Study shows school nurses can help prevent and address chronic absenteeism

Kate King has dedicated 23 years to aiding high-need students as a school nurse. Throughout her tenure, she has observed a common trend: students tend to visit the nurse’s office to avoid classes they find challenging or unpleasant.

Confronted with this familiar scenario, King initiates probing questions to address what she calls an “age-old story.” Do you not like the class? Is something else going on? She assesses their academic performance and, upon pinpointing the underlying issues, coordinates wraparound services involving school counselors, social workers, teachers, and parents.

Kate King, school nurse and president of the National Association of School Nurses. (X, formerly Twitter)

The primary objective is to swiftly provide students with the necessary assistance to facilitate a prompt return to the classroom. She refers to school nurses as “the sentinels” and emphasizes their responsibility in recognizing issues and mobilizing support from various stakeholders.

Located in Columbus, Ohio, King’s current workplace, World Language Middle School, a bilingual language immersion institution, electronically monitors students’ visits to the nurse’s office to swiftly identify recurring patterns.

“My main focus — and that of a school nurse — is to ensure that children are present in school,” she emphasized. “Many assume that our main goal is sending children home, but, in reality, it is to maintain students’ presence in school.”

King’s experiences mirror the findings of a recent study involving 21 school nurses conducted at the University of Missouri Sinclair School of Nursing. The research, led by Knoo Lee, a registered nurse, revealed that students with frequent partial-day absences often seek solace and support from school nurses, positioning the nurses to intervene proactively before absenteeism becomes chronic.

“We made a groundbreaking discovery,” stated Lee to The 74, emphasizing that school nurses possess the capacity to detect early signs of partial-day absenteeism. Understanding that such absences often escalate to full-day absences, Lee believes that school nurses can significantly contribute to addressing chronic absenteeism.

Knoo Lee is an assistant professor at Missouri University’s Sinclair School of Nursing and a registered nurse. (Deidra Ashley/University of Missouri)

Despite their crucial role, school nurses often find themselves excluded from policy-making discussions, as indicated by Lee’s research. They necessitate enhanced support and resources to address student challenges that contribute to chronic absenteeism, including mental health issues, homelessness, transportation difficulties, and food insecurity. The report suggests that school districts ensure appropriate staffing levels of trained and certified nurses equipped with essential supplies to enable effective nursing services.

Amidst the post-pandemic period, chronic absenteeism, defined as missing 10% or more of school days annually, continues to pose significant challenges. The 2020-21 academic year witnessed over 14.7 million students nationwide grappling with chronic absenteeism, marking a notable increase compared to pre-COVID figures, as reported by Attendance Works. Children from impoverished backgrounds are disproportionately affected, with increased risks of chronic absenteeism affecting students of color and those with disabilities.

In previous research on chronic absenteeism, Lee noted a tendency to overlook partial-day absences, although they are prevalent and can serve as precursors to full-day absences, both influencing academic performance. Lee’s study is pioneering in examining the potential impact of school nurses on reducing partial-day absenteeism, a phenomenon not consistently tracked across states.

Based on interviews from nearly two dozen school nurses participated in six online focus groups between June and August 2020, serving in diverse school settings across Minnesota, this research provided insightful perspectives. The nurses’ varying years of experience and backgrounds offered a comprehensive view on how school nurses could address partial-day absenteeism effectively, collaborating with projects like the Minnesota Youth Sex Trading Project to benefit young individuals.

The study underscored that students engaging in partial-day absences often sought assistance by approaching the school nurse’s office independently. Nursing interventions ranged from students evading specific classes to seeking essential meals or requiring rest after supporting their family. This hands-on approach enabled nurses to identify and support at-risk students effectively.

The significance of school nurses expanding their role to encompass mental and emotional support remains pivotal, as highlighted in the study.

King emphasized the challenge posed by absenteeism patterns when nurses are not present on the school premises daily. Serving as the president of the National Association of School Nurses with more than 17,000 members, King noted that approximately two-thirds of public schools have access to full-time nurses. However, in rural districts, this percentage drops to 56%, plummeting to merely 16% in the Western regions. Additionally, about 40% of school nurses alternate between at least two schools.

Parents, especially those with children facing chronic illnesses, exhibit greater trust in sending their children to school when a nurse is available daily. This is particularly vital for students lacking access to medical care outside school. King illustrated that students were more likely to be sent home without a nurse’s presence, significantly affecting their healthcare opportunities.

Though the number of schools with full-time nurses has increased notably due to pandemic-related funding, there remains concern that schools may lose this resource post-federal funding depletion, according to King.

Notably, Lee conducted this study during the initial pandemic phase, which exacerbated chronic absenteeism. Despite numerous interventions attempted over the years, school districts continue to grapple with finding effective solutions, as reported by Lee.

Lee expresses hope that his research serves to underscore the pivotal role school nurses play in addressing chronic absenteeism.

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