The Cost-Effectiveness of School Nursing Communities of Practice on Elementary Student Attendance and Chronic Absenteeism: A Clustered Randomized Controlled Trial

Qualitative and descriptive studies suggest that school nurses can help mitigate student absenteeism. However, rigorous empirical evidence supporting specific attendance-related nursing activities is limited. Therefore, we conducted a clustered randomized controlled trial among 84 urban elementary schools to assess the cost-effectiveness of forming separate online communities of practice (CoPs) for licensed practical nurses (LPNs) and registered nurses (RNs) to improve student attendance. Using the ingredients method, we estimated average implementation costs of $764 per LPN school and $896 per RN school. Multilevel regression indicated statistically significant reduced odds of chronic absenteeism for all students (and a subgroup with chronic health conditions) and practically significant increased attendance for all students in LPN treatment versus control schools, but no significant RN CoP effects. Findings suggest online school nursing CoPs are a potential low-cost, light-touch approach to reduce student absenteeism, given context-appropriate structure, content focus, and adequate nurse participation.