On May 9, 2017, the Network's Eastern Region Office co-hosted a symposium with the National Association of School Nurses (NASN) entitled School Nurses: Understanding Legal Strategies for Advancing a Culture of Health in Schools. School nurses, lawyers, school administrators, and public health officials gathered in Baltimore to explore legal and policy barriers and opportunities to fully realizing the potential of school nursing services for improving child and adolescent health. Invited panelists discussed a number of issues related to school nursing, including school nurses’ role in promoting public health; epidemiological evidence of improved student health outcomes when school nurses are present, such as decreased absenteeism and increases in vaccination rates; the role of school nurses in delivering care to underserved children and adolescents; and the legal framework for school nursing, such as privacy laws, Medicaid reimbursement for school nursing services, and state laws that mandate a school nurse-to-student ratio. The symposium was an invaluable learning experience that highlighted the need for law and policy change to improve access to school nursing services.
Registered professional school nurses provide important access to prevention services, early detection, and mental health services for school-aged children and adolescents. For many children, the school nurse may be the only health care provider they will see all year. School nurses are uniquely positioned at the intersection of student health and education; and they are trained to understand the complexity of the relationship between physical and mental well-being and academic success. It just makes sense: kids who don’t feel well or are in pain aren’t ready to learn. One symposium speaker highlighted this critical role that school nurses play by telling the story of a young boy who was disruptive in class and never made an effort to learn. The school nurse found severe tooth decay on one side of his mouth, and after speaking with the child, realized that he was in terrible pain. She was able to connect him to reduced-cost dental care to repair his teeth, after which his behavior and performance in school improved dramatically.
While school nurses are critical leaders and advocates for student health in schools, and could play a key role in promoting child and adolescent health, laws that ensure access to school health services are inconsistent across the country. For example, there is only a patchwork of state mandates for coverage of school nursing services. According to Erin Maughan, NASN Director of Research, 25.2 percent of schools in the U.S. have no part- or full-time nursing support, with cost and school size cited as reasons for this shortage. The American Academy of Pediatrics has also noted that uniformity in laws that enhance access to school nursing services is lacking.
Healthy People 2020, a federal initiative supported by many health-related federal agencies, set an objective to increase the proportion of elementary, middle, and high schools that have a full-time registered school nurse-to-student ratio of at least 1:750. According to Healthy People 2020, the baseline proportion of schools with a 1:750 nurse-to-student ratio was 40.6 in 2006. Research by Network attorneys found that, as of April 2017, only 22 states had statutes or administrative regulations requiring school nurses, and only 15 states required certain staffing ratios. For example, Georgia law requires one school nurse per 750 elementary school students and one school nurse per 1,500 middle and high school students. Achieving Healthy People 2020’s nurse-to-student ratio objective would improve access to school nursing services for all students regardless of where they live.
Furthermore, underfunding of school nursing services is a chronic problem as school districts must juggle competing priorities with shrinking budgets. A Robert Wood Johnson Foundation publication from August 2010 noted that, although “school nursing proved its value more than 100 years ago…advocates are once again faced with the challenge of making this specialty an established, well-resourced part of the educational, health care, and public health systems.”
The Network looks forward to its continued collaboration with NASN to find ways that law can help harness the full potential of school nursing in public health. A nurse in every school would go a long way to ensuring that children can be reached and their health problems addressed where they spend the most time—in school. As Arne Duncan, former secretary of the U.S. Department of Education said, “We know that students need to be healthy to learn.”
A live recording of the symposium is available online. Network attorneys have also prepared a compilation of statutes and regulations governing school nursing in all 50 states and D.C., which will be posted to the Web site this summer.
Network attorneys are available to answer questions on this and other public health topics at no cost to you, and can assist you in using law to advance your public health initiatives. Visit the Network’s website for a list of Network attorneys in your area.
This blog post was developed by Kerri Lowrey, Deputy Director, Network for Public Health Law - Eastern Region Office. The Network for Public Health Law provides information and technical assistance on issues related to public health. The legal information and assistance provided in this document does not constitute legal advice or legal representation. For legal advice, readers should consult a lawyer in their state.
Support for the Network is provided by the Robert Wood Johnson Foundation (RWJF). The views expressed in this post do not necessarily represent the views of, and should not be attributed to, RWJF.