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

Abstract

This study assessed associations between school nurse workload and student health and academic outcomes. We hypothesized that lower school nurse workload would be associated with better student outcomes, with associations being greater for members of groups who experience health disparities. Our methods entailed secondary analysis of data for New York City school students in kindergarten through 12th grade during 2015–2016 ( N = 1,080,923), using multilevel multivariate regression as the analytic approach. Results demonstrated lower school nurse workload was associated with better outcomes for student participation in asthma education but not chronic absenteeism, early dismissals, health office visits, immunization compliance, academic achievement, or overweight/obesity. Our findings suggest school nurses may influence proximal outcomes, such as participation in disease-related education, more easily than downstream outcomes, such as absenteeism or obesity. While contrary to our hypotheses, results align with the fact that school nurses deliver community-based, population health–focused care that is inherently complex, multilevel, and directly impacted by social determinants of health. Future research should explore school nurses’ perspectives on what factors influence their workload and how they can best impact student outcomes.

Psychological coherence, inclusive leadership and implicit absenteeism in obstetrics and gynecology nurses: a multi-site survey

“…Nurses, despite being numerically superior, face challenges in rights, respect, health and comfort in clinical setting [23,35]. In order to improve the professional status of nurses and create good working conditions for nurses and provide them with all-round support, it is necessary to start from the perspective of management [36,37]. Inclusive leadership plays an important role in the nurse management [38].…”

Achieving the educational mission: Are Connecticut school nurses valued?

“…Having the skills and opportunity to collect adequate and accurate workload‐level data, school nurses can self‐advocate strategically, educating school administration about the resources needed for safe student care. Many school nurses historically are responsible for hundreds and often thousands of students, leaving them inadequate time for safe student healthcare (Endsley, 2017; Schroeder et al, 2021; Willgerodt & Griffith, 2021). Their workload is also affected as they grapple with increasing numbers of students with complex health needs, including a broad range of physical, developmental, behavioral, and emotional challenges (Connecticut State Department of Education, 2020; Jameson et al, 2018; Moyes et al, 2022; Willgerodt & Griffith, 2021).…”

“…Their workload is also affected as they grapple with increasing numbers of students with complex health needs, including a broad range of physical, developmental, behavioral, and emotional challenges (Connecticut State Department of Education, 2020; Jameson et al, 2018; Moyes et al, 2022; Willgerodt & Griffith, 2021). Research shows there is an association between smaller school nurse workloads and positive student outcomes (Daughtry & Engelke, 2018; Lineberry et al, 2018; McKinley Yoder et al, 2021; Rankine et al, 2021; Schroeder et al, 2021). Studies show that school nurses' workload levels lead to emotional exhaustion, burnout, job dissatisfaction, and inadequate care for students (Brown et al, 2020; Jameson & Anderson, & Endsley, 2020; Lineberry & Ickes, 2015; Van Bogaert et al, 2017).…”

Chronic Health Condition Management and School-Based Health Centers in New York: Findings From the 2020 School Health Profiles Survey

“…Even more distressing is that children in the lowest 10% of poverty (9.9%) utilize the health system less than once every two years (United States Census Bureau, 2022). Young people with unmet health needs are more likely to live in impoverished, underserved communities, have higher rates of CHCs, such as asthma, and are at an increased risk for limited or fragmented access to primary health care (Centeio et al, 2021; DePriest & Butz, 2017; Schroeder et al, 2021; Yoder, 2020; Yoon et al, 2021). When healthcare needs are unmet, adverse health and academic outcomes occur (Basch, 2011; Gracy et al, 2018; Michael et al, 2015).…”