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.
School nurses are instrumental in delivering health services to children in schools. This study addresses the gap in school nurse health services data, examining patterns in health services and programs provided by school nurses between 2006 and 2016 for students in North Carolina public schools. This study focused on services and programs related to asthma and diabetes, two health conditions that affect millions of children in the United States. Over 1.46 million children attend North Carolina public schools. In 2006, the average school nurse-to-student ratio was 1:1,340. By 2016, the average school nurse-to-student ratio decreased to 1:1,086, a 19% improvement. Over the 10-year study time period, there were statistically significant increases in the rate of occurrence of all health conditions that students received health services for ( p < .001), asthma ( p < .001), type I diabetes ( p = .0003), orders for all health-care procedures ( p = .01), all school nurse–led health counseling ( p = .004), and diabetes health counseling ( p < .01).
School nurses are pivotal to the safety of school-aged children, particularly those who receive medications in the school setting. The purpose of this study was to explore factors associated with medication administration errors in North Carolina school districts between 2012/2013 and 2017/2018. A longitudinal study using repeated measures analysis of school health services data collected in the North Carolina Annual School Health Services and Programs Survey was conducted. Over time, the number of medication errors ( p = .001) and number of medication corrective action plans ( p < .0001) trended upwards. There was also an increase in medication errors when the number of schools in a district was higher ( p < .0001). Conversely, there was a decrease in corrective action plans when school nurses were directly employed by the school district ( p = .0471). We implore school disticts to consider the important role of school nurses to keep kids safe, healthy, and ready to learn.
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