introduction

1. S T E P H A N I E K N U T S O N , M S N , R N
S C H O O L H E A L T H C O N S U L T A N T
C O N N E C T I C U T S T A T E D E P A R T M E N T O F
E D U C A T I O N
S U Z A N N E L E V A S S E U R , M S N , A P R N
C O O R D I N A T O R O F H E A L T H S E R V I C E S ,
D A N B U R Y P U B L I C S C H O O L S
Introduction to: Competency in
School Nurse Practice
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2. Purpose
 Document designed to support the practice of school
nursing within Connecticut schools.
 Promotes high-quality school health services.
 Delineates the knowledge and skills needed to practice
nursing in the school setting.
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3. Rationale
 Children are now attending school with more
complex health needs;
 Increased frequency of chronic health needs;
 School nurses now need expanded skills and
knowledge in order to meet the growing needs of
students.
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4. How is it used?
A framework for nursing school
instructors;
An orientation plan for new school nurses;
An evaluation tool by nursing supervisors;
A self-evaluation tool for school nurses;
A goal-setting tool for school nurses; and
A program planning tool.
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5. Competency in School Nurse Practice…Why?
To assure continuing professional competence in
today’s environment, where:
 technology and practice are continually changing;
 new health care systems are evolving; and
 consumers are pressing for providers who are
competent.
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6. Competency Assumptions
 The public has a right to expect competence
throughout nurses’ careers.
 Any process of competency assurance must be
shaped and guided by the profession of nursing.
 Assurance of continuing competence is the shared
responsibility of the profession, regulatory bodies,
organizations/workplaces and individual nurses.
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7. Competency Assumptions, Cont’d
 Nurses are individually responsible for maintaining
continuing competence.
 The employer’s responsibility is to provide an
environment conducive to competent practice.
 Continuing competence is definable, measurable and
can be evaluated.
 Competence is considered in the context of level of
expertise, responsibility and domains of practice.
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8. 3 Sections
1. Competencies
2. Supervision
3. Evaluation
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9. Competencies Section
 16 Standards
 Emergent School Nurse
 Competent School Nurse
 Proficient School Nurse
 Expert School Nurse
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10. Benner's Application to Nursing of the
Dreyfus Model of Skill Acquisition
Nurses move through five levels of
proficiency in skill development:
 novice,
 advanced beginner,
 competent,
 proficient, and
 expert.
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11. Emergent School Nurse
 The emergent school nurse can demonstrate
marginally acceptable performance.
 Through practical experience in concrete situations,
the emergent school nurse starts intuitively to
recognize various aspects of a situation when they
are present.
 Principles that guide actions are based on
experience, skills and knowledge as part of one’s
professional education and preparation as a nurse.
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12. Competent School Nurse
 Competence is achieved when the school nurse,
through instruction or experience, begins to adopt a
hierarchical perspective.
 Has been on the job in the same or similar situation
two or three years.
 Devises a plan based on considerable conscious,
abstract and/or analytic contemplation of the
situation he or she is facing.
 Feels responsible for his or her choice and its results.
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13. Proficient School Nurse
 Understand a situation as a whole because they
perceive its meaning in terms of long-term goals.
 learns from experience what typical events to expect
in a given situation and how plans may need to be
modified in response to these events.
 This response is not yet automatic, as the proficient
school nurse has yet to have enough experience with
the wide variety of possible actions in each situation.
In order to determine the correct response, the
school nurse falls back on the detached, rule-based
determination of actions.
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14. Expert School Nurse
 No longer relies on an analytic principle (rule, guideline,
maxim) to connect her or his understanding of a
situation to an appropriate action.
 The extensive background of the expert school nurse
fosters an intuitive grasp of each situation and
identification of the nexus of the problem without
wasteful consideration of many alternative diagnoses and
solutions.
 The expert operates from a deep understanding of the
whole situation.
 The expert school nurse sees intuitively what to do
without applying rules and making inferences.
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15. Standards of School Nursing Practice
Standards of Practice
1. Assessment
2. Diagnosis
3. Outcome Identification
4. Planning
5. Implementation
5a. Coordination of Care
5b. Health Teaching and Promotion
5c. Consultation
5d. Prescriptive Authority and Treatment
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16. Standards (continued)
6. Evaluation
Standards of Professional Performance
7. Quality of Practice
8. Education
9. Professional Practice Evaluation
10. Collegiality
11. Collaboration
12. Ethics
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17. Standards (continued)
13. Research
14. Resource Utilization
15. Leadership
16. Program Management
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18. Standard 1 - Assessment
 The school nurse collects, analyzes and synthesizes
comprehensive data pertinent to the student’s health
or the situation .
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19. Activity- Assessment Standard
 Review Assessment standard.
 Do a group assessment of your skills and knowledge
based on the following scenarios:
1. Collecting immunization data for a Haitian refugee student;
2. Enrollment of a student with a tracheostomy
 Be prepared to:
 Provide the entire group with a brief synopsis of the scenario
assigned and assessment data collected;
 Based on assessment data collected by your group where do
you fall on the CT school nurse competency standard ?
 Describe one or two of the competencies within the standard
that really stood out to the group;
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20. Standards
 Standard 2 Diagnosis - The school nurse analyzes
assessment data to determine the nursing diagnoses
and collective problems.
 Standard 3 Outcomes Identification - The school
nurse identifies expected outcomes for a plan that is
individualized to the student or the situation.
 Standard 4 Planning - The school nurse develops a
plan that prescribes strategies and alternatives to
attain expected outcomes.
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21. Standards Cont’d
 Standard 5 Implementation - The school nurse
implements the interventions identified in the plan
of care/action.
 Standard 5A Coordination of Care - The school
nurse implements the interventions identified in the
plan of care/action.
 Standard 5B Health Teaching and Health
Promotion - The school nurse provides health
education and employs strategies to promote health
and a safe environment.
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22. Standards Cont’d
 Standard 5C Consultation - The school nurse
provides consultation to influence the identified
plan, enhance the abilities of others and effect
change.
 Standard 6 Evaluation - The school nurse evaluates
progress toward attainment of outcomes.
 Standard 7 Quality of Practice - The school nurse
systematically evaluates the quality and effectiveness
of nursing practice.
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23. Standards Cont’d
 Standard 8 Education - The school nurse attains the
knowledge, skills and competencies required for
quality practice in schools.
 Standard 9 Professional Practice Evaluation - The
school nurse evaluates one’s own nursing practice in
relation to professional practice standards and
guidelines, relevant statutes, rules and regulations.
 Standard 10 Collegiality - The school nurse interacts
with and contributes to the professional
development of peers and school personnel as
colleagues.
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24. Standards Cont’d
 Standard 11 Collaboration - The school nurse
collaborates with student, family, school staff and
others in the conduct of school nursing practice.
 Standard 12 Ethics - The school nurse integrates
ethical provisions in all areas of practice.
 Standard 13 Research - The school nurse integrates
research findings into practice.
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25. Standards Cont’d
 Standard 14 Resource Utilization - The school nurse
considers factors related to safety, effectiveness, cost
and impact on practice in the planning and delivery
of school nursing services.
 Standard 15 Leadership - The school nurse provides
leadership in the professional practice setting and
the profession.
 Standard 16 Program Management - The school
nurse manages school health services.
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26. Supervision Section
 Supervision requirements
 Clinical Supervision
 Administrative Supervision
 Models of Supervision
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27. Supervision
Supervision is initial and ongoing direction,
procedural guidance, observation, and
evaluation (Ohio BON, 2001).
 Administrative – an appropriately credentialed individual,
such as building principal, pupil service director, etc.
 Clinical – requires specialized knowledge, skills, and
related credentials for the practice of school nursing.
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28. Supervision Requirements
 Supervision should be offered on an individual basis
for all staff members, including new school nurses,
interns and veteran school nurses.
 For new school nurses, direct on-site supervision
should be provided for two hours weekly — at a
minimum — and consultation by
telecommunications should be available as needed.
 Individual clinical supervision for experienced school
nurses should be arranged, based on individual and
district needs, ranging from two hours on-site
biweekly to biannual evaluations.
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29. Clinical Supervision
 Clinical supervision requires specialized,
professional knowledge, skills and related
credentials for the practice of school nursing.
 It promotes, enhances and updates the professional
growth of school nurses in terms of their professional
and clinical skills and knowledge .
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30. Administrative Supervision
 May be provided by appropriately credentialed
individuals who are knowledgeable about school
nursing, such as a building or district administrator
(CSDE, 2001).
 Includes activities and attributes such as adherence
to school policy and state and federal regulations,
organization, oral and written communication skills,
collaborative skills and the day-to-day nonclinical
duties performed by the school nurse.
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31. Models of Supervision
 Clinical Supervision at the district level
 Supervision by non-nursing personnel
 Regional Models
 Peer/group supervision
 Peer mentoring
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32. Professional Development (PD)
Supervision includes providing PD activities offered
through department meetings, workshops and
conferences. Supervisors should encourage and promote:
 1. school nurses’ participation in state and national
associations to maintain professional identity and an up-
to-date knowledge of the field of school nursing; and
 2. the participation of school nurses in professional
development workshops offered outside the school
system to obtain knowledge and to network with
colleagues.
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33. Evaluation
Based on:
 A comprehensive job description;
 Performance standards and competencies; and
 Direct observation of performance
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34. Evaluation Tool
 Evaluations provide objective feedback;
 Standards and competencies allow for fair and
consistent feedback;
 Assist the supervisor and nurse to come to
consensus on job performance;
 Measure professional growth;
 Identify professional development needs; and
 Assist in identification of annual performance
goals.
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35. Evaluative Techniques
 Direct observation
 Review of documentation, content and maintenance
of:
 School health records
 IEP goals
 IHCP goals
 Assessments
 Direct and indirect interventions
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36. SCHOOL NURSE PERFORMANCE EVALUATION
School Nurse_________________________ School ____________ Review by nurse (date) __________ Review by nursing
supervisor (date) _________
Code: M - Meeting Standard P - Progress Toward Meeting Standard N - Not Meeting Standard
Based on attached school nurse competency indicators for each standard at Beginner (BEG,) Emergent (EMG), Proficient (PRO), and Expert (EXP)
levels
SELF STANDARDS SUPERVISOR
B
E
G
EM
G
P
R
O
E
XP
B
E
G
EM
G
P
R
O
E
XP
Standard 1: Assessment – the school nurse collects, analyzes, synthesizes comprehensive data
pertinent to the student’s health or the situation.
Standard 2: Diagnosis – the school nurse analyzes the assessment data to determine the nursing
diagnoses and identify collaborative health and education problems.
Standard 3. Outcomes Identification – The school nurse identifies expected outcomes for a plan
individualized to the student or the situation.
Standard 4. The school nurse develops a plan that prescribes strategies and alternatives to attain
expected outcomes.
Standard 5: Implementation – The school nurse implements the interventions identified in the plan of
care/action.
Standard 5A: Coordination of Care – The school nurse coordinates care delivery
Standard 5B: Health Teaching and Health Promotion – The school nurse provides health education and
employs strategies to promote health and a safe environment
Standard 5C: Consultation – The school nurse provides consultation to influence the identified plan,
enhance the abilities of others and effect change.

37. Activity - Utilizing Evaluation Tool
 Review Evaluation tool.
 Do a self evaluation based on Standard 5b-Health
Teaching and health promotion.
 What data would you provide to substantiate your
self evaluation to your supervisor?
 What goals would you make for the upcoming school
year based on your self evaluation?
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38. Next Steps
As a district group or with one other nurse:
 Develop an individual or district action plan to utilize the
competencies.
The Connecticut State Department of Education
will:
 Provide technical assistance and consultation
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39. Sample Action Plan
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40. References
 American Nurses Association. Assuring Safe, High Quality Health Care in Pre-K Through 12 Educational Settings [Position
Paper]. Silver Spring, MD: American Nurses Association, 2007.
 National Association of School Nurses (NASN). School Nurse Supervision/Evaluation. [Position Paper]. Silver Spring, MD:
NASN, 2003.
 Parker, M. and Barry, C. Florida Atlantic University Community Nursing Model for Practice, Florida Atlantic University, Nurse Sci
Q. 1999; 12: 125-131. and May 6-7, 1999, workshop.
 Southern Regional Education Board. Curriculum and Faculty Development in Community-Based Care: School Nurses And Nurse
Educators Collaborate, 2000. E. Aiken, Atlanta, GA: Author. Accessed August 2007, from the World Wide Web:
http://www.sreb.org/programs/nursing/publications/CurriculumAndFacultyDev.pdf
 American Nurses Association (ANA) and National Association of School Nurses (NASN). School Nursing: Scope and Standards of
Practice. Silver Spring, MD: ANA and NASN, 2005.
 National Association of State School Nurse Consultants (NASSNC). Clinical Supervision of School Nurses. [Position Paper]. Kent,
OH: NASSNC, 2007.
 Connecticut State Board of Education. Connecticut’s Common Core of Teaching. Hartford, CT: Connecticut State Board of
Education, 1999.
 U.S. Department of Education, Office of the Deputy Secretary. No Child Left Behind: A Toolkit for Teachers. Washington, DC:
U.S. Department of Education, 2004. Accessed August 2007, from the World Wide Web:
http://www.ed.gov/teachers/nclbguide/nclb-teachers-toolkit.pdf.
 Whitehurst, G., 2002. Research on teacher preparation and professional development, White House Conference on Preparing
Tomorrow’s Teachers. Accessed August 2007, from the World Wide Web:
http://www.ed.gov/admins/tchrqual/learn/preparingteachersconference/whitehurst.html
 American Nurses Association (ANA). Continuing Competence: Nursing’s Agenda for the 21st Century. Washington, DC: ANA,
2000.
 Bargagliotti, T.; Luttrell, M., and Lenburg, C., 1999. Reducing threats to the implementation of a competency-based performance
assessment system. Online Journal of Issues in Nursing. Accessed August 2007, from the World Wide Web:
www.nursingworld.org/ojin/topic10/tpc10_5.htm.
 Benner, P. From Novice to Expert: Excellence and Power in Clinical Nursing Practice. Menlo Park, CA: Addison-Wesley, pp. 13-
34, 1984.
 26 competency in school nurse practice

41. References, Cont’d
 Benner, P.; Tanner, C. and Chesla, C. Expertise in Nursing Practice: Caring, Clinical Judgment and Ethics. Springer, pp. 37-43,
1996.
 Bobo, N.; Adams, V. and Cooper, L. Excellence in school nursing practice: developing a national perspective on school nurse
competencies. The Journal of School Nursing: Vol. 18, No. 5, pp. 277–285. Silver Spring, MD: National Association of School
Nurses, 2002.
 Florida Atlantic University. Community Practice Guided by a Nursing Model, M. Parker and C. Barry. Nurs Sci Q.1999;
 12: 125-131, 1999.
 National Council of State Boards of Nursing, Inc., NCSBN. Assuring Competence: A Regulatory Responsibility. Chicago: NCSBN,
1996.
 Southern Regional Education Board, 2000. Curriculum and faculty development in community-based care: School nurses and
nurse educators collaborate. E. Aiken, Atlanta, GA. Accessed August 2007, from the World Wide Web:
http://www.sreb.org/programs/nursing/publications/CurriculumAndFacultyDev.pdf
 Whittaker S.; Carson, W. and Smolenski, M. 2002. Assuring continued competence – policy questions and approaches: how
should the profession respond? Online Journal of Issues in Nursing. Accessed August 2007, from the World Wide Web:
http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/
Volume/ContinuedCompetence.aspx
 American Nurses Association. Scope and Standards of Practice for Nursing Professional Development. Washington, DC: ANA,
2000.
 American Nurses Association. Code for Nurses with Interpretive Statements. Washington, DC: ANA, 1985.
 Baille, V.; Cordoni, T. and Trugstad, L. Effective Nursing Leadership: A Practical Guide. Rockville, MD: Aspen Publishing, Inc.,
p. 118, 1989.
 Bargagliotti, T.; Luttrell, M. and Lenburg, C., 1999. Reducing threats to the implementation of a competency-based performance
assessment system. Online Journal of Issues in Nursing. Accessed August 2007, from World Wide Web:
www.nursingworld.org/ojin/topic10/tpc10_5.htm
 Connecticut State Board of Education. Position Statement on Student Support Services. Hartford, CT: Connecticut State Board of
Education, 2001.
 Connecticut State Department of Education. Standards for School Nursing Services in Developing Quality Programs for Pupil
Services. Hartford, CT: Connecticut State Department of Education, 1999.

42. References, Cont’d
 Kansas Board of Nursing – Legal FAQs., 2007. Accessed August 2007, from the World Wide Web:
http://www.ksbn.org/legal/faq.htm#Can%20a%20nurse%20be%20supervised%20by%20a%20non-nurse.
 Connecticut State Department of Education. Guidelines for the Practice of School Psychology. Hartford, CT: Connecticut State
Department of Education, 2004.
 Descoteaux, A. The school nurse manager: A catalyst for innovation in school health programming. The Journal of School
Nursing: Vol. 17, No. 6, pp. 296–299, 2001.
 Houghton, C. A mentoring program for new school nurses. The Journal of School Nursing: Vol. 19, No. 1, pp. 24–29. Silver
Spring, MD: National Association of School Nurses, 2003
 National Association of School Nurses (NASN). School Nurse Supervision/Evaluation. [Position Paper]. Silver Spring, MD:
NASN, 2003.
 National Association of School Nurses (NASN). Professional Development/Continuing Education [Position Paper] Silver Spring,
MD: NASN, 2006.
 National Association of State School Nurse Consultants (NASSNC). Clinical Supervision of School Nurses. [Position Paper]. Kent,
Ohio: NASSNC, 2007.
 Ohio Board of Nursing. Nursing Standards and Delegation: A Guide to Ohio Board of Nursing Rules, 2001. Accessed August
2007, from the World Wide Web: http://www.acils.com/ohionh/nursestandards.html
 Periard, M.E.; Knecht, L.D. and Birchmeier. A state association surveys school nurses to identify current issues and role
characteristics. Journal of School Nursing, Oct; 15(4): 12-4, 17-8, 1999.
 Whittaker S.; Carson, W. and Smolenski, M., 2002. Assuring continued competence – policy questions and approaches: how
should the profession respond? Online Journal of Issues in Nursing. Accessed August 2007, from the World Wide Web:
http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume/Continu
edCompetence.aspx
 Connecticut State Department of Education, State School Nurse Consultant.
http://www.sde.ct.gov/sde/cwp/view.asp?a=2678&q=320768
 Southern Regional Education Board, 2000. Curriculum and faculty development in community-based care: School nurses and
nurse educators collaborate. E. Aiken, Atlanta, GA: Author. Basic competencies for school nurses.
http://www.sreb.org/programs/nursing/publications/CurriculumAndFacultyDev.pdf