School nurses handle much more than paper cuts and stomachaches. They serve as population health leaders, providing highly complex coordinated care to increasing numbers of children in educational settings.
Children's Hospital Colorado's School Health Program provides comprehensive school health nursing services on a contractual basis. The program employs 40 nurses who collectively serve 77,000 children. They work in settings such as schools, early childhood programs, child care centers, before- and after-school programs and camps.
School nurses can feel isolated as the only healthcare professionals in their workplaces. Many struggle to complete professional development and stay current in their field due to the strains of their workloads and sometimes remote locations.
To address the issue, Children's Colorado partnered with a trusted nonprofit to create convenient, computer-based training that empowers and connects nurses. We turned to ECHO Colorado, an organization committed to helping clinicians and public health professionals by spreading knowledge that improves patient care.
A cause close to our hearts
The project began with diabetes education. School nurses play a key role in helping families manage this serious and complex condition. Clinical manager Christine Perreault and clinical practice specialist Lisa Davis worked closely with ECHO on the program's structure and format.
The team brought together field experts from the University of Colorado's Barbara Davis Center for Childhood Diabetes. They also consulted Children's Colorado pediatric nursing research fellow Pam Brunner Nii. Her previous work explored how expanded diabetes education improves a nurse's knowledge, self-efficacy and confidence.
"Diabetes education for patients and providers is close to my heart," Brunner Nii says. Years ago, she worked in a small school district where four middle school students were diagnosed with diabetes within a few weeks.
"One boy thought he'd outgrow diabetes and was devastated to learn he had a lifelong condition," Brunner Nii recalls. "Later on, he dropped out of high school and lost his connections with me and his teachers who had been his main support system. At that point, I dedicated my career to helping students like him and the nurses who care for them."
Using the expertise of educators like Brunner Nii, the team launched a four-week series, "School Nurses Managing Diabetes," in February 2018. More than 200 nurses quickly expressed interest, but each cohort was limited to 30 attendees to encourage participation.
Nurses accessed the training via a telehealth technology platform on their laptops or smartphones. Each hourlong class began with a lesson from a content matter expert, then transitioned to open-ended, facilitated discussion using video-conferencing software.
This interactive, dynamic course provided dual benefits: Nurses gained clinical education from subject matter experts while sharing their own experiences and building a sense of community.
After the course, participants completed an online survey that assessed their self-efficacy, satisfaction and likelihood of using their new knowledge. One respondent shared:
"I appreciate the expertise of the presenters, starting with the basics and then progressing each week to include the other aspects of insulin management, carbohydrate counting, variables with exercise and developmentally appropriate care."
The nurse added, "The discussion time went by very fast and was well-facilitated to address areas of concern we deal with every day. I was able to use the knowledge learned after the first session in my daily practice, and it seemed to get better every week."
The immediate interest from nurses has been "a wholly unique experience," says Fred Thomas, PhD, Executive Director of ECHO Colorado. "They serve as a critical link in the care equation by carrying out the treatment plan at school, where children spend the majority of their time. This topic hit the nail on the head."
Forging camaraderie among school nurses
With a long wait list, the team offered two more sessions of the diabetes course. They've also held two sessions of a newer series, "School Nurses Managing Neurological Conditions."
Best of all, the partnership has forged camaraderie among nurses across the state. A newly formed community of practice for school nurse leaders runs year-round and extends the sharing of best practices.
Virtual communities can play a role in reducing turnover in school nursing, Davis says. "Community-based practice is very different from bedside nursing, particularly in terms of accessing resources. Our partnership with ECHO empowers nurses to be decision-makers in the field. Many nurses have told us, 'I realize after attending the series that I’m not alone out there.'"
Improving care for children everywhere
School nurses serve on the front lines of public health, care coordination and quality improvement, and their job scope continues to grow.
"Our ECHO partnership helps meet an urgent need for continuing education in collaborative, peer-to-peer learning environments," says Perreault.
It's all part of Children's Colorado's commitment to improve and reimagine children's health. Whether caring for patients inside our hospital or in community settings, we're creating a healthier future for families.