Linda C. Wolfe

Standardized Data Set for School Health Services: Part 1—Getting to Big Data

School nurses collect voluminous amounts of data in a variety of ways and use the data to describe trends in students’ health and patterns of illness in the student population or to identify ways to improve care. NASN identified years ago that a national school nurse data set was needed to enable data-driven decision making for the millions of children who attend school each day across the United States. Informal work has been done in the past 5 years in preparation for the current joint NASN/National Association of State School Nurse Consultants workgroup. This article is the first of a two-part series related to the importance of data and national efforts to develop a uniform data set that all school nurses can collect. Collecting data, and collecting it in the same way as other providers, will demonstrate what school nurses do as well as provide the data necessary for robust research on the impact of school nurses on students’ health.

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.

What Data Do States Collect Related to School Nurses, School Health, and the Health Care Provided?

School nurses collect data to report to their school district and state agencies. However, there is no national requirement or standard to collect specific data, and each state determines its own set of questions. This study resulted from a joint resolution between the National Association of State School Nurse Consultants and the National Association of School Nurses. The study sought to determine whether similar data points were collected so that comparisons could be made among states and to develop a framework to incorporate the data. Thirty-two states provided their questionnaires or reports. There were 855 data points that could be divided into data related to staff and to students. No categories were measured by all states. The most common data points were the number of students, health screenings, and the number of students with particular conditions for whom the district provided services. A framework for data collection is proposed.

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.

National standardized data set for school health-services: step up and be counted!

The National Association of School Nurses and National Association of State School Nurse Consultants Joint Work Group agreed on identified common data points and an initial process for nationwide data collection by school nurses. The emerging process was presented at both the 2014 National Association of School Nurses and the National Association of State School Nurse Consultants annual meetings in San Antonio. The time is now to begin the process for ALL school nurses to collect data to begin building a national school nursing data set. This article is the second of a series and outlines the how, why, and when for collecting identified data indicators. It provides the talking points and collection tool necessary to Step Up and Be Counted!

What's Up With Step Up!? Year 2!

Step Up & Be Counted! (Step Up!) is a joint initiative of the National Association of School Nurses (NASN) and the National Association of State School Nurse Consultants (NASSNC). The aim of Step Up! is for all school nurses across the nation to collect and submit specific, uniform data points for all their students. The program was initiated in 2014. In the second year of data collection, 2015-16, school nurses from more states contributed data, and many states reported on a larger number of school nurses reporting data. This article reports the progress we have made in data collection and reporting in year two.

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.

School Nursing: The Next Hundred Years

On October 1, 2002, school nursing will celebrate its 100th anniversary. Many positive changes occurred in the first hundred years that have had an impact on our specialty practice. Disease management moved from control to prevention. Medical knowledge of the body expanded to the molecular level. Morbidity reduced in children with genetic disorders, prematurity, and chronic conditions. Educational rights extended to all, regardless of intelligence level or physical ability. Computers afforded the opportunity for documentation that is easily retrievable and individualized. Technology brought machines, such as insulin pumps, that fit into the palm of our hands and regulate whole body systems. In the midst of all the changes, school nursing adapted and thrived. Although many things continue to change in the fields of medicine and education, society continues to value the education of our young. School nurses support both health and education. The past brought change and the future promises more, yet the essence of the practice of school nursing remains constant. The mission of school nursing continues to be to ‘‘advance the well being, academic success and life-long achievement of students’’ (NASN, 1999).

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.

Step Up and Be Counted! Update: The National Standardized School Nurse Data Set

There is a significant gap in meaningful school health data in the current national education and health data sets. Current data sets do not sufficiently capture the number and credentials of school health providers, the health of students who receive care at school, or the outcomes of school nurse interventions. Since 2014, school nurses across the United States have embraced Step Up and Be Counted!: A National Standardized School Nurse Data Set. The goal of Step Up is to collect school nurse data in a standardized, uniform format. Prior to the project, no data were recorded in a uniform manner across states and health services delivery models. Data have been reported for two years on who is delivering health care in school, selected student chronic conditions, and the disposition of students once they leave the school health office. Professional development sessions have been conducted at the national conferences of both the NASN and the NASSNC and at the state level. As the project matures, steps are being taken to increase the number of school nurses and states participating and to assure data accuracy and validity.