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Use in an Urban Public School System

Elisabeth Schainker, MD; Mary Jane O’Brien, PNP; Debra Fox, MSN; Howard Bauchner, MD

Arch Pediatr Adolesc Med. 2005;159:83-87.

Objective  To describe the quantity and type of school health services provided by nurses in Boston Public Schools.

Setting  In 2001, the 63 024 students enrolled predominantly belonged to minority groups (48% black, 28% Hispanic, and 9% Asian) and were eligible for a free or reduced-price lunch (71%).

Main Outcome Measure  Analysis of the 2001-2002 Boston Public Schools Health Services database.

Results  A total of 63 024 students generated 721 291 individual encounters with 93.5 full-time equivalent school nurses, including episodic care (57.8%), medication administration (31.5%), procedures (6.2%), and screening (5.1%). A total of 2420 students had an individual health care plan for the administration of medications and procedures during the school day. Students with individual health care plans averaged 117.9 encounters per year with school nurses, and students without averaged 7.2 encounters per year. Outcomes of encounters included school dismissal (3.0%); verbal communication with parents (10.6%), school staff (3.9%), and community agencies or health care providers (1.1%); and referral to a primary care provider (4.6%) or emergency services (<0.1%).

Conclusions  Some school-age children receive a large amount of health care from school nurses in Boston Public Schools. We estimate that these children are 8 times more likely to see a school nurse than a pediatric health care provider. These school nurses were involved in the care of children with mental health and chronic health care needs. Despite the extensive amount of care, little is known about the efficacy of the care provided or the effect of these services on health care use.

Author Affiliations: Division of General Pediatrics, Boston University School of Medicine and Boston Medical Center (Drs Schainker and Bauchner), and Health Services, Boston Public Schools (Mss O’Brien and Fox), Boston, Mass.

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