Erin D. Maughan

Framework for 21st Century School Nursing Practice National Association of School Nurses

The National Association of School Nurses (NASN) developed the Framework for 21st Century School Nursing Practice to reflect current school nurse practice. The Framework of practice was introduced in June 2015, and feedback was requested and obtained from practicing school nurses in a variety of ways. The final version of the Framework is introduced in this article. This article updates (and replaces) the articles in the July 2015 NASN School Nurse related to the Framework. Central to the Framework is student-centered nursing care that occurs within the context of the students’ family and school community. Surrounding the student, family, and school community are the nonhierarchical, overlapping key principles of Care Coordination, Leadership, Quality Improvement, and Community/Public Health.These principles are surrounded by the fifth principle, Standards of Practice, which is foundational for evidence-based and clinically competent quality care. Each of these principles is further defined by practice components. Suggestions are provided regarding how the Framework can be used in a variety of settings to articulate and prioritize school nursing practice. The ultimate goal is to provide a resource to guide school nurses in their practice to help students be healthy, safe, and ready to learn.

What’s Up With “Step Up”? Step Up and Be Counted: The National Uniform School Nurse Data Set

The health and well-being of children who attend school is not collected in any national data sets. To effectively advocate for the health needs of children where they live, learn, and play, it is essential to build a National Uniform School Nurse Data Set. In 2014, school nurses nationwide were invited to join the Step Up and Be Counted! initiative. To prepare nurses for data collection and reporting, an informational website was established, a marketing campaign was launched, and a data collection tool was developed. Trainings were held at the national conferences of both the National Association of School Nurses and the National Association of State School Nurse Consultants, and locally by state school nurse consultants and champions. The goal of the 2014–2015 academic year was to establish the processes for such a large-scale effort. In Year 1, only three initial data sets were collected from participating school nurses from 37 states. The first year yielded much data, and challenges have been identified and addressed.

Creating a Culture of Accurate and Precise Data

There are many stakeholders for school health data. Each one has a stake in the quality and accuracy of the health data collected and reported in schools. The joint NASN and NASSNC national school nurse data set initiative, Step Up & Be Counted!, heightens the need to assure accurate and precise data. The use of a standardized terminology allows the data on school health care delivered in local schools to be aggregated for use at the local, state, and national levels. The use of uniform terminology demands that data elements be defined and that accurate and reliable data are entered into the database. Barriers to accurate data are misunderstanding of accurate data needs, student caseloads that exceed the national recommendations, lack of electronic student health records, and electronic student health records that do not collect the indicators using the standardized terminology or definitions. The quality of the data that school nurses report and share has an impact at the personal, district, state, and national levels and influences the confidence and quality of the decisions made using that data.

Finding the Best Evidence to Support Care of Students With Chronic Conditions: CLUE #2: Acquire:

Every day, school nurses make practice decisions that impact the care provided to school children. Our professional standards require that we stay up to date with best practice options, yet there is neither time nor money to attend a continuing education offering for every practice concern we encounter. Learning how to acquire the evidence that leads to best practice can ensure our practice is current and that our students have the best chance to have positive health and academic outcomes. This article explains where to find good evidence and how to access it.

Using the Framework for 21st-Century School Nursing Practice in Daily Practice:

NASN recently developed a Framework for 21st-Century School Nursing Practice (Framework) to guide school nursing activities. The principles and components of the Framework can be used as a guide in achieving high-quality school nurse practice. The purpose of this article is to share how school nurses can use the Framework in their daily practice, invite nurses to identify one new way the Framework can be used in your practice this school year, and implement and evaluate the change.

Step Up and Be Counted! Development of a national school health database.

Ninety-seven percent of school-aged children in the United States attend a school where their basic health data are recorded. Children from every clinic in the most comprehensive medical centers attend school and require care. Since the 1970s, attention to the rights of children with disabilities to attend school with appropriate accommodations has increased both the number and complexity of children requiring nursing care at school. In addition, rates of chronic conditions in school-aged children have risen steadily due in part to improved survival rates from premature birth, chronic conditions, and childhood cancers. The acuity of these conditions ranges from anaphylaxis prevention to type 1 diabetes to students who are dependent on mechanical ventilation, tube feedings, or central infusions and require continuous skilled nursing assessment to prevent death.

Coordinating Care for Students With Chronic Conditions: CLUE #1:

Care coordination is an important part of school nurses’ responsibilities, but coordinating that care for students in schools with chronic conditions is more complex than what we learned in nursing school. This article is the second in a series of articles for NASN School Nurse that will delve into how to apply evidence-based practice (EBP) to school nursing. The article focuses on the first step of EBP: asking the question. As the series progresses, we encourage you to apply the steps to a situation in your setting or even use the series to increase discussions at nursing staff meetings so all can benefit.

The Role of the Designated State Data Champion

Step Up & Be Counted! (Step Up!) is a joint project of the National Association of School Nurses (NASN) and the National Association of State School Nurse Consultants (NASSNC). The goal of the initiative is to develop a National School Nurse Standardized Data Set that will be used by nurses across the country to uniformly collect data the same way. The data will be used to determine the health of children and youth, the care that is delivered in schools, and the impact of school nurses on academic success and well-being. This article focuses on the role of the Designated State Data Champion in the initiative.

Factors Related to School Nurse Workload.

Recognizing the need for a school nurse workload model based on more than the number of students in a caseload, the National Association of School Nurses issued recommendations related to measuring school nurse workload. Next, a workforce acuity task force (WATF) was charged with identifying the steps needed to further the recommendations. As a first step, the WATF focused on identifying existing literature and practices related to school nurse workload. The purpose of this article is to synthesize and categorize the factors that were identified, delineate sources for collecting and retrieving these factors, and make recommendations for clinicians and researchers interested in developing instruments to measure school nurse workload.

Step Up & Be Counted! Strategies for Data Collection

Step Up & Be Counted! (Step Up!) is an innovative project to collect nationally standardized data from the daily documentation of school nurses throughout the United States. Step Up! provides the standardization needed to promote an “apples to apples” analysis of school health resources, interventions, and outcomes across the United States. While some states have collected data for decades and have an effective infrastructure in place, other states are new to data collection and are creating processes to support data collection. Designated State Data Champions have volunteered to collect aggregated de-identified data from school districts throughout their state. The following is a discussion of some of the data collection innovations shared by Designated State Data Champions at the 2017 NASN Annual Conference.