School nurse perspectives on caring for children with chronic health conditions

School nurses (SN) are among the most autonomous and isolated nurses in the United States. Their responsibilities typically include caring for children's day-to-day health events, managing medications prescribed to children with chronic health conditions, health screening, health education, negotiating family communication and education, and counseling. Nurses also manage the emerging activities around childhood obesity initiatives, wellness committees and oversight of the food/physical environment. The complexity of students' lives further expands this role, as child health is impacted by inadequacies in nutrition and healthcare and family strife. Yet limited research has examined quality indicators specific to professional nursing in a school environment.

This study's purpose was to describe the work of school nurses in rural settings to identify indicators of quality nursing practice as well as barriers to care coordination for children with chronic health conditions. Few studies have examined the work environment of the SN or identified relevant quality metrics. Since SN are supervised and regulated by non-healthcare professionals, it is critical that quality indicators are clearly defined and effectively conveyed across disciplines and to policy makers.

Qualitative methods were used to examine nurses' perceptions of care coordination and quality indicators in school nursing. Focus groups, comprised of 12 nurses from 11 school districts, were conducted in central Pennsylvania. Several themes emerged: the priority of state mandated health screenings over child-focused care; limited resources, difficulties regarding parental accessibility, and HIPAA-related obstacles to partnering with medical providers. The results will be used to formulate and test nurse-sensitive indicators of quality care.