in providing care for students with complex health and social needs, particularly at a time when these students may have been at increased physical and mental health risk. Consequences due to COVID-19 mitigation strategies have been documented in other studies as well. Kratzer and colleagues’ (2022) Cochrane review of 18 studies identified unintended consequences for both school personnel and students, including changes in school performance and mental health/anxiety. A study from the United Kingdom provided insight into school nurses’ concerns about the ability to provide adequate nursing services when required to do so remotely during the COVID-19 pandemic. These nurses expressed concerns about assessing students’ wellbeing using a digital platform during a time when mental health concerns dramatically increased (Sammut et al., 2023).
Prior studies have not identified school nurse characteristics associated with greater perceived impact from COVID-19 responsibilities. Findings from our study indicate that nurses who had higher level of education, more years of experience, and those with dual roles (school nurse and school nurse administrator) were more likely to report negative consequences from COVID-19 mitigation strategies, such as less time to complete their tasks and inadequate resources. It is likely that school nurses with more education, experience, and role authority had more school nursing responsibilities prior to COVID-19 as well as a greater ability to identify and address student consequences due to COVID-19. School nurses with increased knowledge, experience, and likelihood of identifying and addressing student consequences would thus be more likely to report having less available time to meet the additional activities required to manage COVID-19. These more educated and experienced school nurses may have also been more aware of resource needs and therefore more likely to report inadequate resources.
The changing workload of school nurses due to COVID-19 and its consequences have affected the school nursing profession, both positively and negatively. In a scoping review of school nurses’ work during the COVID-19 pandemic, school nurses were positively touted for their resilience, expansion of public health efforts, and innovative efforts to adapt their practice to provide essential care to students and their families (Cook et al., 2023). However, the review also highlighted the negative effects on the school nursing profession, including (a) inadequacies in staffing, resources, and support that have prevented school nurses from practicing to the full extent of their training and (b) experiencing the backlash of controversies surrounding masking, isolation, and surveillance related to COVID-19 (Cook et al., 2023). Amid such experiences, a recent CDC survey study found 82.4% of school nurses felt inadequately compensated for their work (Merkle et al., 2023). Our study highlights inadequate organizational support, particularly in the form of compensation, for school nurses, especially those with more education, experience, and increased role authority.
In our study, school nurses encountered many COVID- related conflicts among state and county departments of health and education, school personnel, and families. School leaders’ response during these conflicts offered opportunities for nurses to experience positive and negative perceived organizational support. School nurses in our study with poor perceived organizational support from school leaders reported sentiments such as, “I’m beyond burned out.” In a study of Taiwanese school nurses, burnout from COVID-19-related job stressors and negative organizational support was associated with poorer school nurse mental health (Chen et al., 2023). Results from a recent CDC study indicate 44.8% of school nurses who worked during the pandemic experienced symptoms of at least one adverse mental health condition, 30.4% reported symptoms of PTSD, and 4.3% reported suicidal ideation (Merkle et al., 2023). A pivotal finding of the CDC study was an association between school nurses feeling supported by school leadership and decreased reports of symptoms of anxiety, depression, PTSD, and suicidal ideation (Merkle et al., 2023). Similarly, school nurses were less likely to report mental health symptoms if they agreed with the way school leadership responded to COVID-19 risks or reported adequate staffing support (Merkle et al., 2023).
Building upon the CDC study findings (Merkle et al., 2023), our study contributes to conceptualizing the poor organizational support during the COVID-19 pandemic that contributed to school nurses’ psychological stress and potential burnout. School nurse professional well-being, including work-related stress and burnout, is a critical concern for the school nursing workforce moving forward. Within our study, management of new job tasks and lack of resources were common work stressors related to organizational support that could contribute to burnout and poorer school nurse mental and professional well-being. Left unchecked, increasing burnout could result in higher turnover rates in the profession, which could have a negative impact on the quality of care students receive.
The reported results should be considered within the following limitations identified for this study. The first limitation is related to the convenience sample, with responses reflecting the experiences of NASN members that may differ from the school nurses who were without the support and resources of NASN. Also, the convenience sampling did not account for diversity in demographics such as race, ethnicity, or gender. Future studies should include sampling of school nurses outside the NASN membership for comparison, perhaps collaborating with state school nurse consultants with greater access to NASN non-members. The second limitation is related to the self-reporting measure that was only evaluated for content and face validity and appropriateness by expert school nurses before dissemination. This one-time self-reporting measure did not allow for clarification by participants and did not account for measuring changes in organization support over time. The third limitation is related to the data analysis plan that was derived after the initial data collection. This study considered only a subset of variables that make up the broader definition of organizational support. The last limitation is related to the specificity of questions related to perceived organizational support. Organizational support perceptions were extrapolated from responses to questions with a broader focus and may have resulted in an oversimplification of the school nurse perceptions of organizational support.
Despite several limitations, this study also has two key strengths. First, this study is heavily informed by existing organizational support literature as well as recent school nurse research findings related to professional well-being during the COVID-19 pandemic. Second, school nurses with experience practicing during the pandemic contributed to the study design, data analysis, and interpretation and dissemination of results.
This study of a national sample of school nurses in the United States documents the relationships between school nurse/school characteristics, measured organizational supports, and perceived organizational support while providing care during the COVID-19 pandemic. Understanding organizational support for school nurses is important because increased work stressors, decreased perception of support, and their documented association with mental health and professional well-being have a direct impact on a school’s climate. The school climate represents the overall school culture and interpersonal environment of a school (Kraft & Falken, 2020). Strong, healthy school climates foster increased engagement and productivity of staff and employee retention. In turn, the students benefit from positive environments that value members of the school community and promote a sense of belonging. Student academic and social-emotional outcomes are positively impacted by strong, healthy school climates that include strong organizational support where staff and students “feel safe, supported, engaged, and accepted” (Prothero, 2020, para. 1).
While school nurses can and should advocate for improvements in organizational support, the onus is on school leaders to evaluate and provide appropriate workload and compensation for school nurses, whether they are practicing during a pandemic or not. School nurses can share NASN resources, such as workforce study publications and infographics, with their school leadership team, school board, and city, state, and federal policy makers to substantiate any organizational support disparities or concerns.
Based upon this study’s findings and limitations, future research should continue to explore the potential impact of organizational support on school nurse mental health and professional well-being. A follow-up study could include a thematic analysis of the open-ended responses collected in the survey. Future studies should evaluate organizational support variables at a more granular level using psychometrically tested instruments to identify more specific and theorysupported relationships and perceptions. School leaders’ efforts to rectify poor organizational support for school nurses—improved staffing, pay, training to support an expanded role in meeting students’ broad health needs, and acknowledgement of value—could be accompanied by measurement of school nurses’ perceived organizational support. Most importantly, future research and intervention development should be devoted to organizational support, its impact on the school nursing workforce, and any resulting impact on the students, families, and communities that school nurses serve.
The COVID-19 pandemic presented school nurses and educational systems with new challenges and highlighted existing challenges. The school nurse experience during COVID-19 varied in relation to years of experience, educational level, compensation, and perception of organizational support. School nurse perceptions of having sufficient time to complete COVID-related tasks and the infringement of these tasks on routine school nursing activities generally worsened as the school nurse experience and educational level increased. Reported compensation for these additional COVID-related tasks was more favorable for LPNs, but not for other licensure levels. School nurse perceptions of organizational support were positively associated with reports of having sufficient resources to address the additional demands of COVID-19 on the school nursing workload. It is essential to identify and address the lessons learned from COVID-19 in schools, not only for the school nurse experience, but also the organizational support of the larger educational system. Addressing organizational support is critical in building a healthy school climate for staff and an increased likelihood of academic success and social-emotional wellbeing for students.
The authors have no financial involvement related to this work or its findings. The authors declare that there is no conflict of interest. The authors received no financial support, other than consulting fees from NASN (AT and NC), for the research, authorship, and/or publication of this article.
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
The authors received no financial support for the research, authorship, and/or publication of this article.
Andrea Tanner https://orcid.org/0000-0002-2965-7749
Supplemental material for this article is available online.
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Andrea Tanner is a nationally certified school nurse with two decades of experience and the consulting research strategist for the National Association of School Nurses. She is also a past president of the Indiana Association of School Nurses and assistant professor at Indiana University School of Nursing in Bloomington, IN.
Mary Thompson is nurse scientist and pediatric nurse practitioner with over 30 years of experience in pediatric healthcare. Dr. Thompson is a consultant with the National Association of School Nurses. In her professional role as an Associate Director of Evidence Based Medicine at Optum Healthcare, she is part of the innovative Clinical Consistency team driving evidence-based best practice in healthcare.
Kim Stanislo is the Research, Education, and Practice Director for the National Association of School Nurses. Prior to this position, Kim was a Clinical Assistant Professor and Program Director for a School Nurse Certificate program at Ashland University and has worked in various school nursing roles since 2004. Kim also served as the State Data Coordinator for Ohio from 2016 to 2022.
Nancy Crowell is an adjunct associate professor in the School of Nursing at Georgetown University. She specializes in evaluation research in education and health care.
1 National Association of School Nurses (NASN), Silver Spring, Maryland, USA
2 National Association of School Nurses, Silver Spring, Maryland, USA
3 National Association of School Nurses, Silver Spring, Maryland, USA
4 School of Nursing, Georgetown University, Washington, District of Columbia, USA
Corresponding Author:Andrea Tanner, National Association of School Nurses (NASN), Silver Spring, Maryland, USA.Email: andrtann@iu.edu
