Diabetes, Hypertension, Obesity. . .The Case of the Missing School Nurse

By Peggy McDaniel, BSN, RN

I was amazed by a MarketWatch article this week about the overall lack of school nurses. According to the article, the National Association of School Nurses recommends that one nurse be available for every 750 well children. Many states operate with ratios greatly exceeding that number. For example, in 2009 Michigan had one nurse for every 4,836 children. To give credit where it is due, that same year Vermont provided one nurse for every 311 students. As a nurse, and a parent, I find this data frightening. Not only are there fewer trained professional nurses available to our children every year, but approximately 30% of American children suffer from chronic conditions such as type 1 or type 2 diabetes, asthma, and high blood pressure.

by woodley wonderworks, via Flickr.

Having more nurses available to patients in an inpatient setting has been proven to promote better patient outcomes. I’m going to go out on a limb and suggest that the same is probably true for school nurses.

Lousy timing. This acute shortage of school nurses could not come at a worse time. With more families than ever feeling the pinch of the recession, children are not immune to the oft-reported outcomes related to our current overall economic condition. Less money can translate into fewer visits to health care providers and dentists, greater family stress, and even hunger, among many other things. School nurses not only help kids with cuts and bruises but also make referrals to dentists and other needed services. The article I mentioned above didn’t discuss the number of children with mental health issues in our public school system, but this factor adds another level of complexity to the care of our nation’s children, one that nurses are prepared to assist with.

As a parent of healthy kids, I didn’t worry too much about the availability of a school nurse. My daughters actually regretted the fact that I was not only a pediatric nurse, but also owned a medical grade thermometer—needless to say, you didn’t stay home at our house unless you were truly sick! My good friend has a daughter who was diagnosed with type 1 diabetes just prior to entering first grade. My friend spent many an hour working with the school and the secretary responsible for watching the child check and report her blood sugar level.

My friend, at the time, was a stay-at-home mom and could more easily afford the extra time for such meetings and calls. But how do parents who both work full-time manage such a child in our current school system? I assume it “works,” but wouldn’t it be safer if every school had a nurse? Having a person who is not medically trained be responsible for a child with significant health issues should concern us all. I’m worried not only for the children and their families, but also the aides, teachers, secretaries, and others “drafted into” these responsible roles.

What’s your experience? I’m sure there are many more examples, and probably more severe than this, that could be shared. Are there any school nurses who would like to weigh in? How do such staffing levels work for you? Have you had any problems as a result? What should the answer be? I’ve never been a school nurse, so if the school nurses tell me this is no problem, then I’ll worry about something else!

(As a last comment: I heard about the pledge from some of our wealthiest Americans to give away a large portion of their assets before or after they die. How about using some of that money to fund a school nurse in every United States school for the next 10 years? These wealthy Americans have accomplished great things and continue to do so every day. Let’s keep some of it at home and promote the health and welfare of American children.)

Peggy McDaniel is an infusion practice manager who occasionally writes for this blog.

Bookmark and Share

Further reading: for a page showing all Off the Charts posts on issues related to school nurses, including the issue of whether non-nurse personnel should or shouldn’t be allowed to give students insulin shots, click here.

2016-11-21T13:16:09+00:00 August 11th, 2010|Nursing|7 Comments
Senior editor/social media strategy, American Journal of Nursing, and editor of AJN Off the Charts.


  1. Debbie September 29, 2010 at 11:45 am


    I agree, as a Certified School Nurse, that children that have school nurses in EACH school building, are kept far healthier, & have less absentism, than schools that DO NOT have a school nurse! I am very fortunate to work in a district that has a certified school nurse in each building; the parents (our greatest ally) have so far insisted on this.
    Also, in this downward economy, many still are not covered by health insurance & parents look to us to diagnose (nursing, that is), give suggestions to treat, & when they NEED to see a healthcare provider (& tell them how to find one).
    What a great idea & goal to aim for, that philanthropist’s will fund a school nurse in every school building in America! That’s a “Win-Win” situation for ALL!

    Who is the first to step up?


  2. KH September 25, 2010 at 4:16 pm

    Thank you to the author for the support of school nurses. I am a district nurse and I cover 5 buildings. I am responsible for 3000 + general education students in addition to covering the special education population in those buildings and the Early On program in our district. Of course, those 3000 students don’t need me everyday, but I am on-call to all locations all day and I travel back and forth throughout the day responding to everything from minor injuries to breathing issues to diabetic “lows” – I rely on my med-surg background every day. I coordinate the care of 10 diabetic students and I have over 90 severe food allergy students, over 100 asthma students, a student with a trach and ventilator on-site not to mention all of the students we have with seizure disorders. I help train our first response teams in each building in addition to numerous other staff trainings. This is a very typical situation for school nurses in our state right now. I work in Michigan where we rank dead last in our student to school nurse ratio. The good news is that I absolutely love my job and I work in a district that values school nurses. We actually have two nurses when most districts our size would have only one or none at all. Most people think school nursing is about bandages and ice packs. We do a lot more but one of the most important roles we play is identifying health problems in children and making referrals to health care professionals in the community. The author makes an excellent point about the economy right now – many families who have always relied on insurance do not have it now. School nurses play a critical role in identifying those families and helping link them to community resources. Thanks for drawing attention to our specialty and thanks to all of the nurses out there no matter what area you practice in.

  3. KImberly September 22, 2010 at 8:47 pm

    School nursing is a specialty of its own. It’s time registered nurses speak up and advocate for our profession by demonstrating evidenced based practice and our impact on children’s education. Healthcare reform is here and will have a dramatic impact on public health/community nursing. We are needed now more than ever! The public and legislators need to be educated on the necessity of having a registered nurse in every school. School districts have dictated too long which schools need nurses and which ones don’t. School nurses are not in it for the “money” because we are the lowest paid in our profession. We are here for the children. Our children are the future and deserve the best chance to succeed.

  4. PJ September 22, 2010 at 5:39 am

    I would like to say that I have worked beside many fine LVN’s/LPN’s in a variety of healthcare settings in my career as a Registere Nurse. Credentials don’t mean everything… “in the trenches” experience hs a lot of value. I also feel that it is better to have a vocationl nurse or even some sort of medication aide than no nurse at all. (I am not betraying my comrades with higher degrees, I am just being real.) In my state funding has been cut down to $10 per student in K-12 per year in pivate schools where I work as a part time contractor. The school itself hired me on for the days not covered by my agency because they have a very large population of students with food allergies, asthma and other health issues. Part of the “draw” to the school is the fact that they have a full time RN on site. I love my profession and all the complexities and rewards of school nursing. My family and I are struggling to make ends meet during these tough times and I have considered getting back into a much higer paid position in a different setting. I still have school-aged children at home and I could not justify giving up my 8-3 hours and having less time to spend with my own kids (one of whom has special needs).
    Every year I see more ad more kids with epipens, metered dose inhalers, nebulizer treatments, insulin pumps, fingersticks, etc. Almost everything you see in the adult population is in our school children….but in a smaller package. Scary how many 3 and 4 year olds have epipen orders….!

  5. Rebecca September 21, 2010 at 2:31 pm

    It would be interesting to know how many health incidents happen in schools where there is no nurse or where the ratio is 1 nurse to 2000 students. These are issues that district administration does not want the public to know. Many of the nations districts are trying to cut the RN’s and hire LVN’s. This is not the same educational and skill level when there are many students now in the schools with chronic illness. We can use all the help by getting the word out the importance and necessity of a nurse in the nation’s schools.

  6. Lauren September 21, 2010 at 1:01 pm

    The current staffing issues in schools are very difficult and getting worse. Many nurses need to cover multiple buildings and a high number of students. School nursing isn’t just first aid and medication administration as is the common perception of the public, but much, much more. I’ve frequently heard that “Schools are in the business of education, not medicine.” In the current economy schools feel the crunch as well and often the nurse is considered a luxury. Many schools have lost a nurse and School Nurses have lost their jobs because schools “can’t afford” to keep them.
    Thanks for your support. We’ll take any that we can get!

  7. christine September 21, 2010 at 12:07 pm

    Thanks for the post. As a certified school nurse, I appreciate when other professional nurses give us a shout out. We are so often forgotten by other specialities. I work in a district that is wonderful in providing nursing care to our students. We not only have certified nurses but also health room nurses who either have an LPN or RN, but I do have colleagues in other districts that are suffering trying to cover a large number of children with all types of chronic illnesses and no nurses to care for them.

Comments are moderated before approval, but always welcome.

%d bloggers like this: