School Nurses – An Integral Member of the School Team Addressing Chronic Absenteeism
It is the position of the National Association of School Nurses (NASN) that the registered professional school nurse (hereinafter referred to as school nurse) is an integral member of the school team, promoting school attendance and combating student absenteeism by addressing the physical, mental, and social needs of the student. Chronic absenteeism puts students at risk for academic failure with effects that can last a lifetime and negatively impact education, health, financial stability, and employment (Robert Wood Johnson Foundation [RWJF], 2016).
Chronic absenteeism, commonly defined as missing 10 % or more of school days for any reason (excused or unexcused), detracts from learning and is a proven early warning sign of academic risk and school dropout (Jacob & Lovett, 2017). A fifth of the nation’s schools report that 20 % or more of their students are chronically absent; no state is untouched by the problem (Jordan & Miller, 2018). Children who are chronically absent in kindergarten and first grade are far less likely to achieve grade level reading by third grade and are four times more likely to drop out of high school (Healthy Schools Campaign, n.d.). Students who live in poverty are two to three times more likely to miss school and face significant health disparities including access to resources. Students who have disabilities or come from communities of color (African American, Native American, Pacific Islander and Latino) may also be affected disproportionately (Attendance Works, 2017).
While there are many contributing factors, addressing health-related chronic absenteeism for students is key to closing the achievement gap (National Forum on Education Statistics, 2018). One study found that 92.4% of students indicated health concerns were the reason they were ‘sometimes’ or ‘usually’ absent (Brundage, Castillo, & Batsche, 2017). Physical and mental health problems such as asthma, allergies, diabetes, obesity, seizure disorders, anxiety, and attention deficit disorder rank high among the factors contributing to chronic absenteeism (American Academy of Pediatrics [AAP] Council on School Health, 2016; Jacobsen, Meeder, & Voskuil, 2016). An estimated 27% of U.S. children have chronic health conditions (CHC) and 1 in 15 have multiple CHCs that impact school attendance (Rezaee & Pollock, 2015). Researchers have also found chronic absenteeism to be a symptom of other issues that hinder student learning, such as socioeconomic distress, health barriers, cultural and social exclusion, housing instability, food insecurity, unsafe or violent living conditions, avoidance of bullying harassment, school phobia, and family responsibilities such as caring for younger siblings (Black, Seder, & Kekahio, 2014; RWJF, 2016).
Experts in chronic absenteeism recommend a 5-part strategy to improve school attendance: engage students and parents, recognize good and improved attendance, monitor school attendance data and practice, provide personalized early outreach, and develop programmatic response to barriers (Attendance Works, 2018). School nurses have the expertise and already perform these five strategies as part of their role and should thus be an integral member of the school attendance team so that efforts are coordinated and efficient.
School nurses engage students and parents and provide personalized outreach as they address the physical and social needs of students. School nurses empower students as they teach them to better understand and address the root causes of health concerns (Engelke, Swanson, & Guttu, 2014; NASN, 2016). School nurses assist families obtain students’ medications, help provide access to care, and work individually with students at school so that they feel safe and are healthy (NASN, 2015). Through these efforts, school nurses provide case management, which improves chronic health conditions and reduces absenteeism (Jacobsen et al., 2016; Moricca et al., 2013). School nurses also address chronic absenteeism by identifying and building on protective factors and connecting students and families with resources to mitigate barriers such as community resources for food, transportation, and housing (Jacobsen et al., 2016; Schroeder, Malone, McCabe, & Lipman, 2018).
School nurses develop trusting relationships with students with chronic health conditions and their families. As integral team members, school nurses help schools build a culture of attendance by creating a welcoming and engaging school environment that emphasizes building relationships with families and stresses the importance of attending school every day (Attendance Works, 2017). For example, one school assigned different team members to mentor and befriend key students at risk. The school nurse’s daily interaction with the students helped improved attendance and supported the team’s approach to absenteeism (NASN, 2015).
School nurses collect, interpret, monitor, and use data to develop population-based programs and identify students at risk for absenteeism due to health or social concerns including students with disabilities. They use their expertise in population-based care to develop programs that provide education and follow up on screenings, which also increases return-to-class rates (AAP, 2016; NASN, 2015; NASN 2016). These skills can be used in developing school-wide programs. When school nurses have access to attendance data, they can track health related attendance rates and address these concerns. School nurses can also address chronic tardiness and early dismissals related to health or social concerns that may lead to absenteeism. Yet, many schools look at daily attendance (students at school) and truancy but fail to look at health related absences (Kemp, 2016).
Chronic absenteeism is a critical problem influencing student academic achievement with potential long-term effects on health, education, and financial stability. Finding solutions to the problem of chronic absenteeism is critical for enhancing educational outcomes for students. School nurses are vital team members who identify and mitigate the health, safety, and social risk factors that are barriers to school attendance (McClanahan & Weismuller, 2015).
American Academy of Pediatrics, Council on School Health. (2016). Role of the school nurse in providing school health services. Pediatrics, 137(6), e20160852. Retrieved from http://pediatrics.aappublications.org/content/early/2016/05/19/peds.2016-0852.
Attendance Works and Everyone Graduates Center. (2017). Portraits of change: Aligning school and community resources to reduce chronic absence. Retrieved from http://www.attendanceworks.org/wp-content/uploads/2017/09/Attendance-Works-Portraits-of-Change-Main-Document-Final-Sept.-1.pdf
Attendance Works and Everyone Graduates Center. (2018). Strategies for school sites. Retrieved from http://www.attendanceworks.org/chronic-absence/addressing-chronic-absence/strategies-for-school-sites/
Black, A. T., Seder, R. C., & Kekahio, W. (2014). Review of research on student non-enrollment and chronic absenteeism: A report for the Pacific region (REL 2015–054). Washington, DC: U.S. Department of Education, Institute of Education Sciences, National Center for Education Evaluation and Regional Assistance, Regional Educational Laboratory Pacific. Retrieved from https://ies.ed.gov/ncee/edlabs/regions/pacific/pdf/REL_2014054.pdf
Brundage, A.H., Castillo, J.M., & Batsche, G.M. (2017). Absenteeism among Florida secondary students. Retrieved from http://floridarti.usf.edu/resources/format/pdf/FloridaAggregateRCAReportFinal.pdf
Engelke, M., Swanon, M., & Guttu, M. (2014). Process and outcomes of school nurse management for students with asthma. The Journal of School Nursing, 30(3), 196-205. doi: 10.1177/1059840513507084
Healthy Schools Campaign. (2017). Addressing the health-related causes of chronic absenteeism: A toolkit for action. Retrieved from https://healthyschoolscampaign.org/wp-content/uploads/2017/02/Addressing_Health-Related_Chronic_Absenteeism_Toolkit_for_Action_Full.pdf
Jacob, B. & Lovett, K. (2017). Chronic absenteeism: An old problem in search of new answers. Retrieved from https://www.brookings.edu/research/chronic-absenteeism-an-old-problem-in-search-of-new-answers/
Jacobsen, K, Meeder, L., & Voskuil, V. (2016). Chronic student absenteeism; the critical role of school nurses. NASN School Nurse, 31(3). doi: 10.1177/1942602X16638855
Jordan, P., & Miller, R. (2017). Who’s In: Absenteeism under the Every Student Succeeds Act. Retrieved from https://www.future-ed.org/wp-content/uploads/2017/09/REPORT_Chronic_Absenteeism_final_v5.pdf
Kemp, C. (2016, October). AAP National Conference: What you can do to promote school attendance. AAP News. Retrieved from http://www.aappublications.org/news/2016/10/23/SchoolAttendance102316
McClanahan, R., & Weismuller, P. (2015). School nurses and care coordination for children with complex needs: An integrative review. The Journal of School Nursing, 31(1), 34-43. doi: 10.1177/1059840514550484
Moricca, M. L., Grasska, M.A.,Marthaler, M.B., Morphew,T., Weismuller, P.C., & Galant, S.P. (2013). School asthma screening and case management: Attendance and learning outcomes. Journal of School Nursing, 29(2), 104-112. doi: 10.1177/1059840512452668
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National Association of School Nurses. (2016). Framework for 21st century school nursing practice. NASN School Nurse, 31(1), 45-53. doi: 10.1177/1942602X15618644
National Forum on Education Statistics. (2018). Forum guide to collecting and using attendance data (NFES 2017-007). U.S. Department of Education. Washington, DC: National Center for Education Statistics. Retrieved from https://nces.ed.gov/pubs2017/NFES2017007.pdf
Rezaee, M.E., & Pollock, M. (2015). Multiple chronic conditions among outpatient pediatric patients, Southeastern Michigan, 2008–2013. Preventing Chronic Disease 2015, 12, 140397.
Robert Wood Johnson Foundation. (2016). The relationship between school attendance and health. Retrieved from https://www.rwjf.org/content/dam/farm/reports/issue_briefs/2016/rwjf431726
Schroeder, K., Malone, S.K., McCabe, E., & Lipman, T. (2018). Addressing the social determinants of health: A call to action for school nurses. The Journal of School Nursing, 34(3), 182-191.
Acknowledgment of Authors:
Linda Neumann, RN
Janis Hogan, BUS, RN, NCSN
Susan Morgan, M.Ed., RN, NCSN
Erin D. Maughan, PhD, MS, RN, PHNA-BC, FNASN, FAAN, FAAN
Kim Bartholomew, BSN, BS, RN
Adopted: June 2018
Suggested citation: National Association of School Nurses. (2018). School nurses: An integral member of the school team addressing chronic absenteeism (Position Statement). Silver Spring, MD: Author.
All position statements from the National Association of School Nurses will automatically expire five years after publication unless reaffirmed, revised, or retired at or before that time.