Abstract
A few weeks ago, I was discussing nursing education with one of the instructional aides at my school. He was exploring future plans for a different career and was considering becoming a nurse. Our conversation turned to types of nurses, such as licensed practical nurses, registered nurses, and advanced practice nurses, as well as specialties such as school nurses, critical care nurses, and hospital nurses, and types of education, such as associate degree, bachelor degree, and accelerated programs for master and doctorate degrees. Then came the question, “but why do you have to take courses like history and psychology and all that other stuff, when what you really need is to know how to do the things?” It made me think, how do I know “how to do the things?” And what are those “things” that make me an accomplished nurse? It brought back memories of my years teaching community health nursing telling nursing students that while we all value competency at skills that they so much want to do, vital signs, urinary catheterizations, suctioning, and so on, the most important nursing skill is thinking. They also wanted to just learn how to do the things and most often, I think, did not agree that “thinking” is the essential “thing” nurses do.
Nurses often categorize themselves as “doers,” myself included. We like to do things, see immediate results, save lives, get glasses for our kids, get a diagnosis and treatment for a set of symptoms, get students vaccinated, and create a safe place for students to talk. And yet, to “do the things” well, we must have a process to guide our practice, starting with thinking and strategizing. A Google search yields The Oxford Dictionary definition of strategize as a verb, “devise a strategy or strategies,” giving a context sentence of, “home is where he has enough quiet and privacy to strategize and plan for the future” (Oxford Languages, n.d.). Clearly strategy takes time and reflection. Stragetizing is essential to the comprehensive, complex practice of school nursing. Along with strategy, school nurses identify desired or projected outcomes.
At the 2023 School Nurse International Conference this summer, I experienced a presentation by Donna Gaffney (2023) on well-being based on the book, Courageous Well-Being for Nurses: Strategies for Renewal. I was very interested to hear what she had to say especially in regard to self-care and how I could expand my repertoire of what I could do to help myself and other school nurses in moral distress. My brain had autocorrected “well-being” to “self-care” and was focused on doing. Dr. Gaffney astoundingly discusses the myth of self-care which is action-oriented, another task for nurses to do and who are assigned blame for not doing it well, as what we want to accomplish when really well-being is the outcome we strive for. How could I have missed that? I know a lot about outcomes, and yet I too was fooled into thinking that the doing of self-care was my outcome, when really all along it was well-being. The strategies to reach well-being are broad and a shared responsibility and commitment among family, friends, nurses, and health care organizations. We must take time to reflect, collaborate, plan, and yes, strategize to achieve an outcome of well-being for ourselves and for the profession to move forward.
The National Association of Nursing (NASN) has a vision, “that all students are heathy safe, and ready to learn,” a mission, “to optimize student health and learning by advancing the practice of school nursing,” and a strategic plan (NASN, 2023) to operationalize our vision and mission. Each iteration of the NASN Strategic Plan begins with a lot of thinking, exploration, and discussion and reflects current issues, needs, and desired outcomes. A strategic plan is a document that needs to be read often and be front and center in all the NASN staff’s, Board of Directors’, and members’ work. Recently, the NASN Executive Committee met in Chicago to study and explore how strategy and a strategic plan moves an organization forward in its work on a broad level and how it provides the foundation, the outcomes, and the measurement for all the “things” that we want so badly to do and accomplish. Getting back to the basics of using the NASN Strategic Plan allows us to focus on outcomes. It keeps our sights on engaging school nurses in the 21st century practice, pursuing health, education, and social equity for students through shared leadership and securing foundational school heath evidence, all desired outcomes for our work. We strategize on a national level to support school nurses in identifying outcomes and strategies at a state, local, and individual level.
Creating a strategic plan for an organization or practice is not a one and done concept. Much of the work we are doing in strategy and outcomes for NASN can also be translated into school nursing practice. Focusing on engaging a board of directors in strategy and outcomes, Ken Favaro (2017) lists some groundwork for issues and opportunities related to strategy: identifying emergent issues and opportunities, assessing for potential change or creation of strategy, framing and prioritizing, determining alternative responses, and identifying outcomes rather than projects or tasks. School nurses can use the same model to strategize for practice.
What are the emerging school health issues and opportunities in your state, district, or school? Is vaping in schools an emerging issue? School-located vaccine clinics? Health care access? Increasing mental health concerns? These are all emergent issues for my district. These may change my strategy for health education or collaboration with community partners or routine health assessments in my school clinic. Which are my top priorities based on data, need, or availability? Are my responses to these issues more health education, outside agency collaboration, in-school practitioners, a school support staff team response, or individual student responses? And finally what outcomes will I measure? Fortunately we don’t have to do this strategizing alone. The NASN School Nurse Net Communities can provide examples and discussion of work. State affiliates and regional school nursing organizations can work together as strategizing supports, or nurses can engage a group of school nurses or support staff in their school or district. This investment in strategy and outcomes provides priorities, focus, and guardrails for school nursing and, rather than just “doing the things,” contributes to a comprehensive practice of school nursing.
Finally, an acknowledgment of an accomplishment of strategy and outcome. This is the last issue of the NASN School Nurse with Cynthia Galemore at the helm as editor. Cindy took a school nurse newsletter, and through strategic planning, knowledge, expertise, a love for lifelong learning, and a commitment and love for the practice of school nursing, she created a clinical journal that we know today as the NASN School Nurse. She will most likely tell you that this was not her accomplishment but the work of many. This is true; however, Cindy has been the principal foundation and leader in this endeavor. She has, through this work, shaped and influenced my school nursing practice in addition to thousands of school nurses throughout the world. A truly exceptional outcome. Thank you, and I wish you well on your coming adventures.
