Degree Name

Doctor of Nursing Practice (DNP)

Document Type

Project Paper


School of Nursing




Healthcare systems are increasingly accountable for safety and quality. States have a key role in protecting and promoting the health of their youth, setting regulations and standards for school health services structures and processes. Yet, the lack of an instrument for state-level self-assessment of equity and quality infrastructure supports hinders progress toward improving in school health services delivery. This macro health system project, conducted in three phases, developed a valid and reliable instrument for state-level self-assessment of infrastructure necessary for supporting quality school nursing services. The phases were identification of state-level structures and processes domains and indicators; a content expert survey evaluating the validity of the measure; and a pilot test of the measure with Rhode Island state-level school health leaders. The resulting State-level School Health Infrastructure Measure, comprised of seven domains and related indicators assesses for the presence of evidence-based school nursing practice standards and resources; school nursing workforce professional competency standards and professional development; school nursing delivery of school-age population healthcare; equity in student access to professional school nursing services; cross-sector state leadership, governance, collaboration, linkages, and networks among health and youth service entities; school health information technology and data integration; and stable funding for school nursing services. The instrument appears to be feasible, cost effective, valid, and reliable for assisting states to identify and build quality school nursing services delivery capacity to improve the health of school-age youth.