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The purpose of this descriptive study was to explore utilization of nurse substitutes in the school setting in Illinois. The literature described personnel who staff the school health office in the absence of the school nurse and the barriers to obtaining nurse substitutes. There were no empirical studies conducted on school nurse substitutes in the literature. Thus, a sample of 148 Illinois school nurses was recruited to complete a 20-item online survey. In the absence of a school nurse, 10.1% of health offices were not staffed, 37.8% were covered by a nurse who was simultaneously responsible for their usual assignment, and 25.7% were staffed by non-licensed personnel. Therefore, 73.6% of the respondents' assignments had no registered nurse immediately available the most recent day the nurse was absent.

Eighty-four percent of children with food allergies have a reaction in school, and 25% of first food reactions occur in schools. An evaluation was conducted comparing food allergy emergency plans to the Food Allergy and Anaphylaxis Network's (FAAN) Food Allergy Action Plan. Of the 94 respondents, 60 provided food allergy emergency plans for comparison. Although two-thirds used food allergy plans, only 15% used the current FAAN plan. Plans were missing essential components, including emergency contact information, medication administration instructions, and health history information. School nurses must adhere to current clinical guidelines to provide an accurate resource for personnel in charge of a food allergy reaction in school. Professional associations and state school health agencies must create and market a resource that provides easy, one-stop access to current best-practice guidelines and tool kits.