I first started working as a public health nurse in 1996 in one of North Carolina’s coastal communities. I enjoyed occasionally working alongside school nurses providing immunizations to school-aged children. I was continually in awe of the positive impact school nurses have on the students’ health and their success at school. However, it was not until recently that I learned that having a full-time school nurse can deliver a 220 percent return on investment. I had never thought of a school nurse as a financial investment, but there it was right in front of me: for every dollar invested in school health nursing services, $2.20 is saved in related healthcare costs.
A new study recently released by the NC General Assembly’s Program Evaluation Division shared that the cost of filling the need for school nurses in North Carolina and reaching a more reasonable school nurse-to-student ratio could cost as much as $79 million a year. Many opponents of investing in school nurses believe that children’s healthcare needs are met by having a medical home and pediatrician that the child regularly visits.
However, when a school nurse is accessible, the school nurse is the healthcare provider that school children most often see. Many healthcare issues that arise during school hours can be appropriately addressed by a school nurse, avoiding the parents having to miss work and the child being sent for further follow-up. A study published in 2014 showed that the Massachusetts school system spent $79 million on school nurses and medical supplies during the 2009-2010 school year. The study showed that the $79 million dollars invested in school nursing services prevented an estimated $20 million in medical care costs, it prevented an estimated $28.1 million in parents’ productivity loss, and it prevented a whopping $128 million in teacher productivity loss. That is a net of $98.2 million return on investment, or $2.20 for every dollar invested in school health services delivered by Registered Nurses.
So why else is it so important to have school nurses? School nurses are specialized Registered Nurses who positively impact students’ ability to stay in class and learn by caring for their physical, mental, emotional, and social health needs. For underinsured and uninsured children, the school nurse is often the sole provider of access to health care, which makes the school nurse’s role even more critical. As the school’s healthcare provider, the school nurse’s duty is to advance the well-being, academic success, and lifelong achievement of students. School nurses advocate for their students, encourage self-empowerment, problem-solving, effective communication and they help keep the school environment healthy so that students, teachers and staff remain healthy.
The National Center of Education tells us that nearly one in five school-aged children has a chronic disease such as asthma, diabetes, a mental/behavioral health issue, or seizure disorder (to name a few). Adequate school nurse-to-student ratios have been a concern since the 1970s when laws were enacted to protect rights for all children to attend public schools. Since then, the recommended ratio of one school nurse to 750 students has been included in Healthy People initiatives and widely advocated for by the Centers for Disease Control & Prevention as the optimal ratio for child and school health. The American Academy of Pediatrics goes even further and recommends a minimum of one full-time Registered Nurse in every school. Yet, some North Carolina school nurses are assigned to multiple schools and are accountable for the care of as many as 2,242 students.
Many supporters of safe school nurse-to-student ratios, such as the American Academy of Pediatrics, support school nurses as being uniquely qualified to deal with school children’s increased social and emotional issues by engaging with school-based mental health teams. Supporters have also identified school nurses as crucial partners in the streamlined coordination of school-aged children’s healthcare services and as healthcare providers, school nurses assure a healthier school environment so that students, teachers, and staff remain healthy. A healthier school environment leads to healthier teachers and students and more time in the classroom.
As North Carolina citizens, we need to talk to our principles, school board, and governor about the importance of having Registered Nurses in our NC schools and combating the trend of reduced school nurse funding that results in a negative impact on our school children’s education. We need to talk to our private industries and healthcare organizations about the importance of investing in our children and encourage them to help provide supplemental grants and funding to support school nurses. And, we also need to talk to our legislators about the return on investment in dollars that school nurses deliver, the benefits school nurses have on children’s health, and encourage them to authorize appropriations that will help our children remain in school, healthy.
Dr. Susan Haynes Little, RN works full time as an advanced-practice public health nurse in North Carolina, volunteers her time as a national leader in public health nursing and is a member of the advisory council of D-CHIPP: Duke University School of Nursing Community Health Improvment Partnership Program.