Standard 4 Aspect A

4a.  Partnerships and Stakeholder Collaboration to support high needs schools and participates in efforts to reduce disparities in educational outcomes

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Offering the Fresno State School Nurse Services Credential Program online across the state of California provides an opportunity for our students to engage with K-12 schools in all areas of the state, including areas of high need.  Before entering the program, candidates are employed by a school district and usually have 2 or more years of school nursing experience. Candidates come to school nursing with varied and oftentimes extensive nursing experience.  Once in the program, candidates bring their experience in diverse settings across the state into discussion and problem-solving forums to share with fellow students.

Site Placement
All of our candidates are employed by their school districts. Typically school nurses are responsible for the provision of a comprehensive health and wellness program at multiple school sites.  The majority of school nurses work full time during the SNSC program duration and most complete their practicum in their own districts.  A school nurse in California typically has responsibility for 3-4 school sites; each site with multiple grades Preschool to Grade 12, diverse cultures and languages, and various economic and  health challenges.  Many of our school nurses are the only health personnel in a district and serve multiple roles.  Therefore, the SNSC program has little control over district and/or site placement. Instead of schools we have listed the district partnerships, as our school nurse candidates have multiple schools within a district to provide health and wellness services.

• Demographic Data from California Healthline 

As discussed in Standard 3, the 64 districts we have worked with in the past three years cover a large area of California.  However, to reduce health disparities, our program prioritizes admitting candidates from the Central Valley area of California. 

The Central Valley is a 450-mile-long stretch and one of the fastest growing regions of California. Migration is the leading source of population growth in the valley. Central Valley residents are ethnically diverse. Most regions of the valley have high poverty rates. Education levels are lower in the Valley than in the rest of the state.  For example, Fresno county’s population is just under one million people.  Forty-four percent speak a language other than English, twenty-one percent are foreign born, and twenty percent live in poverty.  There are few universities in the area to provide education. The valley has 30% fewer doctors than the statewide average. School nurses provide an important link between families and the community in terms of health care access and sometimes the only health resource a family reaches out to. Therefore, we give additional points on the application rubric for candidates who serve the Central Valley area due to the high health care needs of the student population. 

By supporting the special needs of the Central Valley, we are providing school nurses to areas that have few medical options; and for students and families school nurses might be the only medical resource and/or gateway to medical referrals and treatments. School nurses work closely with medical providers to provide needed medical care and treatment options as well as working in and in conjunction with school-based clinics.

• (Admission Rubric)
• (Map of California and Central Valley) 

Participates in efforts to reduce disparities in educational outcomes
“Healthy Children Learn Better….School Nurses Make it Happen” is a frequent saying among school nurses.   In order to learn effectively, students in the K-12 setting must be healthy.   The school nurse reduces barriers to learning through health assessments and health maintenance and brings needed community resources to the school site or to the families' awareness.  

• (CCTC Role of the School Nurse)

SNSC candidates participate in activities to reduce disparities in educational outcomes by addressing health concerns, medical issues, prejudices, and discrimination in K-12 schools. The SNSC program provides guidance to candidates on social issues through weekly instruction and practicum courses and these areas are documented in practicum experiences.  Discussion forums with scenarios addressing bullying, family violence, migrant health, mental health, substance use disorder and other social issues help the candidate develop skills in identifying and finding solutions to educational disparities.

In practicum courses, documentation of skill includes Preceptor Skills checkoff forms asking specific feedback on candidate advocacy and knowledge of diversity issues. Student journals are used to track hours, learning opportunities and reflection to practice.  As noted in the Standard 1 AAQEP Report data, a final evaluation asking preceptors to provide feedback of each candidate's overall ability to provide appropriate school nurse services in a variety of settings is reviewed.  From cohort-to-cohort preceptors tend to rate the candidate skill level as excellent or very good indicating that the SNSC program is successful in helping students become successful advocates for all students.  

• Research Question Book N185
• Research Question Book N184
• (Syllabus N186)
• (Syllabus N187)
• (N186 Practicum Discussion Topics)

Descriptions of Partnerships:
Partnership/Advisory Board 1: Liaison between CSUF and the School Health Advisory Panel (SHAP) and Valley Children’s Hospital

Description of group’s purpose/function:
The SHAP, in collaboration with Valley Children's Hospital (VCH), consists of School Nurse Leadership and Administrators in the Central Valley of California to discuss current issues and challenges that impact the standards and practice of school nursing.  In addition, members often serve as SNSC program preceptors and advisors and work with the SNSC program coordinators as needed. In the SHAP meetings school nurse leadership discuss current events affecting school nurse practice, keep up to date on new medical practices affecting students, identify trends in school nursing, and provide support to smaller districts without a Health Services Director.  Members meet once every other month.

Examples of specific challenges/identified needs: application of school nursing in legal areas i.e. after-school programs, CPR, Automated External Defibrillators, diabetic care, finding preceptors and school nurse experiences for practicum experience.

Employer/Supervisor Survey
The SHAP participates in the Employer/Supervisor Survey to determine how well the SNSC program prepared their school nurses for professional school nursing.  

• Employer/Supervisor form

• (SHAP Agenda)

Partnership/Advisory Board 2: School of Nursing and SON Faculty and Graduate Committee

• Description of group’s purpose/function: The faculty of the School of Nursing reviews all SON program curriculum including School Nurse Services credential curriculum and standards for alignment with the School of Nursing.
• Meets once a month
• Examples of specific challenges/identified needs: program review, curriculum changes and department and university updates are reviewed.  

Partnership/Advisory Board 3: California School Nurse Organization

Description of group’s purpose/function: The California School Nurses Organization (CSNO)
The mission of California School Nurses Organization, the leading force for excellence in school health services, is to ensure that “school nurses optimize student health and enhance learning” through a network distinguished by: facilitating grassroots efforts within regional sections; developing and providing professional learning opportunity; fostering the development of leaders; conducting research and using evidence based practice; providing standards of care; and advocating for school health services.

Examples of specific challenges/identified needs:
CSNO is the sole California school nurse professional organization providing School Nurse Services Credential Program support and visibility on their website. In addition, CSNO works with the SNSC programs to provide professional development platforms after graduation and is the legislative arm of professional school nursing working to improve the standards, training and administration of school nursing in the state of California.

CSNO provides an annual State conference platform for Fresno State SNSC outreach to potential candidates as well as in-service opportunities statewide and at local sections.  Supports the California School Nurse Educators forum where SNSC programs collaborate on educational areas.

• (CSNO.org)
• (CSNO webpage of SNSC Programs)
• (School Nurse Educators Forum Agenda)   

Summary of Findings 4a
Data show that the SNSC program has adequate partnerships and stakeholder collaboration to support high needs schools and participates in efforts to reduce disparities in educational outcomes.  However, in the future, developing a candidate focus group to evaluate the SNSC program may be warranted.

Aspect B →