School nursing in the United States dates back to 1902 when school nurses were used to intervene with students and families in the prevention and control of communicable diseases. The main objective of school nursing at that time was to help prevent absenteeism from school. Even though the responsibilities of school nurses have expanded over the past century, the core concept of school nursing remains true to its origin.
The Role of School Nurses
School nursing is recognized as a specialty nursing area and has become more clearly defined with the development of standards of practice. School nurses deal not only with the physical health of students, but also their mental, emotional, and social health in order to provide students with the support they need to grow and learn. The school nurse is often a child’s main provider of health care. Nationally, twelve percent of students served by school nurses have no other source of regular medical care. Uninsured students in particular are more likely to have unmet medical, dental, or prescription drug needs. Many working parents lose income if they must leave work to attend to their children’s health needs. When possible, the school nurse works with primary care physicians, specialists, and local public health and social service agencies to ensure that a child receives the complete range of services that are needed for the child’s growth and development.
School nurses are effective in enabling children to remain in school. Data collected by the State Department of Education for most school nurses in Mississippi show that the vast majority of children and school staff seeking care from a school nurse are able to return to the classroom.
School Nurse Services
The nature of services provided by school nurses has become more intense as the number of children with highly specialized health care needs has grown due to higher rates of obesity, diabetes, and other chronic conditions among children. The topics of education sessions conducted most often have also shifted in recent years, with increasing emphasis on tobacco prevention, nutrition education, and fitness, a likely impact of the Mississippi Healthy Students Act that was enacted in 2007 to improve nutrition and promote physical activity and health education in Mississippi schools.
Availability of School Nurses
The Centers for Disease Control and Prevention (CDC) and professional associations such as the National Association of School Nurses (NASN) agree that a school nurse should be responsible for no more than 750 students. Recent surveys report that some school nurses are overwhelmed and unable to keep up with the demands of everyone in need, particularly in schools or school districts where the school nurse is responsible for 1,500 or more students. According to the NASN, schools where a nurse is responsible for no more than 750 to 1,000 students showed decreased absenteeism and increased graduation rates. In the United States, there are about 45,000 employed school nurses to provide care for 52 million students. These numbers illustrate that school nurses employed in the U.S. provide care at a ratio of 1 school nurse for every 1,155 students.
The Department of Education reports that Mississippi has 442 school nurses for the 2010-11 school year, giving MS a ratio of one school nurse for every 1,109 students. After increasing for several years, the total number of school nurses dropped in 2011. Currently, 14 school districts in Mississippi do not have any school nurses, up from 2 in 2010. School nurses who are Registered Nurses with at least a Bachelor’s degree and who pass the National Certification Exam for School Nurses can become nationally certified and be eligible for a $6,000 annual salary supplement. Mississippi has 27 Nationally Certified School Nurses, but this number is capped at 30 by state law.
Funding
The main source of funding for school nurses comes from local school districts and Mississippi Adequate Education Program (MAEP) funding. Federal funding, which includes Title I, Title IV, and Individuals with Disabilities Act (IDEA) programs for special education students, supports a little more than one-fourth of the nurses. Local hospitals provide twelve percent of funding. Another thirteen percent of funding for school nurses comes from the State’s School Nurse Intervention Program. The remaining thirteen percent of funding comes from the Bower Foundation, miscellaneous grants, and Medicaid reimbursement for health care services provided by school nurses to children enrolled in Medicaid.
The Mississippi Legislature allocated $3.6 Million for the School Nurse Intervention Program for Fiscal Year 2011, and the Department of Education issued grants to school districts, prioritizing the grant money to school districts without nurses. Given a statewide student enrollment of 490,526, the Department of Education estimates that Mississippi would need 212 additional school nurses at a cost of $10.6 Million ($50,000 each) to reach the student-to-nurse ratio of 750 to 1.
Sources
- Mississippi Department of Education. (2011). School nurse assessment report. http://www.healthyschoolsms.org/
- National Association of School Nurses (1999). Definition of school nursing. Castle Rock, CO: Author. Available at http://www.nasn.org
- National Association of School Nurses. (2002). Issue Brief. Role of the school nurse. Castle Rock, CO: Author. Available at http://www.nasn.org
- Selekman, J. (2006). National Association of School Nurses. School nursing: A comprehensive text.
