Not Enough School Nurses in California

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Not Enough School Nurses in California

Student health is at risk

By Elizabeth Hanink, RN, BSN, PHN
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While healthcare improvements have made it possible for more children with health issues to attend school, students with chronic and serious health conditions are being shortchanged by school-based care in California. That’s the conclusion of a new report from researchers at Sacramento State’s School of Nursing, presented at the California School Nurses Conference on March 28.

The study found that California schools are ill-equipped to meet the healthcare needs of the state’s 1.4 million children with special health needs. While those students may require routine care like urinary catheter insertion, ventilator monitoring, tracheotomy suctioning, insulin injections or blood glucose testing, trained providers are in short supply.

Outdated Assessments

The study also found that public schools are often unaware of their students’ health needs. Unless a student qualifies for an individualized education plan under the Individuals with Disabilities Improvement Education Act of 2004 (which only about one-third of students with special health needs do), there is no requirement for schools to even identify a student’s health needs. Health assessments are currently required only when entering the first grade. HIPAA and other federal privacy rules also complicate the process of obtaining necessary health information.

What should be done? The report offers a variety of recommendations, including:

• An additional student health assessment prior to entering the seventh grade
• Increasing the number of school nurses with the goal of achieving a 750 to 1 student-nurse ratio state-wide
• Proper training for all school personnel providing health services
• Requiring schools to establish systems to identify and support students with special health needs. 



Recommended school nurse-to-student ratio: 1 to 750
California’s average nurse-student ratio: 1 to 2,635
Percentage of school districts with no school nurses on staff: 57

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