Schools across the U.S. continue to face a shortage of licensed nurses. In 2018, more than 60% of schools didn’t employ a full- or part-time nurse, according to the National Association of School Nurses (NASN).
“When a nurse isn’t present, the care of students is left to unlicensed personnel who don’t have the education or training to address the complex health conditions in schools, which puts those students at risk,” says Laurie G. Combe, NASN president.
This year, more than 700 of New York City’s 2,000 schools are going to a partial or full day without a nurse on-site, while shortages in Chicago and Los Angeles have led to teacher strikes, according to published reports. The Chicago Public Schools strike ended when leaders agreed to employ a nurse at every school five days per week.
“When budgets are tight, administrators make decisions to hire teachers over nurses, but what many administrators don’t understand is that having a nurse on staff can actually save dollars,” says Combe.
For example, in schools where full-time nurses were present, Massachusetts gained $2.20 for every dollar invested in a statewide school health services program, according to a cost-benefit study published in JAMA Pediatrics.
Rather than trying to staff their own health services, some districts have turned to outside providers.
South Bend Community School Corp. has full-time nurses at every school, in part because of a contract that the Indiana district signed with Beacon Health System, a nonprofit organization that provides care in north central Indiana and southwestern Michigan. Since 2012, Beacon has provided school nursing services to South Bend to properly train and support nursing staff.
However, South Bend still has two job openings. “This year, I’ve had more openings than most,” says school nurse manager Susan M. Cullen. “School nurses are typically paid less than nurses working in the hospital setting even though the work is still very demanding, so in many cases it becomes a question of pay.”
Cullen manages a pool of substitute nurses, who fill in when needed. “When they aren’t available, I along with my nursing supervisor cover the school health office,” she says.
‘We are going to support you’
In California, intensive care unit nurses who transferred to San Jose USD typically left within the first week. After improving training and support, San Jose USD has now successfully recruited and retained 27 school nurses in addition to 40 health clerks and licensed practical nurses.
“Part of hiring is being able to say, ‘Yes, we are going to support you,’ because that’s what nurses always ask for,” says Melinda Landau, manager of the district’s health and family support program.
A multiyear nursing orientation program at San Jose USD prepares recent recruits for working in a school environment during their first year. Those nurses then mentor and train new hires the following year.
With support from the assistant superintendent and using funds from a Healthy Start grant, Landau also employs a full-time nurse whose primary duty is to provide professional development for other school nurses.
“By providing regular training for those staff,” says Landau, “we are able to get a better product, we have better standardization, and our nurses and health office staff feel supported.”