Many U.S. Schools Have No Nursing Coverage; How Will They Handle a Pandemic?

As the coronavirus threat increases in the United States, policymakers are assessing our nation's capacity to handle a pandemic. One of our first lines of defense -- and one I've yet to see discussed -- is our school nursing workforce.

Ask anyone who has worked for a while in a school, and they will tell you how valuable it is to have a good nurse on staff. This is because school nurses do a lot more than put bandaids on boo-boos. They are, in many cases, a primary healthcare provider for school-aged children. They disseminate information to staff, students, and families. They monitor the health of school buildings and ensure employees and students follow good sanitary practices. They administer medicines to younger students who need supervision. They provide vision, hearing, and dental screenings. They are first responders in emergencies, and the liaison between trauma care providers and the school.

And, as I've seen time and again in my career, they are often the first adult a child trusts when that child is in crisis. Countless tragedies have been avoided because a school nurse was there to hear a student's cries for help.

In the face of the looming coronavirus threat, I think we need to take a minute and ask about the current state of our school nurse workforce. Luckily, there is a very good paper from 2018 that conducted a survey on school nurses. Surveys like these are tough for a variety of reasons, but my read of the paper is that this is a high-quality piece of research that aligns with previous work on the topic.

I made these charts based on tables in the survey.

One in five American schools has no nursing coverage. And another one in five has less than full-time coverage. The breakdown by region suggests to me that part of the issue is that we've got a lot of rural schools in the West that are probably too small to be able to sustain a full-time nurse. That said, you'd think these schools would find a way to share nurses so they'd get at least part-time coverage. But the data suggest a lot of schools can't make this work.

The breakdown by urban/rural supports this idea: 17 percent of urban schools have no nursing coverage, while 30 percent of rural schools have no coverage. Still: how did we get to a place where one in six urban schools have no nurses?

You might think that districts, facing budgetary constraints, would choose to put more nursing staff into elementary schools. But there's really no evidence of that.

So, is our school nursing coverage adequate to deal with a pandemic? I'm completely unqualified to say... but it seems to me that if 63 percent of schools have a full-time nurse equivalent, there must be some consensus that school nurses are important.

As of now, I can't say whether nursing coverage correlates with class and/or race. But given how often we've seen funding adequacy tied to student demographics, it wouldn't surprise me at all if many of the children in schools without nurses were students of color or in economic disadvantage. 

The time to have been thinking about all this, of course, was before the coronavirus threat. We're going to have to hope we've got enough school nurses who are up to the task this time... but we should take this opportunity to think carefully about whether our current school nursing coverage is adequate to meet our students' needs.