School Nursing Practice for the 21st Century: Assessing Scope of Practice in the Current Workforce

Abstract

School nurses play a vital role in the health and readiness to learn for the nation’s 56 million students. However, wide variation exists in school nursing practice across states and school districts, impacting the school nurse’s ability to practice. No national database exists from which to examine school nursing practice and scant literature describes the school nursing workforce. This study utilized a gap analysis to examine the scope of school nursing practice in the United States. A 39-item self-assessment survey of scope of school nursing practice was developed utilizing the one existing validated tool for general nursing scope of practice, and exemplars linked to evidence based school nursing practice. Evidence links school nursing practices that exemplify school nursing standards of practice and the National Association of School Nurses (NASN)’s Framework for 21st Century School Nursing Practice with positive health and education outcomes for students and school communities. The survey tool was organized around the five principles of NASN’s Framework: Standards of Practice, Quality Improvement, Care Coordination, Community/Public Health and Leadership. Barriers to practicing to full scope were identified through the school nursing literature and included in the survey. The survey was reviewed by expert researchers and leaders in school nursing, and was then was sent to a national convenience sample of practicing school nurses. The survey was completed by 3108 practicing school nurses. Gaps were identified in four of five domains measured: Quality Improvement, Care Coordination, Community/Public Health and Leadership. Self-identified barriers to full scope of practice included inadequate resources, school/district’s expectations, and state laws and policies. Identified barriers accounted for significant variances in school nursing scope of practice. Certification status and years of experience had small but significant effects on school nursing scope of practice. Recommendations include strengthening the data infrastructure for evidence based school nursing practice, support for school nurses to implement their care coordination role for students with chronic illness, local advocacy to shape the regulations that impact school nursing practice, and mentoring school nurses in navigating the unique complexities of their role to provide population focused health care.