Development of a School Nurse Simulation Boot Camp

Abstract

A school nurse continuing education program was developed by School of Nursing faculty at an East Texas university, providing school nurses with documented competence in nursing skills focused on equitable health outcomes. The 8 hr School Nurse Boot Camp program consisted of a keynote address on local pediatric health topics and a series of 30-min speed simulations focused on mental and physical health issues. A total of 62 school nurses attended the three boot camp offerings during the 2023/2024 academic school year and represented a student population of 78,275. Participants indicated satisfaction with the event and interest in future continuing education opportunities. The boot camp event provides a local continuing education offering, a record of competency for school nurses, and a regional partnership between school nurses, School of Nursing faculty, and Educational Service Center personnel.

Background

School nurses are charged with upholding the scope of nursing practice, which includes the responsibility to reduce health disparities through collaborative partnerships, as established in Provisions 8 and 9 of the Code of Ethics for Nurses and NASN Code of Ethics for School Nurses (American Nurses Association [ANA], 2025; National Association of School Nurses [NASN], 2024). These provisions affirm that health is a universal human right that can be negatively impacted by social determinants of health, thus obligating nurses to engage in collaboration to bring about health equity. Health equity refers to equal opportunities to achieve optimal health outcomes (Centers for Disease Control and Prevention [CDC], 2024). The provisions in the codes of ethics highlight the responsibility of all nurses, including school nurses, to keep health equity at the forefront of their practice.

School nursing in the United States was founded at the turn of the 20th century and focused on health equity in a small number of New York City schools that served an impoverished immigrant population (Houlahan, 2018). School nurses provided health care to these students and families that they otherwise would not have received. Lacking an established network of community health partners, the first school nurses used their resourcefulness to build various relationships with those who could help them address the health disparities impacting students and their families and improve academic success. Since then, school nursing has evolved to meet the changing needs of students. However, the relationship between a student’s health and academic outcomes remains constant, making school nurses’ resourcefulness in addressing the health equity of students as important as that of their predecessors (CDC, 2020; NASN, 2023; The Lancet Public Health, 2020).

The impact and types of health inequities students face varies. The social determinants of health can positively and negatively impact health equity, with rural areas often experiencing higher levels of inequitable health outcomes (CDC, 2023; World Health Organization [WHO] 2025). School nurses are well positioned to focus on how the social determinants of health impact students, with one of those determinants being the provision of quality care (WHO, 2025). For some students, the school nurse may be the only healthcare professional they see, making the care they receive from the school nurse a significant contributor to health equity.

Ongoing education and skill development on best practices, along with regular evaluations of nursing competencies help to ensure that quality nursing care is provided. Due to the nature of the position, most school nurses do not have access to collaborative partners who can provide this type of training and evaluation, including those in East Texas, a predominantly rural area (Texas Department of Agriculture, 2012). This gap in access to continuing school nurse education was recognized when a small group of school nurses in East Texas became aware of the 2016 case of Chan v. Kickstart. In this case, a school nurse failed (presumably due to a lack of knowledge) to employ an AED for a middle schooler who collapsed and later died during a physical education class (Wiley, 2016). Discussion of this case prompted these East Texas school nurses to raise concerns about their lack of means to improve and record their school nursing competence. They shared their unease with a representative at their regional Educational Service Center and the local School of Nursing faculty. Soon after, a discussion was started regarding a possible collaborative relationship to provide continuing education focused on improving school nursing competence and the provision of safe and equitable care to students.

In response to the concerns of the school nurses, School of Nursing faculty with school nursing experience developed a continuing education program. The program was titled The School Nurse Simulation Bootcamp: Best Practices in K-12 and focused on the desired outcome measures of adding to school nurses’ knowledge and providing opportunities to practice skills and demonstrate competencies. Attention was given to the needs expressed by the school nurses who requested the continuing education opportunities. Based on those needs, the program was designed with a trifold purpose: (a) to provide continuing education opportunities for school nurses to maintain current documented competence of their nursing skills, (b) to provide continuing education on topics of interest to the school nurses with a focus on equitable health outcomes in rural school districts, and (c) to establish an ongoing collaborative partnership between the school nurses, the Educational Service Center representative, and the University’s School of Nursing faculty.

Offering a School Nurse Boot Camp

The creation of the School Nurse Simulation Boot Camp was a multistep collaborative process (see Figure 1) involving school nurses, Educational Support Center personnel, and School of Nursing/University faculty and staff. The boot camp aligned with the School Nursing Practice Framework, which establishes school nurses’ responsibilities to students through their nursing leadership and a focus on community/public health (NASN et al., 2024). Additionally, the nursing process guided the development of the boot camp.

Figure 1.

Steps to Offering a School Nurse Boot Camp

After becoming aware of the concerns of the school nurses, the School of Nursing faculty formed a boot camp committee and arranged a meeting with the school nurses to discuss their needs and the needs of their students. Additionally, the boot camp committee met with the Educational Service Center representative to discuss the provision of continuing education focused on nursing competencies. After the initial assessment of the school nurses’ continuing education needs and determining the feasibility of providing a continuing education program, the boot camp committee requested and received permission from the University and School of Nursing administrators to proceed with the planning phase.

The planning phase consisted of coordination within the University and School of Nursing, as well as with Educational Support Center personnel and took place over a 4-month period beginning in April 2023. An initial step of the planning phase was selecting event dates that were amenable to school nurses’ attending the boot camp. The final decision was to offer four different boot camp event dates to accommodate the demand of school nurses and variations in school district calendars. The first boot camp was offered in August 2023, with three subsequent offerings during the 2023/2024 academic school year. All boot camps were offered on weekdays during school nurses’ professional development days, when possible.

Another immediate consideration was consulting with the appropriate University personnel to ensure facility and parking space availability on the days of the scheduled boot camp events. Additionally, the Educational Service Center agreed to advertise the events through their established school nurse listserv, their website, and via email using marketing materials created by the University and the School of Nursing’s marketing departments. The Educational Service Center also facilitated the registration and payment for the boot camp.

Planning also involved coordination with the School of Nursing’s Continuing Professional Development team to provide continuing education units to the boot camp participants. The School of Nursing Simulation Director was consulted and arranged for appropriate rooms and supplies to accommodate the planned simulation events. Administrative assistants in the School of Nursing were also integral in coordinating food services to provide breakfast and lunch for the boot camp participants and volunteers.

Full-time and adjunct faculty within the School of Nursing volunteered to develop simulation content and lead simulations during the event that were focused on the impact of social determinants of health in the region’s school districts. Faculty volunteers, or “boot camp instructors,” were recruited by the boot camp committee members on a rotating basis for each boot camp with respect to volunteers’ expertise and availability. Volunteers included psychiatric-mental health nurse practitioners and family nurse practitioners. Additional clinical faculty, with expertise in the topics of interest identified by the school nurses, also volunteered to guide simulation activities. The boot camp committee partnered with Texas Child Health Access Through Telemedicine (TCHATT) and counselors within the School of Education at the university to provide a keynote presentation on current evidence regarding school mental health support.

The implementation phase of each School Nurse Boot Camp involved a 1-day event lasting 8 hr, coinciding with the typical school nurse’s working hours (see Table 1). The inaugural boot camp in August 2023 began with a presentation by a keynote speaker, followed by a morning session of presentations given by a series of guest speakers with mental health expertise from the TCHATT network. The afternoon was spent in the simulation center, where participants rotated through a series of four, 30-min speed simulation stations involving common and emerging physical health issues encountered by school nurses in the region.

Table 1.

Example Agenda

School nurse simulation bootcamp: Best practices for PK-12 agenda
0730-0800	Sign-in/Breakfast
0800-0815	Welcome/Introductions/Overview of the day/Expectations
0815-0915 (60 min)	Keynote
0915-0930	Networking break
0930-1145 (135 min)	Mental Health Case Study Speed Sims with Debrief
1145-1215	Lunch
1215-1515 (180 min)	Physical Health Case Study Speed Sims with Debrief
1515-1530 (15 min)	Wrap up/Evaluation
1530-1630	Open house/Practice skills/Q&A

Evaluation results from the first event revealed that participants wanted “longer simulations” and “more skills” in future boot camps. Therefore, the itineraries for the remaining boot camps were modified to commence with a 1-hr keynote address focused on local pediatric mental health trends, followed by the remainder of the day dedicated to speed simulation stations. To facilitate the speed simulation format, participants were divided into small groups with no more than 10 participants per instructor. The morning stations involved a series of three, 30-min, low-fidelity scripted case scenarios (Ellinas et al., 2015) related to pertinent mental health topics (self-harm, substance misuse, and interprofessional collaboration). The afternoon consisted of four 30-min stations involving common and emerging physical health issues (diabetes, complex chronic care management, reportable conditions, and infectious rashes). After both the morning and afternoon sessions, a guided large group debriefing took place between the bootcamp coordinator and the school nurse participants to discuss their experiences (The International Nursing Association of Clinical Simulation and Learning Standards Committee, 2016). Additionally, following the conclusion of the boot camp, participants were provided the opportunity to revisit the skills stations to practice psychomotor skills competencies under the guidance of a nurse practitioner and simulation center staff (Shin & Roh, 2020). At the boot camp conclusion, all participants were required to complete an evaluation to receive continuing education credit for the event. Participants were provided with a QR code to scan, linking them to a Qualtrics survey.

The boot camp planning committee met monthly with the Nursing Continuing Professional Development team in the early stages of planning. Meetings also took place 1 month preceding and 1 week following each boot camp event to further evaluate and refine the simulation case scenarios and selection of the boot camp instructors fit for the event.

Results

Overall, a total of 62 school nurses from 18 school districts in the region attended the August, October, and January boot camps in the 2023/2024 school year, representing a total student population of 78,275. The March 2024 boot camp was canceled due to scheduling conflicts. Attendees of the three completed boot camps included 14 licensed practical/licensed vocational nurses, 20 associate degree nurses, 27 bachelor’s degree nurses, and 1 master’s-prepared nurse.

Most participants indicated they were satisfied or very satisfied with their boot camp experience and stated they planned on making changes to their school nursing practice. Written feedback from the participants revealed that they felt their assessment skills were improved, they developed a greater understanding of the importance of teamwork and collaboration, and they garnered a better understanding of mental health issues affecting students. Participants’ feedback also showed interest in future boot camps and suggested other topics they would like to see addressed.

Additionally, the outcome measures set by the School of Nursing boot camp committee were achieved. These goals aligned with the reasons for developing the boot camp which was to provide continuing education on current best nursing practice and offer an opportunity for school nurses to practice their competencies. An additional aim of the boot camp was to create an event where participants felt free to engage, and a high level of interaction was observed.

Conclusion

The purpose of developing the School Nurse Boot Camp was achieved. A continuing education opportunity was created to serve as a record of school nurses’ competence, simulation topics were focused on the social determinants of health and equitable health outcomes for the rural K–12 population, and a partnership was formed because of the initiative taken by school nurses. The collaboration that took place between school nurses in the region, the regional Educational Service Center nursing representative, and School of Nursing faculty of the local university fulfilled Provisions 8 and 9 of the Code of Ethics for Nurse and School Nurses to reduce health disparities through collaborative partnerships (ANA, 2025; NASN, 2024). However, more than a finite collaborative effort is needed to address school nurses’ potential to positively impact the social determinants of health and equitable health outcomes. Therefore, because of the success, School Nurse Boot Camp offerings will continue.

To align with the schedules and school calendars of most school nurses in the region, future boot camps will be offered twice a year: once before the start of the fall semester and once between the fall and spring semesters. The existing boot camp structure will be used with the nursing process continuing to guide any necessary modifications. Speed simulation topics will be tailored to the ongoing needs of the school nurses and their student population, providing school nurses with opportunities to attain local continuing education opportunities focused on nursing competencies.

Providing an opportunity for all regional school nurses to benefit from the boot camp is one goal of the collaborative effort. Therefore, plans for a “Boot Camp Road Show” that would entail taking the boot camp to school nurses who are unable to attend the sessions held at the university. The overarching goal is sharing the vision of the boot camp with others so that similar partnerships with school nurses become standard collaborative practice.

Biography

Jodi S. Bullard, PhD, RN is an assistant professor in the School of Nursing at the University of Texas at Tyler. With 13 years of school nursing experience, she remains actively engaged in the field by serving as a substitute school nurse, and chairing a School Health Advisory Council in her area, allowing her to stay connected to the patients and evolving challenges in school health.

Angela J. Preston, PhD, RN is an assistant professor in the School of Nursing at the University of Texas at Tyler and active nurse scientist with specialized training in environmental determinants and psychometrics. She is a former rural school nurse and is currently funded by the Texas Children’s Mental Health Care Consortium to explore systems-level promotive factors to adolescent wellbeing.

Jenifer M. Chilton, PhD, RN is Associate Dean for Academic Affairs, Professor, and the recipient of the Mary Coulter Dowdy Distinguished University Professorship in the School of Nursing at the University of Texas at Tyler. As a former school nurse, Dr. Chilton understands how health and wellness impacts the education of students.