SEARCHING FOR COMMON GROUND BETWEEN SCHOOL NURSES AND SUPERINTENDENTS

FAYETTEVILLE, Ark. — A study on school nursing conducted by the University of Arkansas shows that the duties of the position are well understood both by nurses and school administrators, but the resources needed to perform those duties are consistently lacking. The findings have led to a series of recommendations that may help any state make more effective use of school nurse services.

Professors Marianne Neighbors and Kathleen Barta of the Eleanor Mann School of Nursing worked with colleagues in the UA department of educational leadership to develop the study in response to concerns voiced by Arkansas nurses. School nurses felt that too much of their time was consumed by mandatory screenings, paperwork and activities with limited impact on overall student health. Furthermore, they felt that school superintendents were not convinced of the need for school nurse services.

Neighbors, Barta and UA researchers Carleton Holt and Roland Smith — assistant professors of educational leadership and counseling — created a survey, which the team then submitted to the school nursing supervisors and superintendents of all 313 Arkansas school districts.

The survey asked each respondent to estimate the amount of time the school nurse spent on various activities; to assess the amount of time the school nurse ought to spend time performing the activities; to identify activities most important to the mission of the school; and to evaluate which activities could be delegated to other personnel.

With a return rate of 74 percent from nursing supervisors and 53 percent from superintendents, the researchers found nearly identical responses.

"I was surprised to see so much agreement between nurses and superintendents," Barta said. "The activities that took up too much time were mutually recognized, and they agreed on areas where nurses needed to spend more time. It’s a starting point for discussion on how we can redesign the workload of the school nurse."

Both nurses and superintendents reported that maintaining records, managing immunizations, administering first aid and performing screenings consumed the majority of a school nurse’s time. In fact, both groups felt that such activities often took too much of the nurse’s time, and they indicated that more time ought to be spent on policy development, health education, school health fairs and professional development.

In other words, nurses and administrators hold the same vision for school health services. According to Holt (a former superintendent, himself) this unexpected accord delivers a clear message — that the reason their vision can’t be attained has more to do with finances than with miscommunication.

"The problem isn’t disagreement. The problem is money," he said. "We need to get support behind these needs in order to open up opportunities."

Based on the survey responses, the UA research team recommends that nurses provide a broader range of services within their schools and districts. Such expanded responsibilities may include greater involvement in policy development and crisis management in the schools; developing health maintenance plans for high-needs children; and managing a school database system, where information about a child’s health status can be collected, stored and shared if the child transfers schools.

In addition, the researchers propose that support personnel be provided to perform mandatory but routine duties such as screening for head lice, reviewing immunization records and maintaining files.

Unfortunately, attaining the finances and resources to broaden a school nurse’s role can be difficult. The UA researchers hope their survey data will help persuade legislators of the importance of school nursing and the potential for expanded health education services. Furthermore, they hope to use the results to inspire creative solutions.

Holt suggests that state departments of health might allot funding to support health education in the schools. He also envisions the medical community stepping forward to donate nursing support and services to schools that don’t have their own full-time nurse. Such an arrangement could be mutually beneficial, he said — providing support to the schools while enhancing the reputation of medical practices that give back to the community.

In an effort to raise awareness and to publicize their findings and recommendations, the researchers will present the study on Aug. 7 at the National Council of Professors of Educational Administration conference in Burlington, Vt. In addition, they have presented the study at state, regional and national nursing conferences.

"We need to get the word out. Let’s start talking to the medical community, the legislature, the school district about the importance of health," Holt said. "There’s a direct tie between what school nurses do and what the state wants our school system to accomplish. Healthy kids are going to make better test scores and bigger educational advancements."