Part II--Factors associated with school nurse ratios: key state informants' perceptions.

This paper is the second of a two-part series examining factors influencing school nurse to pupil staffing ratios. The paper reports data from a qualitative study exploring the social and political factors that potentially influence ratios. Interviews were conducted with 30 key state informants from these states. Content analysis of the data identified common themes. Positive factors reported to influence ratios included: the approach taken to effect change, value placed upon school nurses, local support (from both educators and parents) and community buy-in, fear of litigation, and dynamic leadership. Barriers to improving ratios included: lack of funding and misunderstanding of the role of the school nurse. Philosophical beliefs and state geography were "swing" factors that influenced staffing positively or negatively. This study adds to our knowledge of the factors influencing staffing and highlights important social and political factors that school nurses can target to improve nurse to pupil ratios.