Impact of School Nurse Ratios and Health Services on Selected Student Health and Education Outcomes: North Carolina, 2011-2016.

Publisher: Wiley Country of Publication: United States NLM ID: 0376370 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1746-1561 (Electronic) Linking ISSN: 00224391 NLM ISO Abbreviation: J Sch Health Subsets: MEDLINE

Publication: Nov. 2008- : Hoboken, NJ : Wiley
Original Publication: Columbus, Ohio : American Association of School Physicians

Diabetes Mellitus, Type 2* ; Nurses* ; School Nursing*; Humans ; North Carolina ; School Health Services ; Schools ; Students

Background: Determination of adequate school nurse staffing is a complex process. School nurse-to-student ratios and the health services school nurses provide to students should be considered. The purpose of this study was to examine the impact of North Carolina school nurse-to-student ratios and school nurse health services on the health and education outcomes (eg, absences, grades, self-management) of students receiving services for asthma and diabetes.
Methods: This study of all 115 school districts in North Carolina used the Annual School Health Services Report Survey from 2011 to 2016. Descriptive statistics for health services, programs and outcomes, and generalized linear modeling were used to estimate the association of ratios and health services with asthma and diabetes outcomes.
Results: By the 2015-2016 school year, the average ratio decreased to 1:1086 in North Carolina public schools. Annually, 100,187 students received services for asthma, 3832 students received services for type 1 diabetes, and 913 students received services for type 2 diabetes. Lower ratios and nurse health services were associated with improved student outcomes, including decreased absences (p = .05), improved grades (p = .05), and student self-management of their health condition (p = .05).
Conclusions: Lower school nurse-to-student ratios and services were associated with improvements in students' health and education outcomes.
(© 2021 American School Health Association.)

Maughan ED, Cowell J, Engelke MK, et al. The vital role of school nurses in ensuring the health of our nation's youth. Nurs Outlook. 2018;66(1):94-96.
Moricca ML, Grasska MA, Marthaler M, Morphew T, Weismuller PC, Galant SP. School asthma screening and case management. J Sch Nurs. 2013;29(2):104-112.
The Role of the 21st-Century school nurse: position statement. NASN Sch Nurse. 2017;32(1):56-58.
Centers for Disease Control and Prevention, CDC Healthy Schools. Chronic disease management. 2019. Available at: https://www.cdc.gov/healthyschools/shs/chronic_disease_management.htm. Updated May 29, 2019. Accessed November 3, 2020.
National Association of School Nurses. Students with chronic health conditions: The role of the school nurse (Position Statement). 2017. Available at: https://www.nasn.org/nasn/advocacy/professional-practice-documents/position-statements/ps-chronic-health. Updated June 2017. Accessed November 3, 2020.
Bethell C, Forrest C, Stumbo S, Gombojav N, Carle A, Irwin C. Factors promoting or potentially impeding school success: disparities and state variations for children with special health care needs. Matern Child Health J. 2012;16(S1):35-43.
Jacobsen K, Meeder L, Voskuil VR. Chronic student absenteeism. NASN Sch Nurse. 2016;31(3):178-185.
Wang LY, Vernon-Smiley M, Gapinski MA, Desisto M, Maughan E, Sheetz A. Cost-benefit study of school nursing services. JAMA Pediatr. 2014;168(7):642-648.
AAP Council on School Health. Role of the school nurse in providing school health services. Pediatrics. 2016;137(6):e20160852.
National Association of School Nurses. Framework for 21st century school nursing practice. NASN Sch Nurse. 2016;31(1):45-53.
North Carolina General Assembly/Program Evaluation Division. Meeting current standards for school nurses statewide may cost up to $79 million annually. 2017. Available at https://www.ncleg.net/PED/Reports/documents/SchoolNurses/School_Nurses_Exec_Summary.pdf. Accessed November 3, 2020.
Daughtry D, Engelke MK. Demonstrating the relationship between school nurse workload and student outcomes. J Sch Nurs. 2017;34(3):174-181.
Centers for Disease Control and Prevention. Most recent national asthma data. 2018. Available at: https://www.cdc.gov/asthma/most_recent_national_asthma_data.htm. Updated October 26, 2020. Accessed November 3, 2020.
Miller GF, Coffield E, Leroy Z, Wallin R. Prevalence and costs of five chronic conditions in children. J Sch Nurs. 2016;32(5):357-364.
Centers for Disease Control and Prevention. National diabetes statistics report. 2020. Available at: https://www.cdc.gov/diabetes/library/features/diabetes-stat-report.html. Updated February 11, 2020. Accessed November 3, 2020.
North Carolina Session Law 2002-103, Senate Bill 911, § 115C-47 (2002).
North Carolina Session Law 2009-563, Senate Bill 738, § 115C-375.3 (2009).
Guttu M, Engelke MK, Swanson M. Does the school nurse-to-student ratio make a difference? J Sch Health. 2004;74(1):6-9.
Maughan E, Adams R. Educators' and parents' perception of what school nurses do: the influence of school nurse/student ratios. J Sch Nurs. 2011;27(5):355-363.
McCabe E, McDonald C, Connolly C, Lipman T. Factors associated with school nurses' self-efficacy in provision of asthma care and performance of asthma management behaviors. J Sch Nurs. 2019:105984051987886. https://doi.org/10.1177/1059840519878866.
Best NC, Nichols AO, Oppewal S, et al. An appraisal of school nurse health services and programs in North Carolina public schools, 2006-2016. J Sch Nurs. 2020:1059840519899439. https://doi.org/10.1177/1059840519899439.
McCullagh P, Nelder J. Generalized Linear Models. 2nd ed. London, UK: Chapman & Hall; 1989.
Cicutto L, Gleason M, Haas-Howard C, et al. Building bridges for asthma care program: a school-centered program connecting schools, families, and community health-care providers. J Sch Nurs. 2018;36(3):168-180.
Kise S, Hopkins A, Burke S. Improving school experiences for adolescents with type 1 diabetes. J Sch Health. 2017;87(5):363-375.
Wilt L. The relationships among school nurse to student ratios, self-efficacy, and glycemic control in adolescents with type 1 diabetes. J Sch Nurs. 2019:105984051987031. https://doi.org/10.1177/1059840519870314.
McClanahan R, Weismuller P. School nurses and care coordination for children with complex needs. J Sch Nurs. 2015;31(1):34-43.
Carpenter L, Lachance L, Wilkin M, Clark N. Sustaining school-based asthma interventions through policy and practice change. J Sch Health. 2013;83(12):859-866.
Engelke M, Swanson M, Guttu M. Process and outcomes of school nurse case management for students with asthma. J Sch Nurs. 2014;30:196-205.
Engelke MK, Swanson M, Guttu M, Warren MB, Lovern S. School nurses and children with diabetes: a descriptive study. N C Med J. 2011;72(5):351-358.
Willgerodt M, Johnson KH, Helmer C. Enhancing care coordination for students with type 1 diabetes. J Sch Nurs. 2020;90(8):651-657.
National Association of School Nurses. School nurse workload: Staffing for safe care (Position Statement). 2020. Available at: https://www.nasn.org/nasn/advocacy/professional-practice-documents/position-statements/ps-workload. Updated June 2020. Accessed Novemeber 3, 2020.

Keywords: child and adolescent health; chronic diseases; ratios; school health services; school nurses; student outcomes

Date Created: 20210412 Date Completed: 20211015 Latest Revision: 20211015

20231215

10.1111/josh.13025

33843082