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Are You Up For A Challenge?


We have seen the ice bucket challenge, book reading challenges, and other social media challenges. This academic year, I invite you to participate in a different kind of challenge: The Outcome Challenge. What is it? How do you participate? Let me explain.

Do you ever feel you need to defend your position and what you do? Do you need proof of school nurse effectiveness, but don’t have it. Several school nurses have asked me how to best articulate what they do. I often times get asked for data for school nurses to use. Data begins with you, the school nurse.

Others have asked me how to calculate school nurse outcomes from their interventions. To measure or calculate outcomes we must identify what outcomes we want to achieve and intentionally measure them. This may seem overwhelming-but does not have to be: Join the Outcome Challenge (#NASNOutcomeChallenge). Start now, join the revolution to identify an outcome(s) you want to measure this year. Start small, be strategic and continue reading.

Think of it as a road trip. When planning for a trip you first need to identify where you want to go. For example, when planning a vacation you have to decide do you want to go to the Grand Canyon, the Statue of Liberty, or somewhere else? Once you decide on a destination, you will have to determine all the landmarks (actions or interventions) you need to meet in order to achieve your goal and arrive at your desired location.  

Outcomes are the same. You need to have a goal identified so you know when you have achieved it. A school nursing outcome example could be to have 98% attendance for students with asthma.

Learn more by reviewing the outline below.  And, select "watch the outcome challenge webinar" for more information.

Watch the Outcome Challenge Webinar.


I challenge you to identify 1 outcome you want to measure this year. Start small. Choose an outcome that is specific and sensitive to your role as a school nurse. Be strategic. Choose an outcome that is dependent on the value, talents and competencies of a school nurse or explains what school nursing is to your supervisor, principal, or school communities. Choose something important to them. Examples could include:

  • Decreasing the students chronically absent by 5%.
  • Increasing the number of students who were referred to an eye specialist and how many obtained an eye exam and corrective lenses by 10%.
  • Determining the percentage of health office visits that result in the students returning to class ready to learn. (If you have tracked this in the past, make a goal to see how you could increase this percentage so more return to class).
  • Increasing student seat time by decreasing the length of student health office visits.

To “calculate” outcomes from data, you collect the data you believe measures the desired outcome.


Once you select your outcome-identify the activities (interventions) you believe will lead to the desired outcome. Back to our road trip example, someone with a map, funding, and time scheduled for the trip is more likely to get to their destination. The same is true for nursing. You will need to plan appropriate nursing activities (interventions) that will help you reach your outcome. For our example of the 98% attendance for students with asthma, the nursing actions may include developing an asthma action plan for each student, including interventions that assist students to understand their triggers and how to use their medication along with having an appropriate rescue inhaler at school. Completing these actions will increase the chances of reaching your goal of 98% attendance for students with asthma.


The final step is to create a plan to collect the data you need to know if you achieved your desired outcome as a result of the nursing actions (interventions) you took. For example:

  • How can you measure 98% attendance of students with asthma? You will need a list of the students with asthma and a way to track their attendance rates. (example: create a spreadsheet)
  • How will you know if students had an action plan and a rescue inhaler? You can track the number who have them and follow up with those who do not until they are in place.
  • How do you know if a student is knowledgeable about triggers and medication use? You could talk to them and ask them questions and see what they know or do not know, provide counseling or use motivational interviewing, and reassess periodically if the knowledge and skills remain. Be sure to document each of these steps.

Your start into collecting data could be that simple.

At the end of the year you not only want to measure the outcome, but you will want to share your results and explain what you did with your supervisor, principal, colleagues or school community so they better understand what you do.


That is the challenge. To make it easier, invite a coworker or even your district to accept the challenge together. Share the outcome you chose on SchoolNurseNet or tweet it out with the hashtag #NASNOutcomeChallenge.

Outcomes don’t appear-we have to deliberately measure them.
Join the revolution! Let’s continue to optimize student health together!
Accept the Outcome challenge.


I have received several inquiries regarding how school nurses can address chronic absenteeism. Here is a more complex and detailed example that you could personalize to your school for those of you interested in using chronic absenteeism as your outcome.

Desired Outcome

What to track

Decrease number of students chronically absent for health reasons by 5% by end of school year

  • Number (#) of students chronically absent
  • Of those students, number who are not chronically absent by end of year

Nursing Action Steps

Considerations of Data to Track

Identify student with health concern

  • Who are the students with health concern
  • # of student with health concern

Participate on chronic absenteeism task force

  • # of meetings held
  • # of meetings attended
  • # of meetings participated

Contacting students to better understand reasons

  • For each student identify reason for absenteeism
  • # of different reasons

Addressing specific health concerns of each student


  • With each student develop a plan to address the concern
  • # of students with plan to address concerns
  • # of plans followed

Follow up with students when back in school


  • # of students seen at school
  • Type of follow up contact
  • Any follow up concerns learned

Keep track of your activities including the students, the concerns, the plan, and tracking of progress. It may be a useful way to record your actions. Count numbers and activities at the end of the school year to determine if you met, exceeded, or did not meet your goal (outcome).

1 comment



I'm up for the challenge! 90% of the students who visit the nurse clinic return to class ready to learn for school year 2018-2019.