MO DHSS School Health
Overview
Prior to collecting data, the school nurse should consider how the data will be used. It is more important to collect small amounts of meaningful data versus a large quantity of unnecessary data (Guthrie, 2019). In deciding what data to collect, it is essential to consider who you need to share the information with, for instance, the school nurse’s supervisor, the principal, superintendent, and/or the school board. In addition to these common stakeholders, the school nurse should also consider if there are others that should be included. For instance, are there others that “have influence over decisions that affect your work” (Johnson, 2019, p. 340).
When the school nurse has decided what data to collect they must develop a workflow to ensure that the information is documented using a standardized process. If the data is being collected on paper, the school nurse should consider developing a template that can facilitate the collection of consistent and accurate data (Guthrie, 2019).
Once the school nurse has collected the necessary data, the data must then be translated and presented to the stakeholders in a way that facilitates their understanding of the importance of the school nurse’s role. When sharing school health data with educational stakeholders, it is important to remember that the mission of schools is to facilitate academic success and prepare students to be active and responsible citizens. The school nurse should highlight how the data is associated with educational measures and outcomes such as attendance, access to learning/accommodations, student/parent/family engagement, and school climate (Stanislo, 2024).
Considerations
- Who are the stakeholders?
- What are the priorities of the stakeholders?
- Do you have access to data that relates to their priorities?
- What data do the stakeholders want to see?
- What opportunities do you have to communicate the data to the stakeholders? (i.e., meetings, presentations, written reports, stories?)
- Stories are a powerful way to share data with stakeholders, consider sharing (with the appropriate consent) a story about a change a student/family made because of your intervention.
- Are there indicators from the school district surveys (i.e., School Climate Survey) that the school district is working to improve?
- Does the school nurse’s role have an impact on these indicators?
- Examples from the School Climate Survey:
- “My child receives the educational support they need.”
- 504 Plans, IHCPs
- “If my child has a problem, there is someone at school who can help.”
- Data regarding the number of students that the school nurse is providing active case management
- The number of students who seek out the school nurse to assist with a problem or issue
- “The school has programs that develop my child’s self-control, responsibility, problem solving, and respect for others.”
- The number of students that have IHCPs that include interventions related to transition planning, introducing, or increasing student’s self-management of health condition.
- “My child receives the educational support they need.”
- Examples from the School Climate Survey:
- Does the school nurse’s role have an impact on these indicators?
Confidentiality
- It is important to ensure that all personally identifiable information is removed from the data that is being shared.
- In some instances, for example, when there are a small number of students who have a specific health diagnosis, sharing the data is not recommended as it may make the student’s identity easily distinguishable.
- Special considerations should be made if the district has a small enrollment.
- If the school nurse will be sharing stories about a student(s) and/or family(ies), the school nurse should obtain consent from the parents/guardian and student, if appropriate.
- The school nurse may also want to consider changing details about the student to help protect their identify, even if consent is obtained.
Sample Report
Health Room Visits
A very relevant data source are the number of students that are seen in the health room daily. Although the total number of students seen could provide some meaningful data related to workload, monitoring the reasons for the visits and the disposition after being evaluated (return to class, sent home, or 911 call) can demonstrate the school nurse’s role in in-class time and attendance.
| Student Visits | Sept | Oct | Nov | Dec | Jan | Feb | March | April | May | June | Total |
| Returned to Class | |||||||||||
| Sent Home | |||||||||||
| 911/Emergency Medical Services (EMS) Calls |
Students with Chronic Health Conditions
Although it may be tempting to share data on the total number of students with chronic health conditions, people may lose interest in a long list of various health conditions and numbers. Focusing on health conditions that have the potential to result in emergency situations and require substantial case management, education, and training of not only the student but also school staff, including unlicensed assistive personnel (UAPs) and teachers, is a more compelling way of highlighting the school nurse’s important role.
| Students with Life Threatening Health Conditions | Total |
| # of students with an asthma diagnosis | |
| # of students with Type 1 Diabetes diagnosis | |
| # of students with Type 2 Diabetes diagnosis | |
| # of students with seizure disorder diagnosis | |
| # of students with life threatening allergy (anaphylactic reaction diagnosis) | |
| # of students with any cardiac condition diagnosis |
Students with Complex Medical Needs
Another important aggregate of students to collect data on are students with complex health conditions. This could include students who require daily nursing interventions such as gastrostomy tube feedings, tracheostomy suctioning, or urinary catheterization. It could also include students who have medical devices that require ongoing supervision such as students with continuous glucose monitoring or insulin pumps.
| # of students with complex medical needs* | |
| # of students who receive daily nursing interventions | |
| # of school staff who have been trained to respond to the health needs of these students |
* It is not recommended to share data if there are a small number of students with complex medical needs since it may make the student’s identity easily distinguishable
Health Issues that Have Greatest Impact on Attendance
Chronic absenteeism is a proven early warning sign of academic risk and school dropout (Healthy Schools Campaign, 2017, p. 1). The health conditions listed below are associated with increased risk of chronic absenteeism. School nurses should emphasize data that illustrates how they are supporting students with health conditions that are associated with increased risk of chronic absenteeism. The school nurse could demonstrate how they are providing case management for students to help prevent absenteeism and how they are actively working to support students with these health conditions that are currently experiencing chronic absenteeism.
| Asthma | |
| Oral Health | |
| Mental/Behavioral Health (ADD, anxiety, depression, substance use) | |
| Food Insecurity | |
| Acute Illness (influenza*) |
*While there are a number of acute illnesses that impact student attendance, focusing on influenza allows the school nurse to illustrate their role in communicable disease prevention.
Medications
The number of medications administered is another data point that may be of interest to school leaders. The information can illuminate the process management that the school nurse needs to ensure is in place along with the education and training that needs to occur throughout the year. In addition to daily medication information, highlighting the number of emergency medications administered draws attention to the role the school nurse plays in emergency preparedness and response.
| Daily and Over-the-Counter Medications | Administered by | |||
| School nurse | LPN | UAP | Student | |
| # of students taking daily medications | ||||
| # of students with parent authorization for OTC medications | ||||
| Emergency Medications Administered | ||||
| # doses of epinephrine administered | ||||
| # doses of seizure emergency medications | ||||
| # doses of glucagon | ||||
| # doses of naloxone | ||||
Emergency Preparedness and Response
Schools are responsible for ensuring student safety. The school nurse should highlight their role in emergency preparedness. Not only is this exemplified in emergency medication administered data, the school nurse can also provide evidence of their role by collecting data on Emergency Action Plans and training and education.
| # of students with emergency action plans (EAP) | |
| # of EAPs that include planning for shelter-in-place, lock-down and evacuation situations | |
| # of staff who have been educated to respond to an emergency* | |
| # of emergency drills that have been conducted | |
| # of emergency responses that school staff have responded to | |
| Does the school district stock epinephrine? | |
| Does the school district stock asthma-related rescue medications? | |
| Does the school district stock naloxone? | |
| Does the school have an AED? |
*include the number of staff who have been trained to administer stock and student-specific emergency medications.
Advocating Educational Attainment
Schools are required to track chronic absenteeism rates and most states utilize this measure for school funding, grading of school systems, and how effective schools are in educating students (Stanislo, 2023, p. 312). The school nurse should consider collecting data that highlights the school nurse’s role in advocating for educational attainment. This could include data that demonstrates the school nurse’s role in preventing absenteeism and identifying and implementing interventions that support the student’s access to education.
| % of students sent back to class versus sent home | |
| # of students who have chronic absenteeism* | |
| # of students with chronic illnesses who have chronic absenteeism | |
| Number of IEP meetings attended | |
| Number of 504 Plan meetings attended | |
| Number of students with individualized health care plans |
* A student who is chronically absent has missed at least 10% of school days, for any reason (Attendance Works, 2018).
Process Improvement
School leaders may be familiar with the day-to-day interventions that school nurses provide (medication administration, training and education of UAPs, nursing procedures). The school nurse should consider collecting and presenting data that highlights some of the less familiar aspects of the school nurse’s role, process improvement. Sharing the data and possibly a case study could demonstrate the school nurse’s leadership role with the school and their attention and commitment to quality improvement. This example provides data that could be collected related to medication administration process improvement.
| Medication administration audits completed | |
| Additional training and education provided to staff | |
| Medication administration process changes made to increase safety |
Addressing Student and Family Social Needs
As with health conditions that can contribute to chronic absenteeism, unmet social needs can significantly impact academic achievement and school attendance. The stakeholders may not be aware of the role of the school nurse in assessing for and responding to identified student and family social needs. Sharing this data also allows the school nurse to highlight their collaboration with other student support staff, such as the school social worker along with community social service and health care providers.
| # of students assisted in accessing health care | |
| # of students assisted in accessing medication | |
| # of students assisted in accessing housing | |
| # of students assisted in accessing transportation | |
| # of students assisted in accessing food |
Health Screenings
The ability to properly hear and see are crucial to achieving academic success. Collecting data regarding the number of students screened and referred along with the number of students who receive follow-up can demonstrate how the school nurse develops processes to identify and provide case management to students with health conditions, that with treatment, have the potential to improve academic outcomes.
| Screening | Total Referrals Sent | Referrals Completed | Follow Up | ||
| Eye Glasses Prescribed | Hearing Aids Prescribed | Dental Treatment Provided | |||
| Hearing | |||||
| Vision | |||||
| Dental | |||||
Communicable Disease Prevention
One way that school nurses minimize health-related barriers to learning is by surveillance, case management, and referral. This data also demonstrates how the school nurse assists the superintendent in meeting state regulations related to immunization compliance reporting*.
| % of students who are up-to-date on immunizations | |
| # of students who were referred for immunizations | |
| # of students who received required immunizations |
* Chapter 28—Immunization 19 CSR 20-28.010 Immunization Requirements for School Children
Staffing
Providing school leaders with information regarding current staffing allows the school nurse to engage in dialogue regarding whether the staffing resources are appropriate for the identified health needs of the students.
| Total number of RN FTEs with an assigned caseload providing direct services | |
| Total number of LPN FTEs providing direct services to all students | |
| Total number of non-RN, non-LPN, Health aides FTEs that provide regular health services to all students | |
| Total number of supplemental/float RN FTEs providing direct services to all students | |
| Total number of RN FTEs with special assignments (medically fragile children, e.g., 1:1 etc.) |
Resources:
- Bergren, M. D., & Johnson, K. (2019). Data sharing. NASN School Nurse (Print), 34(4), 211–213. https://doi.org/10.1177/1942602X19852934
- Community Toolbox–Section 8. Identifying and Analyzing Stakeholders and Their Interests: https://ctb.ku.edu/fr/node/376
- Hinkle, D. L., & Maughan, E. D. (2020). Collecting data: Where do I start?. NASN School Nurse (Print), 35(1), 18–19. https://doi.org/10.1177/1942602X19890049
- Lepkowski A. M. (2018). Unlocking data collection: Practical tips for school nurses. NASN School Nurse (Print), 33(1), 27–28. https://doi.org/10.1177/1942602X17744214
- Maughan, E. D., & Mehr, D. (2019). Sharing your story with data. NASN School Nurse (Print), 34(5), 278–279. https://doi.org/10.1177/1942602X19865330
- Maughan, E. D., & Schneider, L. J. (2019). Comparing apples with apples: The importance of clean data. NASN School Nurse (Print), 34(2), 107–108. https://doi.org/10.1177/1942602X19825670
- Missouri:
- Inventory of Students with Special Health Care Needs: https://health.mo.gov/living/families/schoolhealth/pdf/SHCNSurveyForm.pdf
- Missouri Kids Count: https://mokidscount.org/stories/school-nurses-and-school-based-healthcare-the-data-and-the-stories/
- Climate and Culture Survey-Parent: https://dese.mo.gov/media/pdf/climate-and-culture-survey-parent
- National Association of School Nurses:
- Data Infrastructure: https://www.nasn.org/research/everystudentcounts/data-infrastructure
- Every Student Counts: https://www.nasn.org/research/everystudentcounts
- Uniform Data Set: https://www.nasn.org/research/everystudentcounts/uniform-data-points
- National School Health Data Set: Every Student Counts! Definitions: https://higherlogicdownload.s3.amazonaws.com/NASN/8575d1b7-94ad-45ab-808e-d45019cc5c08/UploadedImages/PDFs/Research/ESC_22-23_definitions_6-9-22_final.pdf
- Nowak, M., Sayers, P., & Ashton, K. (2014). A school nurse’s guide to PowerPoint presentations. NASN School Nurse (Print), 29(4), 175–177. https://doi.org/10.1177/1942602X14528983
- Stanislo K. J. (2023). Data Collection: Time to revisit the WHY, WHAT, and HOW. NASN School Nurse (Print), 38(6), 310–315. https://doi.org/10.1177/1942602X231199932
- Stanislo K. J. (2023). Revisiting the National School Heath Data Set: Every Student Counts!. NASN School Nurse (Print), 38(1), 26–30. https://doi.org/10.1177/1942602X221137519
- Stanislo K. J. (2024). Data sharing: HOW to tell your story. NASN School Nurse (Print), 39(1), 21–29. https://doi.org/10.1177/1942602X231214247
- Wysocki, R., & Maughan, E. D. (2019). Using data to tell your school health story. NASN School Nurse (Print), 34(5), 274–277. https://doi.org/10.1177/1942602X19865327
References:
Attendance Works. (2018). The problem. Chronic absence. Available at: https://www.attendanceworks.org/chronic-absence/the-problem/
Bergren, M. & Maughan, E. (2019). The school nurse’s role in evidence-based practice, quality improvement, and research. In J. Selekman, R. A. Shannon, & C. F. Yonkaitis (Eds.). School nursing a comprehensive text. (3rd ed., p. 111). Philadelphia, PA: F. A. Davis Company.
Guthrie S. (2019). Data fidelity: Building credible reports. NASN School Nurse (Print), 34(2), 104–106. https://doi.org/10.1177/1942602X19825678
Healthy Schools Campaign. (2017). Addressing the health-related causes of chronic absenteeism: A toolkit for action. Available at: https://healthyschoolscampaign.org/wp-content/uploads/2017/02/Addressing_Health-Related_Chronic_Absenteeism_Toolkit_for_Action_Full.pdf
Johnson K. (2019). Sharing your message: Every student counts!. NASN School Nurse (Print), 34(6), 340–344. https://doi.org/10.1177/1942602X19877566
North Central Educational Service District. (n.d.). Draft school nurse year end report. Available at: https://www.ncesd.org/wp-content/uploads/2019/01/NASN_Draft_End-of-Year-Report.docx
Stanislo K. J. (2023). Data Collection: Time to revisit the WHY, WHAT, and HOW. NASN School Nurse (Print), 38(6), 310–315. https://doi.org/10.1177/1942602X231199932
Acknowledgement of Reviewers
Renee Falkner, BSN, RN
School Nurse Supervision Specialist | Therapylog
Katherine Park, DNP, RN, NCSN
Nationally Certified School Nurse, Pierremont Elementary
Adjunct Professor, Maryville University School of Nursing