I. School Nurse Workforce Gap

To many students, schools act as a second home, where they spend a considerable amount of their teenage years learning, growing, and making friends. However, to facilitate students’ proper development, their health is of a paramount concern as student health comes in tandem with academic achievement. This is where school nurses come in. For the 40% of schoolchildren across the U.S. who suffer from chronic health conditions, the presence of a nurse on their school’s grounds could be the simple difference between a routine recovery and an urgent emergency, as they are often the only healthcare provider at a school. Not only do school nurses attend to students’ daily healthcare needs, they can also help students and their families get access to health insurance, coordinate care between families and their healthcare providers, and educate families on the healthcare services available to their child at school. School nurses even help society to save money, as for every $1 spent on school nursing, society saves $2.20. Such savings come from costly emergency room visits, as well as parents missing time at work to care for their children. 

Despite the proven importance of school nurses to schools and society as a whole, many schools within the U.S. lack a full-time school nurse. Only 65.7% of schools have access to full time nurses, with one-third of students lacking full-time access to a school nurse every day. This shortage is especially pronounced in rural areas, as data shows that just over half of rural schools employ full-time nurses, compared to over 70% of their urban counterparts. The disparities between states in students’ access to school nurses is also quite significant, as districts within states in the Midwest and West employ the fewest number of school nurses, amidst 20 states requiring K-12 schools to have a school nurse. Lastly, school nurses in many districts often have overly large workloads, as they are often required to serve large numbers of students, with responsibilities across multiple school buildings. 

This shortage of school nurses across the country has serious ramifications for both students and schools alike. Financially, the absence of a school nurse could mean increased costs for the school, who must now pay more for medical supplies and transportation for students who require medical aid. Meanwhile, students who don’t receive adequate care are more likely to require additional medical care, increasing costs for the healthcare system as a whole as well. Most crucially however, school nurse shortages have a negative impact on student health, as a lack of school nurses leads to issues such as an increase in chronic health conditions, mental health issues, and the need for emergency care. The lack of proper care and support from the absence of a school nurse may only worsen such emotional and mental health issues, leading to disruptive behaviours in the classroom, higher absenteeism, and poor academic performance. Furthermore, the lack of a school nurse could mean that students cannot access the appropriate help needed in the event of an accident or a medical emergency, thus putting students at risk of serious injury or even death. Overall, without regular access to a school nurse, students are much less likely to receive the care they need to stay healthy and succeed at school. 

There are many reasons behind the nationwide school nurse shortages. One such reason seems to be the misconception about the role of school nurse, as there is a general perception that school nursing is simply about very simple matters, driving many potential nurses away from the profession as they seek for a job that is “more challenging”. Another reason would be the significant pay disparities: data shows that just 34% of school nurses make more than $60,000 per year compared with almost 70% of the total RN workforce. This often forces school nurses to pick up additional shifts in hospitals and clinics, worsening their already-large workload. Lastly, nursing schools across the country are limiting student capacity due to faculty and infrastructural shortages, when the need for professional registered nurses continues to grow, thus worsening the shortage at hand. 

II. Current Policy Response

A. Funding 

Currently, federal funding is aimed at increasing the overall nursing workforce. The Health Resources and Services Administration (HRSA) has grant, scholarship, and loan repayment programs, such as the Nurse Corps Loan Repayment Program, which pays up to 85% of unpaid nursing education debt if a nurse serves two years in a critical shortage facility. The HRSA also runs the NEPQR Workforce Expansion Program that funds nursing schools, healthcare facilities, and tribes and tribal organizations to increase the number of nurses in rural and underserved areas. The NEPQR Workforce Expansion Program awarded over $4.8 million to five universities and colleges in 2024. Over four years, the HRSA gave over $19 million in funding to increase the number of nurses in rural and underserved areas. However, these HRSA programs are not specifically addressing the school nurse shortage, as these programs target nurses serving in critical shortage facilities, not K-12 schools.

There are non-profits that give funding for research on school nursing. The National Association of School Nurses (NASN) awards grants from $1,000 to $25,000 to school nurses or members of the NASN who research topics like the school nursing workforce, the school nursing work environment, economics of school nursing services, and the effectiveness of school nursing. The National Council of State Boards of Nursing (NCSBN) operates a grant program that provides up to $300,000 to investigators researching topics like the nursing workforce and the impact of policy on nursing.

B. Legislation

The One School, One Nurse Act of 2025 was introduced to ensure every elementary and secondary school had at least one registered nurse on staff. It awards competitive grants to local educational agencies to hire school nurses, convert part-time school nurse positions into full-time positions, increase school nurse salaries, and maintain recommended nurse-to-student ratios. Similarly, the NURSE Act, introduced in 2025, awards competitive grants to hire nurses to schools where at least 20% of students receive free or reduced-price lunch and breakfast. However, neither of these bills were passed.

The Elementary and Secondary School Emergency Relief Fund provided $190 billion to help K-12 schools respond to the COVID-19 pandemic. Many schools used these funds to hire school nurses, but the fund expired in 2024, forcing many schools to get rid of health services provided by school nurses.

In 2024, through the Bipartisan Safer Communities Act, The Center for Medicare & Medicaid Services awarded $2.5 million grants to 18 states for the expansion of Medicaid and Children’s Health Insurance Programs that allowed for at least one provider, like a school nurse, to provide services. This allows schools to fund nursing services without relying on education budgets.

C. School Nurse Staffing

There is no federal requirement that every U.S. public school has to have a full-time nurse, because federal law prohibits the U.S. Department of Education from controlling local school staffing. Instead, school staffing requirements depend on state laws and local school districts. 35 states and the District of Columbia require schools to have school nurses, and 7 states require making school nurses available. These requirements can range from full-time nurses to part-time nurses. Some states set required or recommended nurse-to-student ratios, ranging from 1:500 to 1:3,000.

D. School Nurse Staffing 

School nurse understaffing is not reported by the federal government. The National Association of School Nurses Workforce Study monitors access to school nurses, funding for school nurses, school nurse workforce characteristics, and other data.

III. Benefits and Drawbacks to Policy

The staffing requirements for school nurses are created with the purpose of protecting students, more specifically through the process of having qualified registered nurses standby to assess illness and injury, administer and monitor medications, craft emergency and chronic-conditions plans, coordinate with families and clinicians, as well as train staff. This is particularly consequential for students with asthma, diabetes, seizure disorders, severe allergies, disabilities, and mental-health needs. The American Academy of Pediatrics recommends at least one full-time nurse on every elementary, middle, and high school campus, while the National Association of School Nurses (NASN) suggests that students need full-time access to a professional registered nurse, with workloads based on each school’s actual health needs rather than a single universal ratio. 

School-nurse policies generally focus on requiring nurses on campus, setting staffing ratios, providing dedicated funding, expanding recruitment, and building school-health partnerships. Supporters—including medical organizations—argue that full-time registered nurses improve safety, help manage chronic conditions, and support attendance and learning. Staffing standards may also prevent unlicensed employees from being asked to handle medical responsibilities beyond their training. However, the National Association of School Nurses recommends that districts assess local needs—not just enrollment—because schools with more medically complex students, limited community health care, or multiple campuses may require more support.

The largest challenge is financing. Advocates view nurses as an investment that can prevent emergencies, reduce missed class time, and help families access care, while some administrators and fiscal conservatives worry that permanent staffing mandates add recurring costs for salaries, benefits, training, and coverage. Rural and small districts may face additional recruitment and budget barriers. A balanced approach could establish baseline registered-nurse access while directing added funds toward high-need and rural schools, using workload reviews to determine when a dedicated on-campus nurse is necessary.

IV. Future Outlook

To increase the number of school nurses, it’s necessary for the United States to address the severe regional disparities and vulnerabilities in funding. Many schools are unable to meet staffing standards for full-time school nurses, with significant disparities between urban and rural regions. Addressing this issue involves measures like the NURSE Act and the One School, One Nurse Act. Lower pay contributes to shortages, with school nurses averaging a yearly salary of $47,650 compared to $68,620 for general RNs as of 2022. This is despite the fact that school nurses often hold more advanced degrees and educational credentials compared to other RNs.

Nurses also face heavy workloads, leading nursing students to avoid this speciality of nursing and many practicing  nurses to leave their jobs; subsequently leading to poor job retention rates. This can be improved with more efficient processes like electronic health records and reduced documentation burdens. Some initiatives like Virginia’s Earn to Learn program offer paid clinical experience to support nursing students through partnerships between nursing schools and hospitals/health facilities; similar programs could be implemented to create partnerships between nursing schools and schools.

Policymakers can use federal funds to address budget constraints while protecting student healthcare. Cost is a primary reason for a school lacking a nurse, exacerbated by the expiration of Elementary and Secondary school Emergency relief (ESSER) funding “which many schools used to hire school nurses,” according to NASN. Expanding school based Medicaid programs beyond funding just IEPs (Individualized Education Programs) provides a major opportunity for revenue. Policies that implement NASN’s recommended measures such as automated billing systems and allowing other “school health team members” to be reimbursed under RN supervision can help ease burdens on school nurses further, creating a more efficient support system within schools (NASN).

V. Acknowledgement

The Institute for Youth in Policy wishes to acknowledge Adwaya Yesare for editing this policy brief.

VI. References

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