The Role of the School Nurse in Increasing Instructional Time Using Multi-Tiered Systems of Support for Behavior (MTSS-B): A Quality Improvement Project

Abstract

Frequent visits to the health office can lead to considerable time spent out of the classroom along with affecting relationships and health office resources and staffing. This article features the practice component of continuous quality improvement in the principal of quality improvement in the Framework for the 21st Century School Nursing Practice™ and is the third in a series focusing on the Framework. The article discusses how using multi-tiered systems of support for behavior (MTSS-B) to create expectations for the health office environment, along with intense, individualized plans for specific students, were successful in decreasing health office visits across the school district, with the ultimate goal of increasing instructional time. Outcome data revealed reductions in health office visits with a district-wide decrease of 4.1% one-year postimplementation of the project. More importantly, school nurses are providing better trauma-informed care with intentionality while still meeting the needs of students.

State School Nurse Consultants Issue RN Action Agendas

“…School nurses function at each of the three MTSS levels: providing systemwide prevention and health promotion strategies for all, targeted group interventions for some students who are at risk, and intensive individual services for the few who are in high need. The third level includes children with chronic health conditions and families with multiple economic and social needs who require supports so children can attend school consistently and participate fully in regular and special education (Bobo et al, 2023; Rau & Lytle, 2020).…”

Designing School Health Services to Provide Multi-Tiered Systems of Support (MTSS) for All Students

“…Engage families and strategic community members to expand capacity for meeting the often-fluid needs of students moving across and between tiers and levels of prevention. Identify the data that will be used to drive decisions when identifying student needs and evaluating progress within each tier/level of prevention; and include patterns and trends of school health office student visit data (Rau & Little, 2020).…”