Addressing Chronic Absenteeism

Addressing Chronic Absenteeism

Position Statement

printable version


It is the position of the National Association of School Nurses (NASN) that attendance at school is essential to student learning and success. The registered professional school nurse (hereinafter referred to as school nurse) is an integral member of the interprofessional school team, promoting regular school attendance and addressing chronic absenteeism by supporting students’ physical and emotional health and well-being.


School attendance is essential for academic success. Significant loss of learning time due to chronic absenteeism critically impacts academic attainment and places students at risk for school dropout and potentially negative life-long effects on health, education, employment opportunities, and financial stability (Healthy Schools Campaign, 2019). Chronic absenteeism is defined by Attendance Works (2018a) as missing 10% or more of school days within one academic year for any reason (excused or unexcused). Absenteeism can start out insidiously as when a student misses just two or more days of school a month. Poor attendance patterns may begin in kindergarten and can contribute to lack of achieving sufficient reading ability which is a critical skill to accomplish by third grade. This is when students typically transition from learning to read to reading to learn. (Weyers & Casares, 2019).

Each school district sets attendance policies based on individual state regulations, though legislation varies from state to state. Some states have enacted laws that allow an excused absence for a mental health day (Ingalls, 2022; Jacobson, 2022; Styx, 2022). School nurses are essential collaborators in addressing evolving complex issues to meet district and state goals for student attendance and health (NASN, 2020a).

To resolve chronic absenteeism, it is critical to first identify underlying root causes. “Absenteeism is a cross-cutting issue and cannot be solved alone by any one person, department or agency” (Attendance Works, 2020, para 7). Many complex factors contribute to chronic absenteeism. Causes are often related to health, academic, school, family, community, or structural factors (Allison et al., 2019). Students who have been diagnosed with chronic physical or mental health conditions tend to miss more days of school, as do students affected by the multiple effects of living in poverty. Unaddressed health and behavioral health issues may also play a role in school attendance patterns (Attendance Works & Everyone Graduates Center, 2021). To successfully decrease chronic absenteeism, it is essential that “school nurses routinely be included as integral members of school attendance teams” (Rankine et al., 2021, para 38). Research shows that the “presence of a school nurse is associated with reduced absenteeism and missed class time” (Yoder, 2020, p. 49).

Appropriate systemic strategies to address the diverse needs of individual student absenteeism require proactive approaches by school attendance teams that identify and build on protective and restorative factors, rather than punitive approaches (Attendance Works, 2018b). Comprehensive, multi-tiered support system approaches to absence prevention, early and consistent interventions, and individualized remediation plans have been shown to be the most effective and equitable ways to address chronic absenteeism (Attendance Works, 2018c). Settings that facilitate a positive school climate and a sense of belonging and connectedness help students to feel engaged with, and committed to learning (Korpershoek et al., 2020; Garcia & Weiss, 2018). Linking students and families with community resources to mitigate barriers to school attendance, such as transportation, housing, and childcare, promotes student and family engagement in school and can positively impact school attendance (Attendance Works. (2018d).

As members of school attendance teams, school nurses provide expert guidance on student health, safety, and social-emotional factors. School nurses contribute critical health perspectives to the development of individualized attendance intervention plans, school programs, restorative practices, and equitable policies that address chronic absenteeism (NASN, 2020b). These school nursing actions align with the Framework for 21st Century School Nursing Practice domains of care coordination, leadership, quality improvement, and community and public health, and contribute to decreasing absenteeism (Rankine et al., 2021; NASN, 2016; NASN, 2020a). “Studies of school nurse case management, infection prevention, and evaluation of illness all demonstrated reduced absenteeism or missed class time” (Yoder, 2020, p. 59).

When school nurses have access to accurate, up to date, and consistent attendance data, they can identify, and address absences related to health issues. A standardized state minimum data set with uniform data points that includes absenteeism data is important in collecting information about student attendance trends and monitoring improvement efforts or unmet needs (NASN, 2022; Rankine et al., 2021; Yoder, 2020; Attendance Works & Everyone Graduates Center, 2021). School nurses can also provide valuable insights to help address chronic tardiness and early dismissals related to health or social concerns that also cause missed learning time. The importance of using a data informed approach is essential as "what gets monitored is what gets addressed"(Attendance Works & Everyone Graduates Center, 2021, p. 14).

For students with ongoing health challenges requiring formal educational plans for academic support, school nursing expertise is crucial in developing 504 plan accommodations or individualized healthcare plans as part of special education individualized education plans (IEP). These documents, developed with school nursing input, should detail school nursing care interventions needed to support school attendance and student learning (Rankine et al., 2021). Investing in the health and well-being of students, particularly those with chronic health conditions, increases the potential for students to attend school regularly, experience academic success, graduate, and thrive as healthy adults. Local, state, and federal policies that support resource allocations for sufficient numbers of school nurses in school all day, every day, and that provide infrastructure supports for evidence-based school nursing practice delivery, are necessary for equitably improving student health and academic outcomes (Yoder, 2020; Doremus, 2021). These fundamental elements are “key prerequisites to school nurses’ effective engagement in activities proposed to reduce chronic absenteeism” (Rankine et al., 2021, p. 7).

Student academic success is dependent upon regular school attendance. As professionals who bridge education and health, school nurses are vital school team members in supporting student attendance and addressing chronic absenteeism. School nursing interventions enhance student health, well-being, and educational achievement and prepare students for technical skills training or college, careers, and lives as healthy productive citizens.


Allison, M., Attisha, E., Lerner, M., Duncan De Pinto, C., Savio Beers, M., Gibson, E., Gorski, P., Kjolhede, K., O’Leary, S., Schumacher, H., & Weiss-Harrison, A., (2019). The link between school attendance and good health. Pediatrics, 143(2), doi: 10.1542/peds.2018-3648

Attendance Works & Everyone Graduates Center. (2021). Chronic absence to map interrupted schooling, instructional loss, and educational inequity: Insights from school year 2017-18 data.

Attendance Works. (2018a). Chronic absence. The problem.

Attendance Works. (2018b). Chronic absence. Key ingredients for systemic change.

Attendance Works. (2018c). Chronic absence. 3 tiers of intervention.

Attendance Works. (2018d). Chronic absence. Strategies for school sites.

Attendance Works. (2020). Key concepts for leveraging chronic absence during the Coronavirus pandemic. aging-chronic-absence-during-the-coronavirus-pandemic/

Chang, H., Osher, D., Schanfield, M., Sundius, J., & Bauer, L. (2019). Using chronic absence data to improve conditions for learning. Attendance Works and American Institutes for Research (AIR).

Doremus, W. (2021). Development of a measure of state-level supports for school nursing services delivery. The Journal of School Nursing. Advance online publication. doi: 10.1177/10598405211000683

Healthy Schools Campaign. (2019). Addressing the health-related causes of chronic absenteeism: A toolkit for action.

Garcia, E. & Weiss, E. (2018). Student absenteeism. Who misses school and how missing school matters for performance. Economic Policy Institute.

Ingalls, N. (2022). Mental health days help kids, but systemic barriers prevent widespread use. Verywell Mind.

Jacobson, R. (2022). Should kids take mental health days? Child Mind Institute.

Korpershoek, H., Canrinus, E., Fokkens-Bruinsma, M. & de Boer, H. (2020). The relationships between school belonging and students’ motivational, social-emotional, behavioural, and academic outcomes in secondary education: A meta-analytic review. Research Papers in Education, 35(6), 641- 680. doi: 10.1080/02671522.2019.1615116

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 Association of School Nurses. (2020a). Framework for 21st Century School Nursing Practice™: Clarifications and updated definitions. NASN School Nurse, 35(4), 225-233. doi: 10.1177/1942602x20928372

National Association of School Nurses. (2020b). School nurse-led surveillance of chronic absenteeism. NASN.

National Association of School Nurses. (2022). National School Health Data Set: Every Student Counts!

Rankine, J., Goldberg, L., Miller, E., Kelley, L., & Ray, K. (2021). School nurse perspectives on addressing chronic absenteeism. The Journal of School Nursing. Advance online publication. doi:10.1177/10598405211043872

Styx, L. (2022). States are now accepting “mental health day” as a valid reason for missing school. Verywell Mind.

Weyer, M. & Casares, J. (2019). Pre-Kindergarten-Third Grade Literacy. National Conference of State Legislators.

Yoder, C. (2020). School nurses and student academic outcomes: An integrative review. The Journal of School Nursing, 36(1), 49-60.

Acknowledgment of Authors:

Wendy A. Doremus, DNP, RN, FNP-BC (retired), PHNA-BC (retired)

Review Team:
Teri Schloss, MSN, RN, NCSN
Lou Ann Gleason, MSN, RN 

Adopted:  June 2018
Revised: June 2023

Suggested citation: National Association of School Nurses. (2023). Addressing chronic absenteeism (Position Statement). 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.