Contributor – Violita L. McDonald

During a high school girls’ basketball tournament, I was called by the coach to the gym to assess a student with an injury. Upon arrival, the student-athlete was on the floor in excruciating pain with an obvious deformity to her right knee. At that moment, I realized how vital my confidence would be in caring for this child during a medical emergency. Managing this injury required confidence in my ability to assess, provide care, and coordinate the next steps –  especially since this occurred in a rural community where the nearest hospital was 65 miles away. For school nurses, this professional confidence is known as self-efficacy, an essential component in effectively managing sports injuries. School nurses in rural school districts often solidify self-efficacy through experience gained out of necessity for problem-solving in isolated locations with limited resources by adapting and tapping into analytical skills and experience-driven approaches for managing unique challenges.

Why Self-Efficacy Matters

Millions of students participate in school athletic programs each year, making sports injuries a common occurrence among young athletes (Pizzarro et al., 2023). These injuries not only affect physical health but can also influence academic performance and emotional well-being. The National Association of School Nurses (NASN, 2022) recognizes school nurses as essential frontline healthcare providers who contribute significantly to student health and safety. Understanding self-efficacy is crucial for school nurses, as it enhances their ability to provide effective care and ensures the overall quality of school health services. However, not all nurses are familiar with this concept or how it develops through education, experience, and mentorship.

 Albert Bandura (1997) defined self-efficacy as the belief in one’s ability to succeed in specific situations or accomplish a task. Bandura emphasized that self-efficacy extends beyond skill possession – it reflects confidence in one’s capacity to overcome challenges and achieve successful outcomes. For school nurses, high self-efficacy translates to confidence in assessing, treating, and managing sports injuries while effectively coordinating with coaches, families, and healthcare providers. Conversely, low self-efficacy can result in hesitation, uncertainty, and reduced quality of care.

Patricia Benner’s (1982) Novice to Expert nursing theory, based on the Dreyfus Model of Skill Acquisition, outlines five levels of professional growth: novice→  advanced beginner → competent → proficient → expert. This framework supports the development of rural school nurses’ self-efficacy in managing sports injuries as they progress through experience, continuing education, and mentorship.

Case Study Examples

Ashlyn is a school nurse with five years of experience working at a large high school with a robust athletics program. Through specialized training in sports medicine and ongoing professional development, Ashlyn feels confident managing injuries. Her school offers access to athletic trainers, dedicated facilities, and sufficient funding for supplies, equipment, and training. Supported by this infrastructure, Ashlyn collaborates effectively with coaches and parents, makes timely referrals, and implements evidence-based care. Her confidence results in efficient, student-centered injury management.

Natalie, a novice school nurse at a small rural high school, faces different challenges. With only basic first aid training and limited access to professional development, she lacks exposure to specialized sports medicine practices. Her school does not employ an athletic trainer nor maintains a training room, and there is a lack of funding for special equipment. She must make do with a basic first aid kit to treat student-athlete injuries. Without mentorship, resources, and support, Natalie often doubts her clinical decisions, undermining her confidence and self-efficacy.

Ashlyn’s case highlights the attributes of high nurse self-efficacy: specialized knowledge, experience, confidence, access to resources, autonomy, external validation, and opportunities for experiential learning. Natalie’s situation demonstrates the absence of these key attributes, highlighting disparities between urban and rural school nursing environments.

Challenges in Practice

Not every nurse has Ashlyn’s support and experience. In rural school districts, limited budgets and staffing often hinder access to training, mentorship, and resources. Without these supports, nurses’ self-efficacy may decline, which can compromise student safety. Self-efficacy is not merely confidence – it underpins equitable, competent care for every student-athlete, especially in resource-limited settings.

Implications for Practice

High self-efficacy among school nurses leads to improved care quality and student outcomes. Confident nurses are more likely to:

• Provide timely and effective care;
• Collaborate confidently with healthcare providers, coaches, and families;
• Implement evidence-based injury management protocols (e.g., concussion guidelines);
• Promote safe athletic participation.

Developing self-efficacy requires investment at multiple levels. Schools, state agencies, and professional nursing organizations should provide structured mentorship, continuing education, simulation training, and access to clinical resources. Constructive feedback from administrators and colleagues further reinforces a nurse’s confidence. According to Boudreaux and Broussard (2018), higher self-efficacy supports better stress management and resilience among school nurses, particularly during crises. Confident nurses are better able to remain calm, problem-solve effectively, and deliver safe, efficient care under pressure – critical components for optimal outcomes in emergency situations.

The Bottom Line

The prevalence of sports injuries among student-athletes underscores the pivotal role of school nurses in providing immediate and ongoing care and support. As a long-time rural school nurse who has transitioned through the “Novice to Expert” levels, I understand the challenges of managing sports injuries in remote settings. I appreciate how isolating this position sometimes feels, especially for the novice nurse. Many rural schools do not have school nurses or there may be a single nurse for the entire district. For the profession to advance in the rural settings, nursing leaders must recognize that self-efficacy is not optional – it is foundational. Building and sustaining self-efficacy through mentorship, professional development and systemic support ensures safer, healthier learning environments for all students.

References

Bandura, A. (1997). Self-efficacy: The exercise of control. W. H. Freeman and Company.

Benner, P. (1982). From novice to expert. The American Journal of Nursing, 82(3), 402-407. https://doi.org/10.2307/3462928

Boudreaux, S., & Broussard, L. (2018). School nurses’ perceived barriers and perceptual influences when implementing AED programs. The Journal of School Nursing, 36(3), 187-192. https://doi.org/10.1177/1059840518805822

Deering, K. M. & Davis, A. H. (2022). Implementing an evidence-based tool to improve nursing self-efficacy of concussion assessments: A quality improvement project. Quality Improvement, 48(5), 248-253. https://digitalscholar.lsuhsc.edu/son_facpubs/11

National Association of School Nurses. (2022). Student access to school nursing services [Position Statement]. https://www.nasn.org/nasn-resources/professional-practice-documents/position-statements/ps-access-to-services

Pizzarro, J. N., Chiang, B. J. L., Monroig-Rivera, C. A., Mehran, N., & Tabaie, S. (2023). Epidemiology of sports injuries among high school athletes in the United States [Poster presentation]. AAOS 2023 Annual Meeting Proceedings. Las Vegas, NV.

Author Bio

Violita McDonald, MSN, RN, has been a school nurse in a rural and remote Texas district since 2007, caring for students in grades Pre-K through 12. She has served as Chair of her district’s School Health Advisory Council since 2008 and was appointed to the Texas School Health Advisory Committee (TSHAC) in 2024. Her professional interests focus on advancing school nursing practice by applying nursing knowledge and innovative tools, including artificial intelligence, to improve asthma management and student outcomes. Violita’s work reflects her commitment to strengthening nursing self-efficacy in the school setting and highlighting the essential role of school nurses as frontline healthcare providers. She earned a Bachelor of Science in Nursing and a Master of Science in Nursing Administration from the University of Texas at Arlington. She is pursuing a Doctor of Philosophy in Nursing Science degree at Texas Woman’s University.