In a recent article in The Journal of School Health. Brink, Dale, Williamson and Nader described the results of a study comparing the activities of pediatric nurse practitioners (PNPs) and regular school nurses in school settings.' The article is certainly thought provoking. To what extent are school nurse practitioners (or pediatric nurse practitioners who work in schools) different from regular school nurses? And, if differences between the two types of nurse are not very large, what institutional or other factors might account for the lack of more significant differences?The Brink et al. article served as a stimulus for the following summary and discussion of available data that pertains to the effectiveness of school nurse practitioners (especially in terms of differences between SNPs and regular school nurses), and to possible impediments to full use of the expanded role in schools. Cumulative information demonstrates that nurse practitioners in schools d o perform different activities than regular school nurses and strongly suggests that such activities help increase and improve school health services. Two other considerations also emerge: 1) there are several important institutional factors that are at least perceived impediments to maximum use of the new role; and 2) further research is needed on the real relationships between institutional factors and nurse practitioner effectiveness.In reviewing the findings from other studies, it is helpful to differentiate among three types of variables that could be investigated: structure, process and outcome ~a r i a b l e s .~J .~ Structure variables include those institutional factors that "set the stage" for delivery of health care in schools, eg, administrative and financial support, pupil-to-nurse ratios, job requirements, responsibilities and restrictions, facilities and support personnel and physician involvement and support. Process variables describe the activities of nurses and relevant other personnel in providing health care to school children, eg, assessment skills, management plans and referral and follow-up activities. Outcome variables are the end results of activities performed and services provided; included would be such factors as the health status of children served, results of referrals and parental satisfaction with services provided. How a particular variable is categorized can be partly a function of the purpose of the study and how the variable is measured. For example, "physician involvement" might clearly be a structure variable in one study, but a process variable in another. Nevertheless, the categorization scheme provides a useful way of generally summarizing the findings from a number of studies and pointing out the areas of study that are in greatest need in terms of future research.Most of the studies conducted thus far on nurse practitioners in schools have focused on process variables that is, what activities SNPs and regular school nurses engage in and the proportions of time spent in various activities. Hilmar and McAtee used p...
