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Background: Few recent studies have focused on the role of school nurses who predominantly care for children with special health care needs (CSHCN). The primary aim of this study was to explore differences related to (a) child health conditions covered, (b) direct care procedures, (c) care management functions, and (c) consultation sources used among nurses who spent the majority of their time caring for CSHCN compared to a mixed student population and among nurses who covered a single school versus multiple schools. Methods: A community-based interdisciplinary team developed a 28-item survey which was completed by 50 nurses (48.5% response) employed by health departments and school districts. Descriptive and comparative statistics and thematic coding were used to analyze data. Results: Nurses who covered a single school (n = 23) or who were primarily assigned to CSHCN (n = 13) had a lower number of students, and more frequently (a) encountered complex child conditions, (b) performed direct care procedures, (c) participated in Individualized Education Plan (IEP) development, (d) collaborated with the Title V-CSHCN agency, and e) communicated with physicians, compared to nurses who covered multiple schools or a general child population. Benefits centered on the children, scope of work, school environment, and family relationships. Challenges included high caseloads, school district priorities, and families who did not follow up. Conclusion: The number of schools that the nurses covered, percent of time caring for CSHCN, and employer type (school district or health department) affected the scope of school nurse practice. Recommendations are for lower student-to-nurse ratios, improved nursing supervision, and educational support. (Contains 6 tables.)

School nurses have key responsibility for children with diabetes either directly when on-site or indirectly when delegating health care services to other school personnel. Few studies describe how nurses plan for and manage school children with diabetes. The purpose of this exploratory study was to describe the scope of school nursing practice related to children with complex special health care needs. Specific aims related to this pediatric population were to determine the educational preparation and continuing education needs of school nurses; identify sources of information, and support; and explore challenges in providing nursing care. A mixed-methods community-based participatory research design included a survey (n=50) and observations with in-depth interviews in a subset of the sample (n=12). Follow-up focus group interviews will be conducted to assist in data verification and interpretation. This is a secondary analysis of survey data from nurses who indicated they provided care to children with diabetes at school. The sample consisted of 47 nurses (8 LPN and 39 RN) assigned to public schools in five counties in Northeast Florida. The questionnaire containing 30 structured and open-ended items was returned by mail. Nurses reported 174 events dealing with hypoglycemia or hyperglycemia with 15 severe hypoglycemic incidents in the past year. All respondents felt "very competent" with blood glucose monitoring. While 86% felt ''very competent" administering glucagon, only half of the respondents felt ''very competent" managing insulin and infusion pumps. Diabetes was identified more than any other topic as a need or area of interest for continuing education. The majority of respondents preferred written or web-based self-study or a mailed newsletter as a source of continuing education rather than attending an in-person continuing education program. Results may be used by community-based stakeholders when designing interventions to support school nurses toward ultimately improving health outcomes for children with diabetes. [ABSTRACT FROM AUTHOR]

Published qualitative studies have not focused on nurses who solely care for children with special health care needs. The purpose of this study was to explore and describe (a) the work of school nurses who care exclusively for these children, (b) nurses' interaction with parents, staff, or providers, and (c) the challenges, benefits, and support for their role. Data from on-site observation and in-depth interviews with experienced, long-term employed nurses (n = 13) were analyzed using qualitative descriptive inquiry. Performing a personally satisfying clinical role, school nurses adapted to a "teachers world" by working alone, feeling responsible; begging, bartering, and subsidizing; and embracing school as family. They bridged home and school by doing for children, building relationships with parents, and knowing the child. Nurses need to be supported through peer supervision and adequate resources to provide family-centered care to students in a setting dominated by education professionals.