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COVID-19 highlights the critical role of school nurses and school-based health services

May 3, 2021 | Madison Moe
Critical Role of School Nurses

Change has been the only constant since the start of the COVID-19 pandemic. While change has affected us all, experts say that school nurses — like all members of those on the healthcare frontline — have taken on unprecedented responsibilities this past year. School nurses across the nation have had to learn how to manage and monitor COVID-19 — which includes contact tracing and symptom screening — on top of their traditional responsibilities. 

School nurses were already overwhelmed prior to the pandemic, but now they are facing the additional challenge of ensuring student and staff safety. 

Schools and state governments have spent months meticulously working on plans for when students return to class, but many educational institutions are missing a critical figure that will guarantee everyone's health and safety: a school nurse.


The School Nurse Shortage

Historically, the shortage of school nurses has received less attention than other issues plaguing the United States educational system. Nurses should be an integral part of any educational organization's school-based health services — especially given that 1 in 4 students has a chronic illness (such as asthma or diabetes). 

According to the National Association of School Nurses, 25% of schools express that they do not have the funds to employ a nurse, while 35% only employ part-time nurses. The Centers for Disease Control recommend that schools have one nurse for every 750 students; however, only about 40% of school districts in the United States actually meet this recommendation. Many districts have only one full-time nurse and they often have to share them with other campuses, because there simply are not enough for each school building within a district. 

Data from 2016. Map: The Conversation, CC-BY-ND Source: National Association of School Nurses

This national shortage of school nurses means that schools often have to ask staff — who, more often than not, don't have medical training — to do tasks such as dispensing students’ medication, managing allergies and asthma, and even handling medical emergencies.

There are currently no federal laws that regulate school nurse staffing. The American Academy of Pediatrics recommends that there be one nurse per school. This is standard that most districts nationwide are failing to meet. School administrators often blame shrinking budgets for the shortfall. Schools without nurses are thus improperly equipped to address the social, emotional, and behavioral effects of the on-going pandemic.


The Critical Role of School Nurses

While many of us are hyper-focused on preventing the spread of COVID-19, the issues that policymakers addressed through school health mandates (passed prior to the coronavirus pandemic) are not going away. In fact, the pandemic most likely exacerbated issues that were negatively affecting students. Emerging studies suggest that childhood obesity rates may be rising as a result of pandemic lockdowns, and many fear that the adverse mental health effects of the pandemic will lead to an increase in suicide rates.

School nurses don't only provide direct care to students, they:

  • Provide basic medical and health training for staff.
  • Consult with school and district leaders on important health issues.
  • Educate students, their families, and staff on how to stay safe and healthy.
  • Perform essential IEP, IFSP, and case management services for students with serious health concerns.


As many schools across the US are beginning to return to in-person instruction, school nurses will now face the challenge of handling additional responsibilities:

  • Checking student temperatures.
  • Distributing masks.
  • Ensuring that students and staff are following sanitation and social distancing guidelines.
  • Contact tracing and coronavirus (COVID-19) testing.


Where Do We Go from Here?

The biggest challenge compounding t­­­­­he school nurse shortage is in funding school nurses, not in finding them — although school nurses do have high turnover rates due to their lower than typical wages and the stress of their responsibilities. When questioned, most school administrators state that cost is the foremost reason behind why a school doesn't have a full-time nurse on staff. While there is an ethical argument that every studen­­­t should have access to a qualified nurse on hand, school administrators say that there is often no funding available. Many school and district leaders have to weigh the risk that a student might have a severe medical emergency against budget concerns. 

The tragic trend that we've seen for public schools in the US is that they have been consistently underfunded, and are continuously asked to do more with less.

The harsh reality is that the only way to truly overcome the shortages facing our school system and to meet school nurse staffing standards is to resolve the national educational funding crisis. In an effort to aid some schools' efforts, certain states have introduced legislation that grants funding for school nurses, and hopefully initiatives such as these will catch on and are passed in other states. Another potential source of financial assistance comes from the expansion of the Free Care Act, which has increased the number of services for which schools can bill Medicaid to include nursing services (beyond students with IEPs).


How can your school provide students with access to a school nurse?

CompuGroup Medical can help you to take advantage of Medicaid billing, which can help to cover the costs of a school nurse.

Additional Resources for Schools

Health Alliance

Prevention Strategies for Schools and Child Care Settings

According to the CDC, prevention strategies should be layered, using many at the same time, to prevent the spread of the virus that causes COVID-19. The key prevention strategies for schools are:

For information on protecting school staff, visit Protecting K-12 School Staff from COVID-19.


For more information from the CDC: CLICK HERE

To view the complete infographic from the National Association of School Nurses: CLICK HERE

Healthy Schools Campaign Resources

School Nurses & COVID-19 (Read More)
Risk Reduction Strategies for Re-Opening Schools (PDF)
US Schools Re-Opening: Plans and Policy Tracker

The School-Based Health Alliance

“The School-Based Health Alliance is closely monitoring the impact of the COVID-19 pandemic on school-based health centers (SBHCs) across the nation. As this situation is rapidly evolving, we advise SBHCs to seek up to date operational and communications guidance from their sponsoring agency, school district and local public health authorities.”

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