New Recommendation Says Every School Should Have a Nurse. Many Don't


Health experts and data researchers agree: school nurses are good for students. So why don't all schools have them?

Boys playing with stethoscopes

Health experts and data researchers agree: school nurses are good for students. So why don't all schools have them?

To keep kids in school, keep them healthy. And that means access to school nurses, according a new recommendation. Photo via Flickr user Gateway Technical College.Photo: Flickr user Gateway Technical College.

All schools should have a full-time nurse, according to a new recommendation from the American Academy of Pediatrics.

But in many school districts, that goal is a far cry from reality.

"Academic achievement, improved attendance, and better graduation rates can be a direct result of a coordinated team effort among the medical, family, and educational homes all recognizing that good health and strong education cannot be separated," reads the policy paper published this summer in the journal Pediatrics. The academy recommended that every school have a full-time nurse on campus -- a change from its 2008 recommendation that called for one nurse for every 750 students.

Across the country, many schools don't meet the new standards. Only 49 percent of elementary schools in the U.S. had a registered nurse available for at least 30 hours a week, according to 2014 statistics from the Centers for Disease Control and Prevention. Only 51 percent of middle schools had a nurse who met that threshold, and only 56 percent of high schools did.

Here in Houston, there's an ongoing conversation about whether schools should be required to hire certain critical positions, including nurses, librarians and counselors. According to an analysis of Houston Independent School District data published by the Houston Chronicle in April, "more than two-thirds of its 284 campuses lack librarians, more than half are without a counselor or social worker, and 14 percent do not have a nurse."

In January, the HISD school board voted to table a discussion about whether those positions should be required at each campus. Several principals said they needed more time to determine the impact the decision would have on their budgets and said it is principals -- not school board members -- who were best positioned to determine which positions were needed at their campuses.

"There is a need for nurses and there is a need for counselors," said board member Rhonda Skillern-Jones at the January meeting. Skillern-Jones said she had long advocated for more nurses in schools but agreed that the district's budget shortfall required it to rethink how such a policy might be implemented.

Still, many have argued the positions are critical to student health and performance. Yet researchers from the Kinder Institute's Urban Health Program and the Houston Health Department and Public Health Authority found that schools where students are most in need of a nurse often lack one.

Researchers focused on asthma which, along with pneumonia, is the leading cause of hospitalization for children. The parts of the city with the highest rates for emergency medical calls related to asthma attacks were in east and south Houston. Those places were also the communities where schools were more likely to serve a higher percentage of poor students. They're also the places where schools are less likely to lack a full-time nurse.

"Respiratory diseases including asthma are a major cause of school absenteeism," said Loren Raun, a member of the research faculty for Rice University's statistics department and one of the researchers behind the study in an email. She cited research indicating that students with asthma who were poor or African-American -- and in schools with full-time nurses -- missed three fewer days each school year than did similar students in schools with only a part-time nurse.

"Asthma education and care provided by the nurse impacts the children all day long, even at times when the principals don’t see the children," wrote Raun, who is also the Chief Environmental Science Officer and Interim Bureau Chief of Community and Children's and Environmental Health with the City of Houston.

But her research found that though 14 percent of schools in the Houston district lack a full-time nurse. And more than 1 in 5 schools in areas with the most severe asthma rates -- those five times the city average -- lack a full-time nurse.

"This needs to change," Katherine Ensor, a statistics professor at Rice University and director of the Kinder Institute's Urban Data Platform, said at the January school board meeting.

With school starting this week, the board has yet to take up the issue again.



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