It’s high time school nurses take their rightful place, alongside teachers and counselors, within every American school. It isn’t just about student health during the school year; it’s about kids’ health for life: longer ones. Since public schools reflect their neighborhoods, in areas rife with zip code health disparities, not having a school nurse adds another barrier for our nation’s youth to receive quality healthcare. The Journal of the American Medical Association recently outlined how providing every child with access to a school nurse could make a difference in health disparities for generations to come.
Life expectancy is largely determined by zip code, with up to 30-year differences in lifespan, even for people who live within miles of each other. This disturbing imbalance is largely due to social determinants of health—external factors like food deserts, healthcare access, and an area’s average level of education—and account for half of the variation in health outcomes. This stark reality especially impacts rural areas and communities of color. For youth living in low-income, underserved, and rural communities, school nurses may be their only access to a healthcare professional. Through coordinated care, screening, health literacy education, and referrals, school-based RNs are well-positioned to improve the life-long health of every child and thus entire neighborhoods.
As a former school nurse who worked with elementary, middle, and high school students for over 15 years, I can tell you that students who struggle with physical or mental health challenges aren’t primed to learn. My clinic was a revolving door of activity: checking blood sugar levels for students with diabetes, giving breathing treatments to those with asthma, distributing snacks to kids who’d missed breakfast, and teaching students how to calm their test anxiety. I also ran flu clinics, screened kids for psychiatric concerns, and taught healthy habits to classrooms full of students. And if the care required was beyond my scope of practice, I served as the connective tissue to resources: medical, behavioral, and social.
Sick kids—especially the more than 40% with chronic conditions such as asthma, diabetes, and epilepsy—aren’t given a fair chance when their school lacks an RN, an issue for many schools throughout the country. Even the best educators can’t teach a child who’s too physically or mentally unwell to focus on academics. School nurses ensure that all youngsters get the best education possible because they give students the care and support needed to thrive. This is why school nurses decrease chronic absenteeism, a key factor in future success. Since chronic absenteeism is associated with losing a decade of life expectancy for individuals who leave high school, hiring an RN for every school could change the longevity of an entire community with low graduation rates.
“When my son—who has Type 1 diabetes—started kindergarten, we met with the school nurse even before his teacher. That’s how important the nurse is to his day-to-day safety and ability to stay in school,” Jay Ell Alexander of Henrico, Virginia, told me. “I’m very aware of disparities in our education system, but I was stunned to learn that disparities extend to school nurses.” Like many parents, Alexander assumed every child had access to one.
Families that don’t use a school nurse daily may not be thinking about the individual and community impact when their school lacks a full-time nurse. Shelly Smith, PhD, DNP, ANP-BC, a nursing workforce expert and associate dean of the University of Virginia School of Nursing, underscores the need for replicable demonstration projects to show the value of a nurse in every school. “Are there less teeth being pulled, less flu, less emergency room visits in communities where school nurses are employed?” Smith asks me, rhetorically. Common sense says that would be the case—that the screening, education, early assessment, care, and referrals that school nurses provide would result in huge savings for families and communities. However, not a lot of local objective measures are in place to prove this point. “We all know that every child deserves access to a school nurse, but when you’re telling poor communities to spend their limited funds on a school nurse salary, it helps to have grassroots proof as to why this investment should be a priority,” Smith tells me.
To be sure, public schools across the country are struggling to cover costs due to dramatic changes in allocation and funding, slanted financial barriers, and looming Medicaid cuts. While hiring and improving pay to attract great teachers remains a priority, policymakers also must recognize that school nurses are equally indispensable staff. With 40% of kids having chronic health conditions, many of which need routine monitoring, schools have emerged as de facto healthcare centers as well as educational facilities. The One School, One Nurse Act—a congressional bill that mandates a nurse for every school—can’t continue to die in committee as it has for the past few years. Aside from helping to level the playing field of our country’s health inequities, parents, school boards, and legislators should recognize that society gets back more than $2.00 for every single dollar invested in a school nurse. Of course, the ultimate return on investment — a longer life for our nation’s youth throughout all zip codes — is priceless.
A former school nurse, Sherrie Page Guyer is a clinical instructor of nursing at the University of Virginia.
References
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