Supportive Solutions: LPS school nurses write national paper highlighting healthy outcomes

February 28, 2025

School nurses across the country are helping children feel better thanks to the academic insights of three Lincoln Public Schools employees.
 
Wendy Rau, Sara Stoner and Megan Lytle have co-authored a paper that shows how LPS school nurses support social, emotional and behavioral health needs of students. The National Association of School Nurses (NASN) published the trio’s research in the peer-reviewed clinical resource journal NASN School Nurse. The journal is distributed in print and online formats to more than 17,000 school nurses and school health researchers.
 
“The Role of the School Nurse in Social-Emotional Assessment and Intervention Using the MTSS Framework” explains how LPS is using multi-tiered systems of support (MTSS) strategies in health offices. The MTSS model uses a proactive approach to health issues. It combines data-based solutions and social-emotional supports to help students succeed.

 
Rau, Stoner and Lytle said they were excited by what they heard from fellow school nurses who read the article. Rau is the LPS director of health services, Lytle is a district health services coordinator and Stoner is a school nurse at Goodrich Middle School.
 
“We’ve had really positive feedback from this,” Lytle said. “We’ve had people from across the country ask us, ‘Can you share the tools you’re using? Can you show us what you’re doing?’ We’re happy to do that.”
 
The LPS trio said they wanted to share how the MTSS approach has benefited the school district. The LPS health services department began implementing MTSS in 2017 after reviewing data from thousands of student visits. School nurses felt it made sense to introduce those strategies in health offices, as students will consistently see nurses in buildings for up to six years.
 
“Our data really showed us that we needed to start including social-emotional services to help students,” Rau said. “It wasn’t just anecdotal pieces of evidence either. It was staring us in the face.”
 
“Whether it was elementary school, middle school or high school, the top two reasons that students would visit health offices was either headaches or stomachaches,” Lytle said. “It didn’t matter what building it was, the socio-economic status of students or any other factors. Those were the top two complaints. We knew that those were likely symptoms of something more that was happening at an emotional level such as anxiety or stress, and we needed to treat those underlying causes instead of just treating the stomachache or headache.”
 
The majority of MTSS services have involved Tier 1 interventions, which are designed to help students understand their own emotions and how those can affect them physically. School nurses formed partnerships with LPS social workers and school counselors to develop visual tools for children to use in their offices.
 
For example, Stoner created a questionnaire for Goodrich students that allows them to identify how they feel both emotionally and physically. Similar tools are available in schools across the district. Younger students can point to a chart of 20 emojis to pinpoint their feelings, while older students can check boxes next to words that apply to their particular emotion.

 
Once school nurses discover those emotions, they talk to children about any stress-causing events that may be happening in their lives. Stoner helped one Goodrich student who had moved to Lincoln with her family and was having trouble making friends. Stoner and the student realized that her illnesses could potentially be a stress response to the emotions she was feeling from being at a new school.
 
“We’re getting to the heart of the problem,” Stoner said. “They can stop and think about the questions as they’re filling out the form, and once we find that out, we can provide calming strategies for them to use.”
 
Tier 2 and Tier 3 interventions include more comprehensive support blueprints. Tier 2 strategies could include weekly scheduled check-in times for students, while Tier 3 could involve the creation of documents such as an anxiety checklist. School nurses partner with teachers, family members, school counselors and school social workers to ensure the plans are successful.

 
Stoner and Lytle both said trust is a primary factor in creating positive outcomes.
 
“Creating a trusting environment is so important,” Stoner said. “You want to build that kind of trusting environment where students are willing to tell you how they feel. That’s a big part of this.”
 
“It’s so easy for students to think, ‘I’m the only one who is feeling this way. What is wrong with me?’ But in reality, this is normal. Everyone feels this way at some point in their lives,” Lytle said. “When you help kids realize this, and you let them know that you’re on their side and are ready to support them with everything, then they’re willing to allow you to help them.”
 
Rau said the calming tools and support strategies are making noticeable impacts. Health office visits across LPS dropped by 15.6 percent from the first quarter of the 2022-23 school year (54,514 visits) to the first quarter of 2023-24 (46,006 visits). Those numbers fell even more to 42,267 visits in the first quarter of 2024-25.
 
Rau said the program’s top goal is to help students become happy and healthy. These outcomes allow everyone at school to write their own academic, emotional, social and physical success stories.
 
“We are light years ahead of most districts when it comes to MTSS,” Rau said. “It’s been a really good thing for our students.”

Visit home.lps.org/healthservices to discover more about the many ways LPS helps students stay safe, healthy and ready to learn at school.

Check out the nurses’ article more in-depth by visiting this edition of the NASN School Nurse journal.   
 
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