While school nurses have long been recognized for their vital role in supporting children’s educational success through better health, there is increasing recognition that school nurses are integral to reforming our health care delivery system. School nurses are the eyes and ears of the school community; being physically present throughout the school day makes them uniquely positioned to be a child’s health care touch point across multiple settings, from the classroom to the physician’s office. 

This past month, American Academy of Pediatrics (AAP) released a policy statement highlighting the important role school nurses play across a child’s continuum of care. In particular, the AAP statement recommends that every school should have at least one nurse. In instances with larger student populations and/or greater need, more than one nurse may be necessary. This is important on a number of fronts but most notably because many schools currently go without this important resource. In 2014, more than half of all elementary schools did not have a registered nurse working at least 30 hours a week.

Why is having a nurse in every school so important?

School nurses can play pivotal roles in improving and maintaining children’s health—particularly for children with special health care needs and low-income children who face challenges outside of school that negatively impact their health. Such challenges may range from food and housing insecurity to safety at home. A school nurse can observe children’s needs, screen for factors beyond health care such as income and housing that impact health (social determinants of health) in addition to medical concerns and connect children and their families to needed support services. A nurse’s role spans the full spectrum of care, from prevention to treatment; they manage upstream factors through surveillance and address downstream health challenges through coordination and collaboration with a child’s medical home and other support services. Specifically, school nurses are able to:

  • Educate and promote health and safety, including what makes a healthy living environment
  • Identify and intervene in potential health and wellness issues—including addressing social determinants of health that impact children
  • Collaborate with physicians and health teams by jointly developing and implementing medical action plans for a vast array of conditions
  • Provide case-management services
  • Provide on-site care for illness or injury emergencies
  • Identify behavioral health risks, while providing support to the student in school and referral to appropriate resources
  • Build capacity for health learning, self-advocacy and literacy

In addition to the diverse roles that nurses can play in supporting children’s overall health, the most obvious reason for a school nurse on each school campus is that they are able to address children’s needs during the school day. For parents and caregivers, taking time off of work for multiple or ongoing medical appointments can be difficult and stressful. Nurses can support families’ economic security by simply collaborating with pediatricians and other providers to address the ongoing care needs of children during the school day. This reduces student absenteeism and parent/caregiver stress.

How can states support one school, one nurse?

A first step states can take is to validate the important role that school nurses play in the securing the health our children, their families and our communities. The second step is to translate this into action through increased investment in a school nurse workforce. Two options include added revenue for a school nurse workforce through changes in Medicaid and dedicated inclusion of a school nurse workforce in health system transformation efforts underway.

One clear way to support school nursing is for states to take the required steps to change their Medicaid policy and allow for reimbursement of all services provided to Medicaid-eligible children in school settings—otherwise known as the revision of the Municipal Medicaid free care rule (learn more about the free care rule here). This new opportunity can potentially bring additional resources to schools, enabling school systems to invest in the school nurse workforce and expand their reach and role in children’s health and wellness.

A second parallel strategy is to include the school nurse infrastructure in delivery system reform planning such as Accountable Care Organizations (ACOs), State Innovation Models (SIM) and other ongoing initiatives aimed at reinventing health care delivery systems. Currently, reforms to improve the pediatric delivery system include the incorporation of social and economic supports for children and families—all with the goal of improving community health. Who better to advance community health goals than the front-line workforce that is already in place, working with children every day?

We know that a healthy child is ready and able to learn. State health stakeholders need to heed the advice of the American Academy of Pediatrics and take the next step in securing a minimum of one nurse in every school.