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Nurse researcher and educator Kasey Jordan, RN, PhD knows the stereotypical image of a school nurse – overworked, underpaid and, over the past two years, often on the front lines of controversial COVID policies.
And while those things are true, they aren’t the complete picture, says this Nurse of the Week.
“We don’t always present them as these strong, capable expert professionals that they are,” she said.
The same could be said for nursing in general – or for any traditionally “female” job. But Jordan sees the power in the interpersonal connections that nurses build with their patients and, from that, their capacity to create community change.
“If we’re serious about having better patient outcomes for society, then it’s areas in which the traditional nursing role can lead that really, I think, have a lot of potential to make a big difference. Things from communication to health promotion to what happens outside of that time when people are sick,” she said.
School nurses as “change-makers”
The possibilities inherent in nursing have inspired Jordan ever since she accidentally ended up in a nursing class in high school in rural Georgia.
“In high school, there were vocational classes that we took with all the other classes, and I wanted home ec, but I got stuck in health occupations against my will. Well, it stuck, and it really resonated with me,” Jordan said. “I ended up including those classes as part of my program of study, and I did an apprenticeship program with a local family practice and just never looked back.”
Even with the limited work that a high school apprentice could take on, she felt a meaningful engagement with patients and saw the role that the nurses played in their patients’ health journeys.
Jordan went on to study nursing with the expectation that she would be a bedside nurse, but by the time she finished her program, she knew she wanted to be in public health. Her first nursing job was in the cardiothoracic unit at Duke University Hospital to gain experience. Then she worked at the health department for a time before taking a job in the emergency department so she could complete an internship while earning her master’s degree.
Through the public health department, she spent a year and a half as a school nurse in Durham, North Carolina, at five alternative schools, each geared toward a different student population that needed extra attention.
“Every school had its own flavor,” she recalled.
Yet she also started to see constraints in the system.
One small example: The alternative schools were well-connected to mental health and behavioral resources for the students. But Jordan saw that some students weren’t having truly basic needs met, like good nutrition, decent sleep and adequate physical movement. Jordan approached an administrator about this, and the answer was, “Well, there’s no grant funding for that.”
“It was like, there’s all these high-level treatments that are so valuable. But then there’s also these basic processes that are so impactful on our outcomes. And it was sometimes harder to work on those things,” she said.
In both public health and school nursing, Jordan found herself surrounded by “incredibly smart people with great ideas” who faced numerous obstacles in bringing those ideas to fruition.
“That core challenge is really what led me to go back for my Ph.D. and what, in different ways, I’ve tried to explore since then,” she said.
Now an assistant professor in the College of Nursing at MUSC, Jordan focuses on innovation management. She especially values how school nurses and other health care providers find ways to develop resilience in communities and address disaster risk.
“What I’m most excited about is nurses and health professionals finding ways to make our communities more resilient to disaster. School nurses are incredible change-makers, and so are our students,” she said.
For instance, students in the accelerated Bachelor of Science in Nursing classes are learning the change-making skills that school nurses often learn, by necessity, on the job, Jordan explained.
Innovative projects the ABSN students have tackled recently included a podcast geared toward mental health challenges during the pandemic and support for educators to understand how COVID-related changes could affect student health.
School nurses play key role in community resilience
Jordan noted, too, that local disaster response requires flexibility to adapt to specific circumstances, and that’s where she’s interested in seeing who’s doing what.
“If you consider disaster response, there’s this piece of improvisation that is in it. It’s such a fascinating area, and school nurses have been on the ground improvising to meet these needs,” she said. “It’s really inspiring – and important to understand.”
“So much of responding to disaster is locally driven,” she continued. “So understanding what professionals in community spaces need is important.”
Jordan said she loves seeing school nurses who understand how comprehensive the role can be and are pushing expectations of what they’re there to do.
“One of the amazing gifts of school nursing practice, because you are outside the traditional system, is there is so much freedom and independence,” she said.
On the other hand, that requires skills that nurses don’t necessarily come equipped with. Unlike nurses in a health care setting, school nurses may need to be more entrepreneurial to “sell” innovations related to health.
“School nurses really have to build their teams and raise whatever kind of capital is needed – social or financial – to see their changes move forward,” Jordan explained.
While there’s general agreement that addressing health and physical needs will ultimately help with academic outcomes, Jordan said, the rub is the school nurses actually have to negotiate to get what’s necessary to address that health. That’s where those skills of teambuilding in a multidisciplinary environment come into play.
“There’s good evidence that school nurses are a great return on community investment, but I think there is more to tell about the community resilience they are building that is outside the traditional expectations of what school nurses have done,” she said.
In follow-up to a previous study she conducted, Jordan is currently looking at how school nurses are leading resilience-promoting change in school settings.
Since coming to South Carolina, Jordan has been working with the South Carolina Association of School Nurses to determine what subject areas need more research to help nurses in schools. That’s how she came to do an analysis of continuing education needs for school nurses, which led to her examining how school nurses are leading resilience-promoting change in school settings.
Throughout her journey, one fascinating thing that she has discovered is that innovation can come from anywhere.
“There’s not a single profile of an innovator,” she said. “It’s something that happens in all parts of an organization. But definitely there are skills we can learn to make it more effective.”