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Safe staffing is a priority issue for nurses in all practice settings – and for one vital reason: to ensure the delivery of safe, high quality health care. The nation’s public schools represent one such setting that faces serious compromises to student safety and wellbeing due to a shortage of school nurses.

The important role of professional school nurses cannot be overstated, given the prevalence of chronic health conditions and other health-related needs among today’s student population. The National Association of School Nurses (NASN) defines school nursing as “a multifaceted area of practice that promotes student health and safety as well as academic achievement.” In addition to monitoring and treating a variety of health conditions, school nurses typically provide health education, first aid and emergency services, medication administration, immunization tracking, state-mandated health screenings, and many other services.

A growing body of evidence supports positive links between school nurse availability and improved health, school attendance and performance among students. Unfortunately, there are not nearly enough school nurses to care for the growing numbers of children with serious health problems. The current shortage of school nurses is due in large part to the lack of federal legislation mandating safe staffing plans and entry level requirements for school nurses. Although federal laws require that school districts provide services to students with special needs, they do not require that such services be provided by school nurses. Consequently, states show wide variations in school nurse-student ratios and many states resort to the use of unlicensed personnel (e.g., school secretaries, attendants, assistants) to provide health care services.

The American Nurses Association (ANA), along with the U.S. Department of Health and Human Services, the NASN and several state organizations, recommends a minimum school nurse:student ratio of 1:750 for general school populations. Many states stipulate more stringent ratios for students with complex health care needs requiring frequent interventions. The central premise for recommending these ratios is that students have a right to safe, high quality health care while in the school setting. The registered school nurse is the health care professional best suited to providing and coordinating the full range of health care services for student populations.

Adverse effects of school nurse staffing have prompted legal action by the nursing community. In 2007, the ANA and the ANA/California filed a lawsuit in the Superior Court of the State of California, claiming that the State Department of Education had violated the State Nursing Practice Act by calling upon unlicensed school personnel to administer insulin in the absence of a true emergency. Not only are children being placed at risk, but RNs, who are charged with providing training and oversight to unlicensed personnel, risk disciplinary action by the State Board of Nursing as a result of this directive. California has one of the highest school nurse to student ratios (approximately 1:2700). The ANA has called upon the Superintendent of Public Instruction to ensure that medications are administered to students only by persons legally authorized to do so, in accordance with California law.

For those who either function in this role or who have children in K-12 educational programs, you may want to view ANA’s recently adopted position statement on School nursing for children in these educational settings.