An Appraisal of School Nurse Health Services and Programs in North Carolina Public Schools, 2006–2016

Abstract

School nurses are instrumental in delivering health services to children in schools. This study addresses the gap in school nurse health services data, examining patterns in health services and programs provided by school nurses between 2006 and 2016 for students in North Carolina public schools. This study focused on services and programs related to asthma and diabetes, two health conditions that affect millions of children in the United States. Over 1.46 million children attend North Carolina public schools. In 2006, the average school nurse-to-student ratio was 1:1,340. By 2016, the average school nurse-to-student ratio decreased to 1:1,086, a 19% improvement. Over the 10-year study time period, there were statistically significant increases in the rate of occurrence of all health conditions that students received health services for ( p < .001), asthma ( p < .001), type I diabetes ( p = .0003), orders for all health-care procedures ( p = .01), all school nurse–led health counseling ( p = .004), and diabetes health counseling ( p < .01).

Impact of School Nurse Ratios and Health Services on Selected Student Health and Education Outcomes: North Carolina, 2011‐2016

“…Prior studies have reported that school staff, despite lacking a medical background, with proper training and oversight by the school nurse, can facilitate a safe environment for students and assist them with their diabetes care until a nurse is available onsite 24 . North Carolina school nurses offer a multitude of trainings for teachers and other school staff in the building 21 …”

“…School nurses representing all 115 public school districts in NC reported data each school year. These data represent 1.46 million students enrolled in public elementary (K‐5th grades), middle (6th‐8th grades), and high (9th‐12th grades) schools 21 . The sample included five school years (2011/2012 through 2015/2016) for which there were complete data on nursing interventions and student outcomes for asthma and diabetes.…”

“…24 North Carolina school nurses offer a multitude of trainings for teachers and other school staff in the building. 21 School nurse case management is a health service for students with assessed needs in chronic or complex health conditions, providing structured nursing time and an individualized plan to help students learn to manage their chronic health condition, as evidenced in the improved HbA1c in the NC students with diabetes. Previous studies also found that case management by school nurses was associated with students meeting goals to establish a safe environment, administer insulin, manage insulin regimen, and decrease symptom/treatment problems.…”

A School Nurse Competency Framework for Continuing Education

“…School nurses should be able to respond appropriately to a variety of health needs of students and staff in schools. Asthma, attention deficit hyperactivity disorder, and severe allergies were the most common health conditions in schools between 2006 and 2016 [ 21 ]. However, the outcomes of school nurse-led practice regarding mental health [ 22 ] and pain have not been satisfactory [ 23 ].…”

“…However, one survey identified a gap between the importance and performance for quality improvement and community/public health practice [ 27 ]. Best et al [ 21 ] mentioned noticeable increases in health services for asthma, type I diabetes, healthcare procedures, school nurse-led health counseling, and diabetes health counseling. There are more children and adolescents with chronic and special public health problems now than in the past.…”