The School Nurse Shortage: Causes and Solutions

Many believe that all a school nurse does is take temperatures, hand out band-aids, and call parents when kids are too sick to remain in class. But school nurses play a much larger role in the health of their students and schools.

In addition to managing students with complex medical issues like asthma, epilepsy, and diabetes, school nurses also provide behavioral and emotional support to all students and their families. For many students, the school nurse is the health care provider they see most often and the one they feel comfortable going to for help.

Most educators who work with a school nurse know the value they bring to the team, but the truth is that even when employers realize how important having a school nurse is, they still struggle to find one.

What is The School Nurse Shortage?

One reason why filling a school nurse position can be so difficult is that there are not many qualified candidates available. The school nurse shortage is real, and schools without one on staff are missing out on several surprising benefits.
School nurses are responsible for much more than simply sending sick kids home from school. They support every student’s health by assessing needs, intervening when necessary, and following up to make sure every child has what they need to stay healthy. School nurses also advocate for patient safety and are often a part of the team that develops policies for how to address issues like bullying and violence.

A school nurse advocates for students in a different way than teachers and principals, especially those students with chronic health issues that require lifetime management. By being a constant source of support and encouragement, a school nurse helps these students feel accepted despite their underlying illness and gain confidence in managing their own care.

School nurses play a critical role in community health as well, by educating students about disease prevention and promoting physical and mental health. Families who need help finding healthcare or other support services can turn to the school nurse for guidance. They act as a source of knowledge and support for students about risk-reducing behaviors, making healthy lifestyle choices, and addressing any new diagnoses or health concerns. The school nurse also plays an integral part in screening students and staff members for potential illness, helping to stop the spread of infection throughout the school.

How many school nurses does a school need? One common recommendation is one school nurse for every 750 students, but according to the National Association of School Nurses (NASN), this number is not always enough, depending on the needs of their student body. Schools can no longer assume they will not have students with complex health needs when they have one nurse for 750 students. The NASN believes that this nurse-to-student ratio is only appropriate when the student population is healthy.

The NASN recommends a ratio of one school nurse to 225 students when daily nursing services are required, one to 125 when schools have students with complex healthcare needs, and one to one for students requiring continuous professional care. The number of students with special healthcare needs has increased dramatically in recent years thanks to laws establishing rights for disabled students, and advances in modern medicine. Many students who attend regular classes today would have been homeschooled in the past, making nurses in schools that much more important.

School nurses are also a valuable asset to the rest of the staff and the community as a whole. When school nurse staffing is appropriate, attendance improves, and students perform better academically. The principal and teachers gain more time during the day because they do not need to focus on student health issues or injuries. Having a full-time nurse on staff also keeps medical costs down for families in the district.

So, if school nurses are so beneficial, why aren’t there enough of them? One contributing factor is the overall nursing shortage. There are just fewer nurses out there. Of those who are practicing, only 3.3 percent are qualified to work as a school nurse. In 2016, there were about 2.8 million registered nurses in the U.S., and only about 96,000 were school nurses. With more than 56 million school students in the country, 96,000 school nurses are just not enough.

Causes and Effects of Nursing Shortage

What is causing the nursing shortage? According to the American Association of Colleges of Nursing, there are multiple contributing factors. 

One problem is there aren’t enough people in nursing school. Although nursing school enrollment has increased slightly, it’s still much lower than what is needed to meet the projected demand. Nursing schools turned away more than 75,000 qualified applicants in 2018. Why? Because there aren’t enough faculty, preceptors, classrooms, and clinical sites to properly educate them.

More than one million registered nurses are expected to retire between 2023 and 2028, according to research from the Health Resources and Services Administration. These nurses have decades of experience and expertise, and their departure will affect the profession for a long time to come.

The nursing shortage touches just about every area of patient care, including schools, but one of the worst things about it is that the shortage itself is driving people away from the profession. Insufficient staffing leads to overworked nurses and low job satisfaction, increasing the number of nurses leaving the workforce dramatically, from 40,000 in 2010 to about 80,000 in 2020.

Combine this with the fact that such a small percentage of nurses are qualified to work in schools, and it’s easy to see why it’s so hard to find proper staffing, even when the school knows the benefits of having a full-time nurse. Ultimately, not having a school nurse has a huge effect on the students as it can impact their grades, attendance, home life, and overall health and well-being.

Is There A Nursing Shortage?

One 2012 study estimates that there will be a shortage of roughly 918,000 nurses by 2030. Some regions will have it worse than others, with the western U.S. projected to be the hardest hit. Over the coming years, finding qualified candidates for any nursing position is going to be difficult, much less finding someone to fill a role as specialized as a school nurse.

Educators and administrators are preparing to face new challenges in the upcoming school year and the years ahead. While it’s never ideal, some schools may have gotten by without a school nurse in the past, either because they didn’t have the funding or couldn’t find anyone qualified for the job. The nature of schools is changing drastically, though, and a school nurse should no longer be considered optional.

With the many challenges ahead, schools would be wise to meet and even exceed school nursing ratios. Whereas before one full-time school nurse may have been enough for a healthy student population, schools may soon need to employ multiple nurses to get closer to the NASN’s recommendation of one nurse to 150 or 250 students.

In this case, finding a school nurse is not going to be easy. With only a limited number of qualified candidates available, recruiting and finding an ideal candidate for the job will be difficult, especially if there are other schools actively recruiting. A shortage of school nurses and an abundance of available jobs means that some schools are going to have a hard time finding a qualified candidate in their area.

Nursing Shortage By State

The same 2012 study broke down the nursing shortage projections by state with the data showing that the hardest-hit areas will be the South and West, though the Midwest and Northeast are facing shortages as well. Overall, every area of the country is facing a shortage compared to where they were in 2009. Only two states, Massachusetts and South Dakota, are projected to have a nursing surplus.

What states will have the worst shortages? According to this model, Virginia is projected to need about 32,500 nurses, Georgia, 43,000; Arizona, 56,800; Texas, 110,000; Florida, 128,000; and California, 193,000.

Nursing Shortage Solutions

There are a lot of ways to solve the nursing shortage, but, unfortunately, recruiting and training new nurses and educators is going to take time.

School nurses have always played an important role in schools and the community, but they will be even more essential in the next school year and those to come. More students with chronic health concerns are entering regular classrooms, and the pressures and changes in modern society are taking a toll on our culture and our kids. Research has shown that having a full-time school nurse is an essential part of keeping the community safe.

Schools looking to fill nursing positions for the upcoming school year don’t have time to wait for the systemic changes that are needed to fix the nursing shortage. If you’re an administrator looking for a quick and effective solution to filling a school nurse vacancy or if you want to bring on additional help for the upcoming school year, the best thing to do is to contact a staffing agency that can provide a qualified candidate for the job. Agencies have school nurses ready to work where and when they’re needed, so you can plan for the new school year knowing you have the health and safety of your students covered.