A critical gap: Advanced practice nurses focused on the public's health.

BACKGROUND: The COVID-19 pandemic has highlighted the need for nurse leaders who "embrace the interconnection" between medicine and public health. The inequitable impact of COVID-19 on people of color demonstrates the importance of applying expertise from nursing practice and public health systems to work with communities and other professions on complex health issues. Yet, despite a clear need for improved population health, educational programs designed to produce Advanced Public Health Nurses, with skills to address complex system changes, have become increasingly scarce. PURPOSE: We put forward the perspective that the nation needs more advanced practice nurses prepared for leadership roles focused on the health of whole populations, marginalized communities, and the systems and policies that promote their health. DISCUSSION: We argue that opportunities should be expanded for nurses to attain education for these roles through increased investments in the Doctor of Nursing Practice model to prepare nurses for advanced public health specialty practice.

Show Me the Evidence: COVID-19 and School Nursing in the 21st Century.

The emergence of COVID-19 and how to control its spread has highlighted the importance of understanding and applying evidence-based decisions into school nursing practice. This is the fifth and final article in NASN's series on how the Framework for 21st Century School Nursing PracticeTM is a mind-set that can be applied to everyday school nursing practice and will focus on the principle of Standards of Practice, and particularly how evidence-based practice decisions are made during COVID-19.

Enhancing Care Coordination for Students with Type 1 Diabetes.

BACKGROUND: Care coordination for chronic health conditions is critical to academic success, yet concrete strategies on its operationalization in schools are not well reported in the literature. Type 1 diabetes (T1D) is one such condition that requires a team-based approach to care coordination. The purpose of this study was to gain a deeper understanding of how care coordination for T1D currently operates and identify strategies for its support and facilitation in schools. METHODS: Focus groups were conducted with school nurses, parents of T1D children, and providers in each of the 9 Educational Service Districts in Washington State. Recorded notes were analyzed using content analytic techniques. RESULTS: Five major themes emerged from the data, each with 3 to 4 second-order themes. Care coordination depended on family, school, and child developmental contexts, knowledge/experience about T1D among school nurses, teachers, parents, and providers, access and availability of team members, communication, and relationships. CONCLUSIONS: Findings highlight the importance of a contextualized and holistic perspective of facilitators and barriers to care coordination in schools. Promoting the development of supportive relationships and effective team-based approaches provides a foundation and informs intersectional care coordination for all children with chronic conditions.

National School Health Data Set: Every Student Counts! Building Capacity for Data Collection.

The National Association of School Nurses (NASN) has launched the National School Health Data Set: Every Student Counts! Building on the success of previous school health data collection, this article describes the steps that the Georgia Association of School Nurses takes to promote the collection of data to support the health of Georgia's school-age children. Building a team, engaging stakeholders, mapping a plan of action, and developing the message are described as ways to build the capacity for data collection. Other states and NASN state affiliates may learn from the ideas presented here.

Introducing NASN's New Data Initiative: National School Health Data Set: Every Student Counts! Make This YOUR Year of Data.

The National Association of School Nurses (NASN) is launching a new data initiative: National School Health Data Set: Every Student Counts! This article describes the vision of the initiative, as well as what school nurses can do to advance a data-driven school health culture. This is the first article in a data and school nursing series for the 2018-2019 school year. For more information on NASN's initiative and to learn how school nurses can join the data revolution, go to http://nasn.org/everystudentcounts.

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.

School Nursing: Becoming Credible and Visible.

A group of school nurses attending the innovation relay event at the NASN 2017 Annual Conference were asked to tackle the problem expressed by many school nurses: How can we increase the visibility and credibility of school nurses? The innovation relay allowed school nurses to look at the problem differently so that they could identify innovative solutions. This article shares more detail on each of the team's solutions and illustrates how school nurses can look at problems in a new light.

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.

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.

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.

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.

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!

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.

Harnessing the power of student health data: Selecting, using, and implementing electronic school health documentation systems.

School nurses manage an immense amount of student health information, making electronic documentation systems essential to provide effective care for students. This article describes the elements of and rationale for using an electronic documentation system, the use of standardized nursing languages, and strategies for successfully implementing an electronic documentation system.

The promise of standardized data collection: school health variables identified by states.

A gap in data prevents measurement of the needs of school-age children and the influence of school nursing interventions on student health and education outcomes. Its remedy is in the data collected in school health rooms. A national clinical database describing school health will allow education and health leaders to build evidence-based programs for children. Several states collect school health data describing student needs and school nursing practice. This study identified, collated, described, and evaluated the variables compiled from state school health reporting documents to identify commonalities and form the foundation of a standardized school health reporting system. A comprehensive content analysis of variables in the instruments yielded a framework within which school health data can be organized and described. It consists of five broad categories describing staffing; risk management; health promotion; episodic care; and care coordination. The result provides a nationally standardized coding set to describe school health.