CHOP Policy Lab recommends staffing, EHR and supervision changes for Wallingford‑Swarthmore school nurses; district begins implementation

CHOP Policy Lab presented its review of school health services to the Wallingford‑Swarthmore School District Education Affairs Committee on Oct. 14, recommending changes to staffing models, electronic health records and supervisory structures for district nurses.

The CHOP presenters said the review found nurses “highly valued and well respected” but often overstretched, with insufficient time for work that does not involve immediate student care such as care plans, parent meetings and reporting. The report recommended expanding staffing capacity, integrating nurses more fully into school culture, and improving documentation systems to better capture visit acuity and time use.

The review used the National Association of School Nurses framework and combined interviews of district school health staff with a survey of six neighboring districts — Garnet Valley, Haverford, Lower Merion, Radnor, Springfield and Upper Darby — to develop evidence‑based recommendations. Dr. Alex Simcoe, a clinical psychologist and Policy Lab faculty member, and Dr. Tracy Wasnorek, director of school‑based programming in CHOP’s Center for Violence Prevention, described the methodology and key findings. CHOP said the district’s PowerSchool system meets basic needs but “does not serve to optimize health service operations” and lacks functionality to record visit acuity, making it harder to characterize nurses’ time.

Why it matters: school nurses’ ability to perform non‑urgent but essential tasks — developing individualized health plans, attending team meetings, conducting mandated screenings and coordinating care — affects compliance with screening requirements and the district’s ability to monitor population health and follow up on students who need services.

Key findings and district response

- Workload and staffing: CHOP found nurses often lack time for non‑visit tasks and that a single float nurse is insufficient to meet needs. CHOP noted that neighboring districts frequently use split‑time nurses (one nurse assigned across multiple schools) and reported satisfaction with that model. The district said it has already added two full‑time staff nurses (non‑certified school nurses): one assigned primarily to elementary schools and one to secondary schools, a change the administration said allows nurses to attend meetings and complete paperwork more readily.

- Integration and culture: CHOP identified siloing as a problem — some nurses reported feeling disconnected from broader school teams — and recommended integrated training, adjusted screening expectations, and development of stronger nursing leadership. District staff said nurses are being included in PBIS Tier 2 work and in drug‑and‑alcohol prevention efforts alongside counselors and health/PE staff.

- Documentation and EHRs: CHOP recommended evaluating electronic health record options, exploring supplemental systems that integrate with PowerSchool, and engaging PowerSchool experts to optimize current use. District leaders acknowledged that PowerSchool stores visits and immunization records but lacks acuity tools; they said they will examine options and try to streamline documentation to reduce nurse burden.

- Supervision and evaluation: nurses reported preferring clinical supervision from other health professionals and said the current evaluation tool (the Danielson rubric) does not capture many nursing responsibilities. CHOP recommended adapting evaluation to the NASN framework, collaborating with other districts for shared clinical observation, and using regional nursing resources. District officials said they plan to retain the Danielson rubric’s core but add school‑nursing components and to explore shared clinical supervision where feasible. Union contract constraints were noted as a consideration for some supervisory changes.

District next steps and timelines

District staff said the CHOP review took about a year to 18 months (interviews, surveys and report writing). Steps already taken include hiring two staff nurses and centralizing screening timelines this school year with contracted screening support. The district is establishing a program appraisal tool and plans to calculate nurse visit acuity and staff‑to‑student ratios based on current staffing (including the two new hires) to determine whether further hires or reassignment are needed. The district said evaluation of the appraisal baseline will occur at the end of this school year, with continued monthly attention and follow‑up through 2028.

Formal committee business

The committee also approved the Sept. 2025 meeting minutes by motion at the start of the meeting; the motion was moved and recorded as “so moved” without a named mover or second in the transcript and was entered as approved.

Who spoke (selected)

- Dr. McCullough, CHOP Policy Lab presenter - Dr. Alex Simcoe, clinical psychologist, CHOP Policy Lab - Dr. Tracy Wasnorek, director of school‑based programming, CHOP - Debbie Sweeney, nursing department chair, Wallingford‑Swarthmore School District - Dr. Russell Johnson, Superintendent, Wallingford‑Swarthmore School District - Dr. Sharon Battig, Assistant Superintendent, Wallingford‑Swarthmore School District - Committee members asking substantive questions: Miss Lane; Miss Vincent; Miss Blaine; Miss Ulbert

Ending

Committee members asked about timelines, participation in county nursing professional development, potential use of Medicaid billing for services, and how the district will measure whether changes are effective. District staff said a Delaware County school nurses’ PD event is being reestablished next year, that initial Medicaid billing trainings are under way (with uncertain near‑term revenue), and that the program appraisal tool will provide an annual baseline for evaluation.