NASN position statement: caseload assignments

Effects of the COVID 19 Pandemic on School Nurses' Resiliency and Ability to Cope: A Mixed Methods Study in the State of Hawaii

This mixed-method study examined school nurses' experiences during the Coronavirus Disease 2019 pandemic related to role change, psychological feelings, and coping/resiliency in the State of Hawaii. A total of 30 school nurses completed a Brief Resilience Coping Scale plus a series of open-ended questions in January 2022. On the coping scale, over 40% of participants scored high, 52% scored medium, and 7% scored a low resilient/coping level. We did not identify any association between coping level and participant characteristics. Three qualitative themes emerged: 1) school nurses experience chronic negative emotions related to the pandemic, 2) school nurses demonstrate attributes of resilience, and 3) school nurses utilize positive coping techniques. The pandemic created significant stresses and negative emotions among school nurses. Yet, school nurses reported effective coping strategies and demonstrated strength/resilience. Support and open communication between school nurses, their employers, and other school-based stakeholders is needed to provide continued support for school nurses.

Attitudes and Feelings towards the Work of Teachers Who Had a School Nurse in Their Educational Center during the COVID-19 Pandemic

The objective of this study was to analyze the influence of the availability of a health professional on the beliefs, attitudes, and work feelings of teaching staff when facing the COVID-19 pandemic. This is a two-phase study: In the first one, the Delphi technique was used to update an instrument used by the authors in a previous investigation in 2020. The second phase was a cross-sectional, descriptive, and comparative study, carried out through an electronic questionnaire distributed among the teaching staff of the Autonomous Community of the Canary Islands (Spain), during the first two months of the 2021/22 academic year, in the midst of the fifth wave of COVID-19. Data were analyzed using Pearson's chi-squared test and the linear trend test. The reasons for advantages were analyzed and the dimensions of the questionnaire were compared between the groups studied (with or without a healthcare professional in the center). Out of 640 teachers in the study, 14.7% (n = 94) stated that they had a reference professional with health training in their educational center (a school nurse) for the management of possible cases of COVID-19. Significant differences were found in five of the nine dimensions studied between the groups of teachers analyzed. Teachers who had a health professional, specifically a nurse, during the pandemic indicated that they felt safer in their educational center, as they perceived that they had more personal protective equipment (OR = 2.03, [95% CI: 1.23-3.35]; p = 0.006). They were also more committed (OR = 1.89, [95% CI: 1.04-3.46]; p = 0.038) with their educational work and assumed more obligations (OR = 1.87, [95% CI: 1.01-3.44]; p = 0.045) and risks (OR = 2.82, [95% CI: 1.13-7.07]; p = 0.027). In addition, they presented fewer feelings of burnout (OR = 0.63, [95% CI: 0.41-0.98]; p = 0.041). These results indicate that having nurses in educational centers improves teachers' ability to cope with a pandemic situation.

Medication Administration Practices in United States' Schools: A Systematic Review and Meta-synthesis

Schools often provide medication management to children at school, yet, most U.S. schools lack a full-time, licensed nurse. Schools rely heavily on unlicensed assistive personnel (UAP) to perform such tasks. This systematic review examined medication management among K-12 school nurses. Keyword searches in three databases were performed. We included studies that examined: (a) K-12 charter, private/parochial, or public schools, (b) UAPs and licensed nurses, (c) policies and practices for medication management, or (d) nurse delegation laws. Three concepts were synthesized: (a) level of training, (b) nurse delegation, and (c) emergency medications. One-hundred twelve articles were screened. Of these, 37.5% (42/112) were comprehensively reviewed. Eighty-one percent discussed level of training, 69% nurse delegation, and 57% emergency medications. Succinct and consistent policies within and across the United States aimed at increasing access to emergency medications in schools remain necessary.

Evaluating the Financial Sustainability of the School-Based Telemedicine Asthma Management Program

Using telemedicine to improve asthma management in underserved communities has been shown to be highly effective. However, program operating costs are perceived as the main barrier to dissemination and scaling up. This study evaluated whether a novel, evidence-based School-Based Telemedicine Enhanced Asthma Management (SB-TEAM) program, designed to overcome barriers to care for families of urban school-aged children, can be financially sustainable in real-world urban school settings. Eligible children (n = 400) had physician-diagnosed asthma with persistent or poorly controlled symptoms at baseline. Total costs included the cost of implementing and running the SB-TEAM program, asthma-related health care costs, cost of caregiver lost productivity in wages related to child illness, and school absenteeism fees. Using data from the SB-TEAM study and national data on wages and equipment costs, the authors modeled low, actual, and high-cost scenarios. The actual cost of administering the SB-TEAM program averaged $344 per child. Expenses incurred by families for medical care ($982), caregiver productivity cost ($415), and school absenteeism costs ($284) in SB-TEAM were not different from the costs in the control group ($1594, $492, and $318 [P > 0.05]). The study findings remained robust under sensitivity analyses for various state- and school-specific regulations, staffing requirements, and wages. The authors concluded that the SB-TEAM program operating costs may be offset by the reduction in health care costs, caregiver lost wages, and school absenteeism associated with the program health benefit.

Improving School Nurse Pain Assessment Practices for Students With Intellectual Disability

School nurses are afforded minimal resources related to assessing pain in students with intellectual disability (ID) and have called for continuing education. The purpose of this study was to measure the effectiveness of an education program regarding best practices for assessing pain in students with ID. Educational sessions were presented to 248 school nurses. Pre-, post-, and follow-up surveys measured (1) difficulty school nurses face when assessing pain, (2) knowledge and use of pain assessment methods, and (3) intent to change and actual changes to professional practices. Participants experienced less difficulty assessing pain following the educational program. Almost all participants intended to change pain assessment practices, but large caseloads limited new practice adoption. Policy makers must consider population size and acuity when determining school nurse staffing. Trainings and other resources should be made available to school nurses in order to make pain assessments for students with ID more thorough and efficient.