Identification of Workload Measurement Indicators for School Nursing Practice

Abstract

Many school districts rely on caseload or student to school nurse ratios that are not grounded in evidence-based research. There is a need for a comprehensive workload instrument to describe the work of school nurses that incorporates the complexities of the role and includes acuity, care processes, and social determinants of health. The purpose of this qualitative study was to identify workload activities from a previous Delphi study that can be empirically measured as items for a workload instrument. A nationally representative sample of 27 school nurses participated in four focus groups, describing activities important to the measurement of workload. Focus group input resulted in identification and confirmation of workload activities that impact school nurse workload. Use of the National Association of School Nurses’ Framework for 21st Century School Nursing Practice™ was integral in capturing gaps and important workload activities for a potential workload instrument.

School Nurses Matter: Relationship Between School Nurse Employment Policies and Chronic Health Condition Policies in U.S. School Districts

“…Recent literature on school nurse workload (Davis et al, 2019; Jameson et al, 2020) suggests that school nurses are doing their best to provide daily health services to students, but they do not have additional time to devote to policy development and implementation. The rapidly changing health technology and health needs of students, such as management of a child with Type 1 diabetes, demand that school districts have a designated individual who is knowledgeable in CHC services and school nursing and can focus on policies that support the implementation of evidence-based care.…”

The Association of School Nurse Workload With Student Health and Academic Outcomes: A Cross-Sectional Study

“…Existing research has often relied on nurse-to-student ratio to assess workload (Yoder, 2020), a measure that is not sufficiently comprehensive (National Association of School Nurses, 2020). While past efforts to define school nurse workload exist, many have not been widely utilized nor psychometrically tested (Jameson et al, 2020). Lack of clarity about and measures for school nurse workload may be due to the complexity of school nurses’ role, which includes diverse responsibilities crossing health promotion, disease management, leadership, quality improvement, care coordination, and involvement in research and policy development (Jameson et al, 2020).…”

“…While past efforts to define school nurse workload exist, many have not been widely utilized nor psychometrically tested (Jameson et al, 2020). Lack of clarity about and measures for school nurse workload may be due to the complexity of school nurses’ role, which includes diverse responsibilities crossing health promotion, disease management, leadership, quality improvement, care coordination, and involvement in research and policy development (Jameson et al, 2020). As a result of such complexity, efforts to measure school nurse workload remain challenging.…”

“…However, there exist recent promising efforts to use rigorous methods to measure school nurse workload (Jameson et al, 2020; Jameson et al, 2018) and to incorporate social determinants of health into workload metrics (Daughtry & Engelke, 2017). Measurable aspects of school nurse workload have been identified, including factors related to health conditions and needs of students (e.g., the number of students with chronic disease), social determinants of health (e.g., the number of students who speak English as a second language), and characteristics of the nursing staff (e.g., skill mix) and school community (e.g., absenteeism level; Jameson et al, 2020; Jameson et al, 2018). Better understanding and measurement of school nurse workload is critically needed, given that school nurses have identified excessive workload as the most common barrier to practicing to their fullest scope (Davis et al, 2019).…”

“…Studies that develop and test workload measures that incorporate the social determinants of health can inform future research demonstrating school nursing impact. To avoid being siloed or duplicative, future work should build off recent efforts to define school nurse workload (Jameson et al, 2020; Jameson et al, 2018), including efforts to consider social determinants of health in staffing decisions (Daughtry & Engelke, 2017). Rigorous methods, entailing collaboration between research teams and frontline school nurses, should be used to test workload measures and explore whether/how such measures need to be tailored across settings or populations.…”