Background: School nurses are natural leaders in schools yet have limited access to formal leadership training hindering confidence and skills development.

Methods: In 2020, School Health Institute for Education and Leadership Development (SHIELD), conducted an assessment showing the limited availability of school nurse leadership training programs. SHIELD assembled a Leadership Advisory Board of 10 school nursing experts to shape a novel leadership program to fill this gap. Through an iterative program design process, we developed a comprehensive learning model with live and self-paced learning components aligned with core leadership competencies from the National Association of School Nurses and the American Nursing Association. This training model is anchored in best practices from the literature and follows a three-pronged approach to address the needs of school nurses to lead themselves, others, and organizations. The final design prioritized accessibility through an equity lens focusing on overcoming geographic and socioeconomic barriers for nurses working in Massachusetts.

Results: Over 330 school nurses have participated in the eLearning component of the course. Preliminary data showed nearly all participants: improved their understanding of the subject matter (99%), were satisfied with the program (98%), and identified actions to apply the knowledge gained from this course (94%).

Conclusion: Virtual programming using synchronous and asynchronous content can be used to deliver an accessible and evidence-based program to increase the ability of school nurses to serve as leaders and change agents in their communities.

Implications for Practice: School nurses now have access to high-quality leadership training to advance their scope of practice.

Background: School nurses need evidence-based, culturally relevant information to provide quality services to diverse students and school communities. School nurses are responsible for the well-being of hundreds to thousands of children, including those in marginalized communities and with special healthcare needs. The barriers to finding, synthesizing, and applying relevant and scientifically sound information to practice include heavy workloads, limited time, lack of awareness of or access to evidence-based information, and limited searching skills. It is believed that most clinical questions that arise in a school setting can be answered by a small number of resources. However, school nurses, many of whom work independently, may not know where to find necessary evidence-based practice information. This study seeks to understand the information needs of school nurses.

Method: A needs assessment survey of Illinois nurses working in schools was disseminated through three statewide professional listservs to determine the care-related questions school nurses ask as part of their regular duties and which resources they use to answer those questions. 405 completed surveys were analyzed. Follow-up interviews were done with 19 of the respondents to obtain more nuanced information.

Results: Results show that school nurses' information needs vary widely, and they rely on numerous sources to answer clinical questions. While most say they are comfortable searching for information, it was pointed out by several that perceived ability does not equal competence. Barriers to practicing EBP include lack of time, isolation, and low staffing levels. School nurses working in suburban areas were likelier to have adequate staffing and memberships paid by their districts. All interviewees spoke of other staff and especially administration, not understanding their role.

Conclusion: School nurses face significant challenges in staffing and student-to-nurse ratios. There are gross misperceptions about the value they provide within the school and their role is not well-understood by other staff. Students who require the most care are more likely to be in underfunded schools where nurses are spread thin. Despite all this, school nurses are motivated to learn more for the betterment of not just their students, but also their communities.

Implications for Practice: The more complex the healthcare needs of the child, the better a nurse must be at locating information that reflects best practice. School nurses can benefit from information search skills training through workshops, classes, and online modules. Medical librarians are well-positioned to develop such educational opportunities.

Background: School nurses are ideally situated to serve as a primary resource for students who have experienced adverse childhood experiences (ACEs) and provide trauma-informed care to minimize long-term effects. Children from minority and vulnerable populations experience ACEs at higher rates where access to school nurse intervention could be critical.

Method: This integrative literature review aimed to describe the types of trauma-informed care practices incorporated by school nurses. To explore the phenomenon of trauma-informed care practices of school nurses, the methodology described by Whittemore and Knafl (2005) was used for this integrative review of the literature. A comprehensive literature search was conducted amongst six databases in which ten articles were selected that satisfied the criteria. The literature was evaluated using the Johns Hopkins Research Evidence and Non-Research Appraisal Tools. Following evaluation, articles were analyzed using content analysis.

Results: Four themes were identified concerning school nurse involvement in trauma-informed care. Themes included 1) the obscurity of the role of the school nurse, 2) the lack of a trauma-informed standard of care, 3) awareness of an increasing need for trauma-informed care in schools, and 4) collaborations are critical to fostering a holistic trauma-informed care environment.

Conclusion: The findings revealed a significant gap in the literature relating to the school nurses’ role in providing trauma-informed care.

Implications for Practice: Consistent with NASN’s School Nursing Practice Framework™, suggestions for actionable interventions and future research were identified.

Background: Workplace violence is detrimental to the mental health of nurses working in schools. Workplace violence contributes to turnover rates and absenteeism. Nurses experience psychological distress and physical symptoms associated with workplace violence.

Methods: School nurses participated in a workplace violence program adapted to the school setting. Participants received education as a recorded video by an organizational leader and additional written resources surrounding a section of the workplace violence program weekly via email. The school nurses completed a Google form each week to verify their understanding of the information and provide feedback surrounding the program. The school nurses completed a General Self-Efficacy before and after the intervention.

Intervention: The Minnesota Department of Health Prevention of Violence in Health Care Toolkit served as the evidence-based intervention. It contains pertinent information to support nurses in the prevention and response to workplace violence, strategies to support diversity, equity, and inclusion within daily practice, and aligns with NASN's School Nursing Practice Framework™. Results: A total of 45 school nurses completed the post-intervention General Self-Efficacy scale of the 48 initial participants (94%). There was a statistically significant increase in self-efficacy from the pre-intervention scale in comparison to the post-intervention scale (p < 0.001). For nurses working in schools, implementing the Minnesota Department of Health Prevention of Violence in Health Care Toolkit significantly improved nursing self-efficacy in 8 weeks.

Conclusions: The toolkit proved to be successful for use among school nurses. All healthcare organizations should implement a workplace violence program and evaluate for success.

Implications for Practice: Implementation of a workplace violence program leads to improvements in nurses’ mental health, quality of life, and quality of patient care. Organizational leaders should develop a culture of safety, communicate nurse safety as a priority, and encourage reporting of workplace violence. This safe culture promotes job performance, job satisfaction, and retention which reduces nursing department costs. Workplace violence training and resources lead to highly qualified nurses, positive patient outcomes, and lower healthcare costs. Leaders need to strengthen policies surrounding workplace violence programs. Policies should be enforced and evaluated for success and improvement. Increased support from organizations, policymakers, and leaders will increase awareness and education to prevent the occurrence and repercussions associated with workplace violence.

Background: Youth mental health (MH) is a growing concern, with 49.5% of adolescents and 17.4 % of children ages 2-8 diagnosed with mental or behavioral health conditions. MH management disproportionately impacts racially and ethnically minoritized youth who experience reduced treatment initiation, maintenance, and quality of care. A recent National Association of School Nurses (NASN) consensus document highlights the value of school nurses in school-based mental and behavioral health (SBMH) teams. Using NASN’s School Nursing Practice Framework™ key principles, school nurses can improve student MH care. However, school nurses report feeling unprepared to manage student MH needs due to inconsistent training practices and have identified this as their number-one educational priority.

Method: We conducted a rapid review of the literature to examine the characteristics of existing MH training programs for pre-K-12 school nurses. This review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and articles were identified using PubMed, PsycINFO, and CINAHL databases. Peer-reviewed literature published between 2013 and 2023 that met inclusion criteria was evaluated using Rapid Critical Appraisal checklists.

Results: Eleven articles were included, and training content, structure, mode, and student and nurse outcomes were evaluated.

Conclusion: MH training improved school nurse knowledge, confidence, and preparedness to address student MH needs and positively impacted student outcomes related to MH identification, referrals, management, and reduction of symptoms.

Implications for Practice: There is an urgent need for further development of evidence-based MH training programs for school nurses and increased awareness and dissemination of existing programs.

Background/Problem: Noise-induced hearing loss may impact social and educational development. The project site hearing screening protocol did not include high-frequency screening to support social and educational development, so an evidence-based solution was sought. NASN’s School Nursing Practice Framework™ provided structure to this project using the principle of Community/Public Health with a focus on risk reduction, social determinants of health, screenings/referrals/follow-up, and population-based care (NASN, 2020).

Method: Using a quantitative quasi-experimental method of inquiry, the aim was to determine if or to what degree the implementation of the American Academy of Pediatrics (AAP)/Bright Futures guideline for high-frequency hearing screening would impact the number of referrals to an audiologist when compared to current practice among 10th-grade students in a California high school over four weeks. Data were extracted from the student information system. The total sample size was 231, with n=108 in the comparative group and n=123 in the implementation group. The p-value of 0.001 showed a statistically and clinically significant increase in the number of students referred to an audiologist.

Results: Clinical significance was noted with a 12.2% increase in referrals to an audiologist post-implementation.

Conclusion: Based on the results, the AAP/Bright Futures guideline for high-frequency hearing screening may result in increased referrals.

Implications for Practice: This project provided additional evidence that adding higher frequencies to the standard school-based screening program for adolescents is significant in the detection of potential hearing loss for this population. This evidence added to what is known about NIHL in adolescents and can be used to inform state laws governing mandated school hearing screening. School-based hearing screening programs that include higher frequencies can improve outcomes for adolescents, especially in diverse communities. Identifying potential hearing loss in adolescents decreases adverse health effects, improves social and inclusive interactions, and increases equitable access to occupational opportunities.

Background: As leaders bridging healthcare and education (National Association of School Nurses, NASN, 2023) school nurses are in short supply. For example, in Massachusetts alone, there were more than three hundred job openings for school nurses during the middle of the 2022-2023 school year. Willgerodt and Tanner (2023) recently reported that less than 66% of our nation's schools have a full-time school nurse. And since the COVID-19 pandemic, many school nurses have left school health entirely (Hale, et al., 2023). Administrators in school districts may consider nurse contractors to fill open school nurse positions... or not. Special Education Directors or Student Support Services Directors, to whom many nurse contractors report, are not nurses. Contracted school nurses need an experienced school nurse to support them. Enter the school nurse clinical advisor. Enabling school administrators to get back to the business of education, as former school nurses and school nurse administrators, school nurse clinical advisors apply their wealth of experiences to facilitate the success of school nurse contractors virtually.

Method: To explore the experiences of school nurse contractors with a virtual clinical advisor, this researcher electronically distributed an electronic multiple-choice survey to more than six hundred school nurse contractors nationwide. Answered through free text responses, the question, 'Is there anything you would like to add about your experience as a school nurse contractor and your clinical nursing advisor?' was queried and themes were explored.

Results: More than five hundred new and practiced school nurse contractors working in school settings responded to the electronic survey. Most participants stated the support they received from their virtual clinical advisor contributed to their success as school nurse contractors. The majority also rated the value of a clinical nursing advisor for nurse contractors working in schools as valuable or extremely valuable.

Conclusion: Illuminating the perspectives and experiences of school nurse contractors with a virtual clinical nursing advisor, this data may support the use of virtual clinical nursing support for new and experienced school nurse contractors placed in school settings.

Implications for Practice: The results of this study may support access to virtual clinical nursing support to facilitate the successful placement of school nurse contractors hired to fill vacant school nurse positions nationwide.

Background: Electronic health information exchange (HIE) is an information system that moves standardized, electronic information among a network of providers and organizations. Regional HIEs exist in most states; however, there is a gap in knowledge for their use to share information electronically with school nurses. This integrated review aimed to obtain evidence-based information on HIEs in the U.S. and the implications for school nurses.

Method: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the socioecological framework, the literature review utilized bibliographic databases (PubMed, CINAHL) to search for peer-reviewed manuscripts.

Results: The search resulted in 425 articles. The review is in progress, with two reviewers initially screening the articles using Covidence systematic review software. The data will be extracted from the final chosen manuscripts and mapped to the four system levels of the socioecological model: interpersonal, intrapersonal, institutional, and community/policy.

Conclusion: The final results of this systematic review will increase school nurses' and policymakers' knowledge of the concepts important in electronic information sharing. This knowledge will inform school nurses to begin conversations with their regional HIEs about the feasibility of including them in the electronic sharing of information.

Implications for Practice: HIEs have not been recognized as a mode of communication between school nurses and healthcare systems to support NASN’s School Nursing Practice Framework™ key principles of care coordination and community public health. When school nurses and healthcare systems leverage information systems like HIEs to exchange medical information, disparities resulting from social determinants of health (SDOH), such as language barriers, chronic conditions, and healthcare access, can be addressed. Therefore, by responding to these SDOHs, HIEs promote an environment of diversity, equity, and inclusion by breaking down systemic communication barriers and gaining a more holistic understanding of the students' healthcare needs.

Background: Required through state mandates, school nurses maintain immunization and physical examination records to ensure student health and safety. In Illinois, students with unmet health requirements may not attend school (first-day exclusion). NASN’s School Nursing Practice Framework™ guides school nurses to address the needs of diverse student populations, at times facilitating access to health services. With a dearth of literature exploring health-related exclusion and interventions to minimize existing health access disparities, this quality improvement project aims to evaluate the effectiveness of three interventions in reducing first-day exclusion of ninth & twelfth grade students in Central Illinois.

Method: Using the Model for Improvement, stakeholders planned three interventions at a Central Illinois high school. Interventions were conducted in sequential order: dissemination of a resource guide, personal telephone communication, and an on-site clinic offering physical examinations and immunizations.

Results: Data was collected utilizing educational healthcare software. Two resource guides provided asynchronous support for families. Nearing the school year, several non-compliant families (n=93) received a personalized phone call. Health examinations (n=14) and immunizations (n=8) were provided at two on-site clinics. Insurance payors reimbursed $1,025.66 for health examinations.

Conclusion: School nurses can reduce first-day exclusion by engaging school administrators and community organizations in innovative partnerships.

Implications for Practice: Practice recommendations include improved school health data management, expanded school nurse autonomy, and promotion of student agency. The next step is the formation of a district nurse work group, guiding future PDSA cycles to limit first-day exclusions and promote program sustainability.

Background/Problem: The school nurse is the most accessible healthcare provider to our youth. They are uniquely positioned to be the first to encounter students who experience violence and trauma, which has become a significant public health concern. Adverse Childhood Experiences (ACEs) are linked to poor health habits, chronic health conditions, early death, and high school dropout rates. School nurses understand school clinics are where healing begins, embracing every type of diversity and honoring individuality. Unfortunately, school nurses may lack the knowledge, experience, and comfort when caring for students impacted by violence and trauma due to insufficient education and training in forensic nursing care.

Method: A needs assessment survey was conducted to identify nursing knowledge, experience, and comfort level regarding the evaluation and response to students affected by trauma and violence.

Results: The gap analysis identified a varying degree of knowledge for novice to expert school nurses. Many reported a knowledge deficit regarding the response and follow-up care for students with forensic concerns. Supportive factors and challenges that assisted or prevented school nurses from providing care were identified.

Conclusion: Forensic education for school nurses is vital for a student’s education, well-being, and success. Early identification of ACEs requires timely, evidence-based interventions to mitigate injury from a psycho-social and physical nature. Additionally, adherence to a trauma-informed, therapeutic process is critical to advancing positive outcomes.

Implications for Practice: Forensic education for school nurses is a strategic endeavor to aid in the reduction of dropout rates and adverse effects of ACEs. Receiving forensic education will improve students' access to quality, equitable healthcare while supporting NASN’s School Nursing Practice Framework™. The challenges experienced by school nurses to provide care indicate the need for education to support best evidence-based practices and empower school nurses to practice to the full scope of their license.

Background: School nurses support students with diverse medical conditions and specialized needs. In order to meet the needs of all students, school nurses must incorporate evidence-based practice consistently across all school settings. Maintenance and assessment of clinical competency is an essential standard in school nursing practice. A primary objective of this education was to standardize clinical practice and ensure safe and competent care. Critical skills and clinical competencies had not previously been measured or provided in a formal capacity in the Red Clay Consolidated School District.

Method: Educational topics were chosen based on the top chronic health conditions of students. Additionally, medication error data and high-risk low-volume skills were included. Education included a mixture of didactic and manipulative components. Baseline knowledge was determined using a pre-assessment survey.

Results: Over 200 nurses statewide participated in the critical skills and school nurse competency training. Once all stations were complete, a post-assessment was administered, and the results were compared to the pre-assessment findings. Pre- and post-assessment data demonstrated an increase in clinical knowledge in all topic areas.

Conclusion: Annual skills education and competency training were an effective way to increase knowledge and promote safe, standardized, and evidence-based clinical care in the school setting. Nurses found value in content areas and educational design.

Implications for Practice: The results demonstrate the need for annual education and training to ensure and maintain clinical competency. The educational design of this program can be adapted to meet the needs of students and school nurses in various school health settings.

Background: Two Delaware school nurses, while involved in their Parent Teacher Organization (PTO), realized the health value of collaborating with their greater school community. Seeing the school community as "one patient", they were interested in pulling levers that would improve resiliency to buoy community health and morale while recovering from the COVID pandemic. The experience emphasized that school nurses can be collaborative problem solvers of health deficits by assessing the community's Social Determinants of Health (SDOH). School social capital, an intangible value related to a student’s social relationships in the school setting, was found to be a mitigating factor for adversity related to poor SDOH and can be grown with key stakeholders by improving local chapter PTOs, an existing and well-established national organization.

Methods: A systematic literature review was the research method used for this project to explore community resilience factors and SDOH. School strengths and challenges were identified to provide collective resources for targeted interventions.

Results: Reviewing the literature identified health benefits found when students are in an inclusive community that encourages and supports them. Specifically, improving school social capital was found to be a powerful intervention to mitigate health outcomes typically found in students with the poorest SDOH. Increasing school social capital is associated with lower BMI, lower risk of binge drinking, improved mental health, lower risk of tobacco use, and improved surveillance of high-risk youth.

Conclusion: Findings from the literature search guided the school nurses' influence and reinforced the importance of school nurses collaborating with their greater communities. PTOs offer opportunities to build relationships with community members, raise funds to increase equitable access for school trips and classroom enrichment, and most importantly influence school social capital. Future research should identify school health outcomes that can be measured in order to evaluate change related to school nurse involvement in PTOs.

Implications for Practice: Detailing a roadmap for PTO involvement and encouraging evidence-based participation in local community organizations.