School nurses are crucial in maintaining the health and well-being of students, which in turn affects their academic success and the overall functionality of schools. The National Association of School Nurses (NASN), American Academy of Pediatrics (AAP), and American Nurses Association (ANA) have historically recommended nurse-to-student ratios, but these recommendations have evolved due to the increasing complexity of students’ healthcare needs and the lack of one-size-fits-all evidence to support specific staffing numbers.
NASN emphasizes a multifaceted approach to determining appropriate school nurse staffing levels, moving beyond simple nurse-to-student ratios. This approach considers various factors, including the number of students, the acuity level of students’ health needs, social determinants of health, and available resources.
NASN believes that school nursing services must be determined at levels sufficient to provide the range of health care necessary to meet the needs of school populations. NASN recommends continuing research developing evidence-based tools using a multifactorial health assessment approach for evaluating factors that influence student health and safety and developing staffing and workload models that support this evidence. All students need access to a school nurse every day. In addition to the number of students covered, staffing for school nursing coverage must include acuity, social needs of students, community/school infrastructure, and characteristics of nursing staff. – NASN National Association of School Nurses. (2020). School Nurse Workload (Position Statement).
The goal is to ensure that all students have access to a school nurse every day, recognizing that the workload and responsibilities of school nurses are much more complex than can be captured by a single ratio. State laws and recommendations vary widely, with nurse-to-student ratios ranging from 1:500 in states like Alabama and Vermont to 1:3,000 in Tennessee.
However, these ratios are not always adhered to, and many districts do not meet the bare minimum recommended staffing levels. It’s important for school administrators and boards to consider the specific needs of their student populations when determining staffing levels, rather than relying solely on state recommendations or minimum requirements.
School nurses must present data to school administrators and boards to make the case for additional staffing or resources. This data can include the average number of student visits per day, the acuity levels of the student population, daily medication administration, screening numbers, and other mandated responsibilities.
The critical role of school nurses in supporting student health, safety, and academic achievement cannot be overstated. As the healthcare needs of student populations become increasingly complex, it is essential to move beyond simple nurse-to-student ratios and consider a more comprehensive approach to staffing that takes into account the unique needs of each school community. School nurses, administrators, and policymakers must work together to ensure that every student has access to the healthcare and support they need to succeed in school.
Demonstrating the direct relationship between school nurse workload and student outcomes can be a powerful tool in advocating for the necessary staffing to ensure students’ health and safety.
Here are some recent blog posts that focus on advocacy:
