Elizabeth McDermott has been a school nurse for more than 20 years. Today, she cares for nearly 600 children every day at Georgetown Day School in Washington, D.C.. McDermott says coronavirus has made this year one of the most challenging of her career, with her workload increasing "exponentially". In addition to her usual work administering first aid, mental health care and helping students with chronic conditions, she's now tackling things like COVID testing, contact tracing and teaching the school community about infection control.

"It's been an overwhelming year," Georgetown Day School nurse Elizabeth McDermott told Spotlight on America. "But it's also been a year where I realized that my job is more important than it ever has been, and that's a good feeling to know."
During COVID-19, school nurses across the country say they are taking on new tasks as COVID rages. According to a survey from April of 2020, 78% of school nurses say they took time to review data to see new trends in COVID infections. The survey shows 43% spent time updating and developing school health policies and nearly half said they were spending time answering phone calls from parents and the community. The CDC recently posted new information about school nurses amid the pandemic, saying, "School nurses and other healthcare personnel play an important role in safely keeping schools and child care programs open for in-person learning."


But a Spotlight on America investigation discovered not every community has a school nurse to play that important role as a result of a national shortage. According to 2017 survey data from the National Association of School Nurses, more than 25% of schools across the country did not employ a school nurse. Our team wanted to know more about the national picture, so we decided to go state by state to dig into statistics across the country. We reached out to organizations that represent school nurses in all 50 states, as well as health and education departments at the state level. We found alarming trends when it comes to school nurse access, uncovering stunning information about a lack of school nurses in many locations, a failure to track those individuals in some states as well as startling student to nurse ratios.

Among our findings:

In Utah, less than 3% of public schools meet the national recommendation of one registered nurse per school
The state of Hawaii told us it "lacks a definition for school nurse," and has no certification requirements for school nursing
Fewer than 7% of schools in Oregon have full-time access to a school nurse
Delaware is the only state in the entire country that legally requires a nurse in every school

Our investigation found at least 11 states that have dozens of public schools with no access to a school nurse (Photo: SBG)

LACK OF SCHOOL NURSE ACCESS

Our Spotlight on America investigation discovered at least 11 states have dozens of schools with no licensed nurse at all. Responses obtained by our team showed the following:

Colorado: 217 schools do not have a CDE licensed school nurse available
Kentucky: 33 districts have no school nurse
Maine: 51 districts have no school nurse
Massachusetts: 245 districts have no full time nurse
Minnesota: Approximately 1/3 of school districts do not have a nurse
Mississippi: 22 districts have no nurse
Montana: 25% of students have no RN school nurse in their district
New York: State Education Department did not quantify but said "we know that all schools do not have a full or part time nurse."
Oregon: 61 school districts report no nurse access
South Carolina: 79 schools have no nurse
Utah: Only 27 of 1035 Utah public schools meet the national recommendations of one registered nurse in every school

NO SYSTEMS TO TRACK NURSES

Another problem our Spotlight on America investigation exposed is a lack of tracking of school nurses in many states, with some unable to provide basic information about how many exist and where they serve. A small professional organization called the National Association of State School Nurse Consultants lists a consultant for each state on its website. That individual, according to the group, serves as a liaison between state boards, agencies and lawmakers on behalf of local school health programs. But we found that in 19 states, that position is listed as either vacant or non-existent. Additionally, at least seven states contacted by Spotlight on America told us they have no official system to keep track of school nurses, including:

Hawaii
Idaho
Kansas
Michigan
Minnesota
Texas
Wisconsin
ALARMING RATIOS OF STUDENTS TO NURSES

Our team also looked into the ratios that detail how many students school nurses are tasked with managing. Our investigation found that in many areas across the nation, ratios of more than 1,000 students to one nurse are common.

In California during the 2018-19 school year, we found one county with a student to nurse ratio of 14,755: 1
2019-20 data shows Kentucky's worst school district had a student to nurse ratio of 8,951:1
In Montana, the most recent data from 2015 showed the student to nurse ratio was 1,728:1
The known student to nurse ratio in Wisconsin during the 2019-20 school year was 1401:1
In North Carolina, a report detailing the 2019-20 school year showed an average student to nurse ratio of 1,007:1

In one California County, our investigation found the ratio of students to school nurses is nearly 15,000 to 1

Many states acknowledged the shortage and some told Spotlight on America they are taking steps to try and address it, especially in light of the pandemic. Maine's Department of Education recruited 21 retired nurses to support schools in their contract tracing efforts. In Alaska, the NASSC coordinator reported that their schools were able to use funding from the CARES act to hire new nurses. School nurses in that state are already taking on new roles, most recently helping to administer vaccinations to senior citizens.

Donna Mazyck, the Executive Director of the National Association of School Nurses, knows the serious consequences of not having a school nurse in every school building. "School nurses are often described as the eyes and ears of public health in schools," Mazyck told Spotlight on America. "It doesn't matter what your zip code is. You need that in a school for students to be healthy and safe and ready to learn." She says in many cases, kids will wait over the weekend to see a nurse on Monday morning because the nurse is their only source of healthcare.

It's estimated that nurses see children about 180 days out of the year, having what Mazyck considers a major impact on their overall health. But when nurses are spread thin, covering too many buildings, or not being present in some schools at all, she says the impact is severe, not just on individual children but also on education and public health in general.

"When school nurses have several schools and they're seeing 4,000 to 5,000 students in the course of a week, they're unable to do the work that they know how to do in the way in needs to be done," National Association of School Nurses Executive Director Donna Mazyck said. "It's not a solution to put a Band-Aid on an issue that's so deep and meaningful for the life and learning of all students."

National Association of School Nurses Executive Director Donna Mazyck told Spotlight on America there is currently no federal funding for school nurses (Photo: Alex Brauer)

Mazyck says what's driving the shortage of school nurses is simple: money. She told Spotlight on America one major problem is a lack of federal funding for school nurses. According to experts, much of the funding for school health services comes from local and state education dollars, with health departments often chipping in to help cover costs.

But with all of those budgets already stretched thin, and a global pandemic severely impacting education, Mazyck says this is the moment to push the federal government to fund school nurses. "This is a time when we recognize that the absence of a health care provider in a school building can be the difference between a school being open, thereby releasing families to be able to work as they need to, or schools being closed. But they need to be opened appropriately," she told us.


The nation's nursing shortage has been on the radar of Congressional lawmakers for years, but no meaningful legislation has passed. Since 2018, Congresswoman Dina Titus, D-Nev., has been a champion for the cause. In her own county in Nevada, she says there's only one nurse for every 1,800 students. To address the problem, she's joined Senator Jon Tester, D-Mont., in repeatedly proposing additional federal grant funding that would help underserved school districts recruit, pay and keep school nurses.

"Now that schools are opening up, we need nurses even more to reassure students so they feel more comfortable about learning and be sure they're getting proper care and assessment," Nevada Congresswoman Dina Titus told Spotlight on America. "Some of these students in our underserved schools, this is their only source of healthcare."

Congresswoman Dina Titus (D-Nevada) has been proposing legislation to address the school nursing shortage for years (Photo: Alex Brauer)

Most recently, Representative Titus introduced the NURSE (Nurses for Under-Resourced Schools Everywhere) Act in Congress in January of 2020. Congress did not take action on the measure, but Titus has new optimism for this year. She says the pandemic is focusing new attention on the issue, shedding light on the role school nurses can play in restarting in-person learning in many areas. In addition, the Biden Administration has promised new investment to double the number of psychologists, counselors, nurses, social workers and other health professionals in our schools.

Those factors, Titus says, may lead to success in an upcoming legislative session, with her team also considering a proposal to put funding for nurses into any future stimulus package. "I don’t care if it doesn’t stand alone or have my name on it. I just want to get the project going," she explained. "Nobody wants schools closed. They want their children to go back to school. But they want it to be in a safe way, so I think public sentiment is going to help us get it over the line now, given the current circumstances."

Nurse Elizabeth McDermott is already back in the office at Georgetown Day, fielding nonstop phone calls and emails as her school community tries to cope with the coronavirus. When we told her our findings on school nurses and how many students simply don't have access to the services she provides, she told us simply, "It's a travesty. Every student deserves a school nurse."