School-based health centers (SBHCs) and school nurses are often the only healthcare providers available to youth; however, they typically operate within parallel, yet distinct, systems. This study examined how many SBHCs serve schools with school nurses and the association between their co-location and collaboration. We examined survey data from the 2021–2022 school year for 1,486 SBHCs. Multivariable logistic regression identified characteristics associated with school nurse presence and levels of collaboration with SBHC staff. Half of the SBHCs (53%) served schools with school nurses located outside the SBHC, 33% had school nurses located inside, and 14% served schools without school nurses. The odds of reporting high collaboration were nearly four times higher when school nurses were located inside the SBHC versus outside (AOR:3.83, CI:2.45–5.98, p < 0.001), after controlling for other SBHC characteristics. Co-locating school nurses within SBHCs may increase collaboration and maximize limited resources to meet students’ health needs.
This study aimed to revisit the validated Scope of School Nursing Practice Tool (SSNPT (c)) and modify it as needed for relevance to the updated School Nursing Practice Framework, and to determine potential uses. A cross-sectional, descriptive design employing quantitative and qualitative methods was used to appraise the ongoing fidelity of the SSNPT (c) with the updated framework. Items on the SSNPT (c) achieved a scale content validity index of 99.6%. Modifications were made to the current version of the tool to address recommended language updates; no items were added or removed, thereby preserving the psychometric properties. Experts identified five potential uses for the tool: self-assessment, performance evaluation, professional development and goal setting, advocacy and stakeholder education, and program and quality improvement (benchmarking). The resulting SSNPT-R (c) is a validated tool that aligns with the updated framework and can be used to advance school nursing practice.
In response to evolving school nurse roles, the National Association of School Nurses (NASN) evaluated and updated its Framework for 21st Century School Nursing Practice™ using a three-phase process that included surveys, qualitative feedback, and interest-holder engagement. Among 878 survey respondents, most (80%) were familiar with the Framework and found it useful for guiding practice. Strong evidence of associations was observed between Framework familiarity and school nurse demographics, including licensure (χ2(3) = 21.51, p< 0.001), years of experience (χ2(4) = 58.03, p<0.001), and certification (χ2(1) = 35.22, p<0.001). Qualitative responses (n = 469) identified areas perceived as underemphasized (e.g., mental health) and sources of misconceptions or confusion. Iterative revisions informed by focus group input addressed these findings, resulting in an updated School Nursing Practice Framework™, which clarifies conceptual relationships and better reflects contemporary practice. This structured, participatory process provides a model for updating professional practice frameworks and highlights the importance of aligning conceptual tools with real-world practice.
Language barriers present challenges in the school health office, particularly for students and families with limited English proficiency (LEP). This study examines how these barriers affect school nurses’ ability to deliver effective healthcare and their perceptions of how language may affect student health. This qualitative descriptive study includes semistructured interviews with 16 school nurses. The data were analyzed through qualitative content analysis. The analysis revealed one overarching theme, Communication Inconsistencies Require Adapting in the Moment, with three subthemes: Accessing, Implementing, and Trusting Interpretation and Translation; Navigating Role Strain; and Missing or Delayed Care as a Result of Miscommunication . When language barriers exist, school nurses must navigate added complexities to provide student care. Applying Leininger's Transcultural Nursing Theory to the School Nursing Practice Framework TM aims to enhance culturally congruent school nursing practices, including advocating for policies and procedures that assist school nurses in meeting the needs of LEP students and families.
School-based stock inhaler programs de-escalate asthma symptoms, yet postprogram implementation experiences of end-users remain limited. The purpose of this study was to examine school nurse and administrator perspectives on benefits, barriers, and sustainability following an Illinois pilot stock inhaler program. Twenty participants from 14 Illinois pilot schools (urban, suburban, and rural) completed semistructured postimplementation interviews. Transcripts were analyzed using thematic analysis and compared with preimplementation interviews. Participants reported reduced emergency services activation, improved school attendance, enhanced asthma identification, and reduced staff stress. Operational challenges including documentation burden, storage logistics, and caregiver communication were described as modifiable. Compared with preimplementation, participants demonstrated greater clinical confidence and normalized stock inhaler use within routine practice. Eleven repeat interviewees emphasized expanded nonhealth staff training as a priority. Stock inhaler programs are feasible and address health equity concerns in schools. Programmatic infrastructure support, training, and clear communication protocols may enhance sustainability and scalability.
