ON THE FRONT LINE IN CHILDRENS HEALTH CARE: CASELOADS, SCOPE OF PRACTICE, AND SATISFACTION WITH CARE

1
ON THE FRONT LINE IN CHILDRENS HEALTH CARE
CASELOADS, SCOPE OF PRACTICE, AND SATISFACTION
WITH CARE AMONG RURAL AND URBAN SCHOOL NURSES IN
PENNSYLVANIA Marianne M. Hillemeier, PhD, MPH and
Lisa A. Davis, MHA Department of Health Policy
and Administration The Pennsylvania State
University

• Over 80 of school nurses reported being very
  satisfied or satisfied with selected aspects
  of services provided they were least satisfied
  with health education for students and staff, the
  level of communication with physicians, and the
  school environment. Three-quarters or more of
  school nurses rated all nursing services assessed
  as very effective or effective
• Both school principals and parents tended to
  report high levels of satisfaction with school
  nurse services and to perceive them as effective
• Lower school nursestudent ratios were positively
  associated with greater perceived satisfaction
  with nursing services provided among school
  nurses (r.08, p.05)

• Research Objectives
• To evaluate the scope of nursing services
  provided in rural and urban public schools in
  Pennsylvania
• To assess perceived satisfaction and
  effectiveness of school nursing services among
  school nurses, principals, and parents
• 3. To assess perceptions of need among school
  nurses, principals, and parents

• School nurse caseloads contain a sizable
  proportion of children with special needs the
  most prevalent problems were asthma, allergies,
  weight disorder, and ADHD.
• Specialized procedures were often provided
  including blood sugar testing, nebulizer
  treatments, insulin pump management, and urinary
  catheterization. Similar types and numbers of
  treatments were provided in rural and urban
  schools.
• Over 70 of all secondary school nurses provided
  education and counseling on pregnancy and STD
  prevention and substance use, however education
  and counseling on other important issues
  including nutrition, injury prevention, and
  aspects of mental health were less often
  provided.

Methods A stratified random sample of school
nurses (n615 response rate61.7) representing
each of Pennsylvanias 500 active school
districts was surveyed about current school
nursing services including perceived satisfaction
and effectiveness of current level of service and
perceived needs. Two additional surveys, one for
school principals and one for a parent (usually
president of the school PTO/PTA) were included in
each mailing. There were 431 surveys returned
from school principals (response rate43.2) the
response rate for parent surveys was 34.8
(n347). Additional information about school
nursestudent ratios and school district
characteristics was obtained from the PA Division
of School Health.
Results

• Nursestudent ratios were lower in rural
  districts
• Students in rural districts were more likely to
  be economically disadvantaged

• The areas perceived by nurses as most in need of
  improvement were budget levels for nursing
  services, nurse staffing levels, training, and
  communication with physicians and parents
• Principals were the least likely to express the
  need for improvement in any of the dimensions
  assessed
• Parents were most likely to mention the budget
  for nursing services and more supplies as needed
  improvements.

• Conclusions
• The health care needs of school children are
  increasingly diverse and complex, and school
  nurses are called upon to perform many
  skill-intensive procedures
• Nurses were least satisfied with the level of
  health education currently provided for students
  and staff
• Professional nursing organizations and Healthy
  People 2010 recommend that school nursestudent
  ratios not exceed 1750 in Pennsylvania where
  the ratio averages 11012 study findings suggest
  that a lower ratio would result in greater
  satisfaction with school nursing services

Acknowledgement This research was funded in
part by the Center for Rural Pennsylvania