From leadership research to district action: School nurse preparedness for critical events – a multi-modal simulation training pilot

AI-assisted editorial implementation guide. Proposed district actions are separate from the original authors’ findings and recommendations. Independent peer review of this guide is not asserted.

Read source Search paper agent CC BY 4.0

Evidence and transfer

Education-related source: verify which participants, institutions and outcomes were actually studied before district adoption. Source publication type: research-article. License and identity checks do not establish study quality or causality.

Original authors’ abstract, reproduced under the source license:

Abstract School-based emergencies, notably school shootings, are emotionally taxing events for school nurses (SNs). As frontline healthcare providers, SNs must rapidly assess injuries, coordinate emergency response, support the school community, communicate with families and emergency medical services (EMS), and manage their emotions. Yet most SNs receive minimal standardized training to manage mass-casualty incidents effectively. In the United States, SNs in the Boston Public School System (BPSS), have experienced increasing penetrating trauma, prompting leadership to pursue targeted educational solutions. Although a U.S. prominence, school violence remains a global concern, emphasizing its worldwide relevance and underscoring the international need for school-based emergency preparedness. In response, an interprofessional team developed a tailored, integrated emergency curriculum informed by a collaborative needs assessment. Recognizing that medical crises occur more frequently than shootings, the curriculum intentionally addressed both traumatic and medical emergencies. The multimodal program prepared SNs to bridge care until EMS arrives and included two hours of interactive workshops followed by two realistic multi-victim simulations. Interprofessional faculty facilitated skills training, simulation, and debriefing while assessing adherence to evidence-based practices. Pilot findings revealed gaps in leadership, communication, triage, CPR/PALS initiation, and task delegation. Strong engagement led BPSS leadership to request continuation in 2024, with returning participants demonstrating improved command presence, delegation, and closed-loop communication. Next steps include formal program evaluation using validated assessment tools and expansion to incorporate disaster triage protocols and preparedness. Given global lack of standardized emergency training for SNs, this innovative curriculum offers a scalable, adaptable, impactful model for strengthening school-based emergency readiness worldwide. Supplementary Information The online version contains supplementary material available at 10.1186/s41077-026-00432-z. Keywords: School emergency preparedness, Simulations for school nurses, In situ simulation, Simulated critical events in schools for nurses

Study methods

A total of 90 BPSS registered nurses (RNs) participated in the two training sessions: 53 in April 2023 and 37 in April 2024. All BPSS SNs hold at least a bachelor’s degree in nursing, as required by the State of Massachusetts. Of the 49 participants from 2023 who listed credentials, 20 held master’s degrees, including four nurse practitioners (NPs), one DNP, and two PhDs. Participants in 2024 did not specify credentials as this information was not required for participation. Aside from mandatory CPR/BLS certification, no prior formal simulation training had been provided to BPSS SNs.

Limitations

There were several limitations in this curriculum development. This was a small cohort of 90 SNs in a single inner-city system in one state. There were no details on prior formal simulation training outside of BPSS and how that could have impacted the sessions. We know formal MCI training for the SNs was non-existent until our pilot. It would have been preferred for an entire video of each participant-victim interaction, as well as an overall widescreen video of the entire scene. This would allow more specific reviewable data in which we could capture further details. Additionally, the educators were not consistent per session; every facilitator was a volunteer, and it was difficult navigating schedules, thus each half day conducted was a slightly different experience for the SNs. The programming was well received and requested repeatedly, however more sessions with formal evaluative long-term data is needed. Finally, the faculty used their own clinical lens for thematic feedback, not standardized assessment tools, given this was not a formal study. This allows for possible bias from subspeciality perspectives.

A 90-day district inquiry

Days 1–15 · Appraise. Read the source methods, recruitment, comparator, outcomes and limitations. Record how the study setting differs from your district and which claim the design can support.
Days 16–30 · Design. Choose one school improvement question with teachers. Protect a short shared planning cycle, agree an instructional change and use a common rubric for examining student work. Agree participation, privacy protections, baseline and stopping rules before starting.
Days 31–60 · Observe. Collect the pre-agreed measures, keep a log of implementation changes and invite confidential voluntary feedback. Preserve existing support for staff and learners.
Days 61–90 · Decide. Review implementation fidelity, teacher time and independently scored student work against a recorded baseline. Examine access differences and competing explanations before attributing changes to leadership. Make a dated decision to stop, revise or extend the inquiry.

Board decision brief

Present the local problem, source setting, evidence limits, intervention, responsible owner, total cost, measured changes and uncertainty. Separate staff perceptions, implementation measures and student learning outcomes.

Attribution and reuse

Samuel Gowan; Marcie Gawel; Barbara M Walsh. School nurse preparedness for critical events – a multi-modal simulation training pilot. Advances in Simulation (2026-03-29). https://doi.org/10.1186/s41077-026-00432-z

Prepared 2026-11-07. Source authorship and DOI are preserved. The abstract and source passages are attributed extracts; this editorial guide is offered under the same CC BY 4.0 license.