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Introduction

In 1986-7, representatives of Johnson & Johnson and the Education and Training Division of the Center of Alcohol Studies, Rutgers, The State University of New Jersey, began discussing possible target populations for an education program. School nurses emerged as the primary target group because they are highly trained professionals who are often the first to recognize that a child is having an alcohol- or drug-related problem. Children and their families turn to school nurses for assistance because of their health care knowledge, the confidentiality and protection their offices provide, and their warm and caring manner. Nurses thus play an important role in the lives of students and their families, and in turn have the potential to significantly impact alcohol, drug, and other health issues among students. We hypothesize that ultimately, by helping the nurses improve the way they do business, we will improve the health outcomes of children in their care.

In creating Johnson & Johnson School Nurse Fellowship Program (JJSNFP),
Johnson & Johnson and the Center of Alcohol Studies sought to elevate the role of the school nurse in the school setting and to empower these nurses to be more effective providers of care. Thus, the JJSNFP was designed primarily to give nurses the tools they need to enhance their roles in their schools. However, because nurses’ roles are also dependent on the attitudes and actions of school administrators, the JJSNFP design includes a mandate that an administrator (i.e., principal or vice principal) be a co-participant during a portion of the program, and that the nurse and administrator co-design a demonstration project to be implemented upon their return to the school.

A weeklong JJSNFP training was piloted in 1988 and has since been conducted yearly. More than 500 school nurses have participated in the program during its 18-year history. The 2007 session will be held July 6 – 13, 2007. Further discussion of the program goals and components—and the linkages among them—is provided below.

Program Components      Back to top

The JJSNFP includes the following components:

1. Training/development sessions - The JJSNFP training takes place at Rutgers University each July as a part of the Institute of Alcohol and Drug Studies (IADS). Approximately 30 school nurses from across the US and several from abroad are invited to participate each year and are provided full scholarships and a stipend by Johnson & Johnson. After registration on Friday, they participate in icebreaker activities. Training sessions (some specific to the JJSNFP, others part of the broader IADS) begin on Saturday and continue through the following Friday. Content areas covered include adolescent alcohol and drug use , mental health issues, addiction and the family, adolescent sexuality, HIV/AIDS, obesity, etc. Also included are school-based issues, such as prevention and intervention programs and the role of school nurse in crisis management. Although the principal focus of the JJSNFP is the nurse, a significant aspect of the program involves the two-day participation of each nurse’s school administrator. Administrators arrive on Tuesday. They are welcomed at a reception and are provided with an overview of what the nurses have experienced thus far. For the remainder of their stay, they attend lectures with the nurses on topics such as the role of the school nurse, alcohol/drug policies and programs, assets , etc. They also attend a Johnson & Johnson-hosted reception/dinner with the nurses, and they work with their respective nurses to design a project to implement in their schools (see also # 3 below).

2. Mailings - Following participation in the training, school nurses receive five to six JJSNFP mailings per year that provide up-to-date information on relevant emerging research (e.g., best practices, resources, news, etc.). The mailings are not sent to administrators.

3. Demonstration projects - Before leaving the training, each nurse submits an application to Johnson & Johnson requesting up to $1,500 to seed implementation of the project that was planned with the administrator. Once back in their schools, school nurses initiate their projects, which usually focus on the planning and delivery of parent programs, peer programs, student assistance programs, community health fairs, or other prevention or education programs.

Program Goals and Goal Pathways      Back to top

As was indicated above, the JJSNFP seeks to ultimately improve adolescent health outcomes in school settings. To achieve this goal, it is hypothesized that a number of short-term, mid-term, and long-term changes need to be effected among multiple target entities (i.e., nurses, administrators, schools, and school systems).

Over the short-term (i.e., by the time training participation has concluded), the program seeks to increase nurses’ knowledge of the causes, correlates, and interconnectedness of adolescent risk behaviors, as well as best practices in their prevention. Also over the short-term, JJSNFP participation is expected to increase nurses’ professional self-knowledge and self-efficacy—specifically, confidence in their ability to develop, implement, and evaluate adolescent health programs—as well as their belief that such programs are beneficial to the school climate. Administrators who participate in the training are expected over the short-term to exhibit increased knowledge of adolescent health issues and a greater belief that programs addressing these issues would benefit the school climate. In addition, it is anticipated that their awareness and recognition of the current and potential roles of the school nurse will increase.

It is hypothesized that if these short-term goals are achieved, then over the mid-term (i.e., 6-12 months after returning to their schools), administrators will increase inclusion of the school nurse in health-related policy and program development efforts, and nurses will be more satisfied with their working relationships with the administrators on adolescent health-related matters. It is also anticipated that training participation, project implementation, and the ongoing JJSNFP mailings will contribute in the mid-term to an increase in nurses’ and administrators’ transfer of their new adolescent health-related knowledge to others through community events, professional meetings, and other forums. In addition, it is expected that through implementation of the projects that nurses and administrators planned at the training, the number of school-based education and prevention programs to promote adolescent health will increase.

Finally, it is hypothesized that if the program is successful in achieving these mid-term changes in nurses, administrators, and schools, then certain long-term goals will be achieved a year or more after training participation. In particular, nurses are expected to exhibit a sustained sense of empowerment to function as change agents in their schools. Both nurses and administrators are expected to exhibit a sustained increase in expectations with respect to health-related programming. Schools and school systems are expected to evidence more active involvement in school health issues, particularly in identifying and providing assistance to students impacted by alcohol and drug problems. Together, these long-term goals, if achieved, will ultimately contribute to improved adolescent health outcomes in school settings.

Related Program Benefits      Back to top

The JJSNFP is also expected, over the long-term, to have additional related benefits for students and communities. In particular, it is anticipated that as adolescent health outcomes in school settings improve, school absenteeism will decrease and school retention will increase. Additionally, it is anticipated that greater awareness of and participation in student health issues by school nurses, administrators, the school system as a whole, and other community constituents will help to make communities healthier places for children.