Does the School Nurse‐to‐Student Ratio Make a Difference?

Abstract

Public schools must provide an appropriate education for students with complex health needs. Chronic illnesses such as asthma and diabetes, social morbidities, injuries, and conditions that limit learning such as poor vision commonly affect school-aged children. School nurses often assume a leadership role in providing services for these children. However, although a national standard for school nurse/student ratio has been proposed, little research has examined the relationship between different school nurse-to-student ratios, level of health services provided in schools, and student outcomes. This study examined data in a 21-county region in eastern North Carolina served by a regional school nurse consultant. The school nurse-to-student ratio in these counties ranged from 1:451 to 1:7,440 based on full-time equivalencies. Two systems offered no school nursing services. Data from school years ending in 2000-2002 were considered in the analysis. A significant correlation was found between the increased presence of school nurses and services provided to children with diabetes (r = -.52, p = .000) and asthma (r = -.43, p = .002). Schools with better ratios provided more counseling services to children for social conditions such as depression and unintended pregnancy (r = -.38, p = .006), and more follow-up for school-related injuries (r = -.43, p = .003), and a higher percentage of children with vision problems received follow-up care (r = -.37, p = .007). A case analysis of one school district that experienced a significant improvement in nurse/student ratio over the study period provides further evidence that school nurses make a difference.

Determinants of the intention of elementary school nurses to adopt a redefined role in health promotion at school

“…This finding contrasts with the literature, where employment status for health-promotion role, ratio of ESNs to students, number of schools per ESN, and ESN educational levels are reported as critical factors in the individual decision to adopt a health-promotion role [2,5,17,65]. Training needs were not expressed as a facilitating factor to playing the proposed role by the respondents, although there is a consensus in the literature on the development of competencies with respect to an expanded role of school nurses [17,18,55,66].…”

Collaborative Consultation to Support Children With Pediatric Health Issues: A Review of the Biopsychoeducational Model

“…School nurses represent the health care system in many educational settings and are vital to the day-to-day health care of many students. However, they are either in short supply or even nonexistent in some districts (e.g., Guttu, Engelke, & Swanson, 2004). Due to these realities, it may be difficult for school nurses to take on the primary role of a liaison within the present model.…”

Asthma screening, case identification and treatment in school-based programs

“…Although the ratio of students to school nurse varies by region, very few areas meet the suggested ratio of 750:1 [21], or about one school nurse per elementary, middle, or high school in metropolitan areas and at least one school nurse for each rural school district. Although the presence of school nurses can make a difference [22,23 -25 ], what Chamberlain and Bauer [20 ] and Guttu et al [22] fail to mention is the lack of training among many of the existing school nurses in assessing and managing asthma or asthma exacerbations. Future comprehensive school programs may need to ensure both that a nurse is present and that resources are available to provide that nurse with education and support in the care of asthma.…”