The Role of the School Nurse in Increasing Instructional Time Using Multi-Tiered Systems of Support for Behavior...

Frequent visits to the health office can lead to considerable time spent out of the classroom along with affecting relationships and health office resources and staffing. This article features the practice component of continuous quality improvement in the principal of quality improvement in the Framework for the 21st Century School Nursing Practice™ and is the third in a series focusing on the Framework. The article discusses how using multi-tiered systems of support for behavior (MTSS-B) to create expectations for the health office environment, along with intense, individualized plans for specific students, were successful in decreasing health office visits across the school district, with the ultimate goal of increasing instructional time. Outcome data revealed reductions in health office visits with a district-wide decrease of 4.1% one-year postimplementation of the project. More importantly, school nurses are providing better trauma-informed care with intentionality while still meeting the needs of students.