School Nurse Task Force says every Ky. school needs a full-time nurse; asks lawmakers for $3 million to conduct a pilot program

By Melissa Patrick

Kentucky Health News

"Every school needs a nurse every day, all day."

So says the Kentucky Nurses Association School Nurse Task Force, which has worked for this goal for more than five years. It says only 43% of Kentucky schools meet the National Association of School Nurses recommendation for a minimum of one nurse for every 750 students

On Oct. 20, the task force made its case to the legislature's Interim Joint Committee on Education, saying there is no more important time than now for it, in the middle of the coronavirus pandemic, when a coordinated school health approach is most needed.

"We know that when students are healthy, they succeed academically," task-force spokesperson Gannon Tagher told the committee. She is a pediatric nurse practitioner and the associate dean for academic affairs on Northern Kentucky University's College of Health and Human Services. 

National Association of School Nurses chart

Tagher ticked off a long list of well-documented reasons why every Kentucky school needs a nurse every day, all day. She said, among other things, that schools with nurses have improved attendance rates, higher high-school graduation rates, reduced transmission of infectious diseases, and positive outcomes related to covid-19.

She also spoke to the major health and socioeconomic challenges facing Kentucky's children, noting that they rank in the bottom 10 states for physical and mental health, diabetes, asthma, obesity, oral health and substance abuse. She said 16% live in high-poverty areas, and the share of Kentucky children without health insurance increased 29% from 2016 to 2019. 

"The ability to learn is affected by health," she said. "If children are hungry, if they're tired, if they haven't had a home to sleep in, if their chronic conditions such as diabetes and asthma are poorly controlled -- then learning falls to the bottom of the hierarchy. They just don't have the ability to learn." 

Tagher said that in addition to addressing the health needs of students, school nurses also regularly address the "social determinants of health," which include very practical things such as housing and transportation.  

School nurses are an integral part of a school's trauma-informed care team, she said, and are often the first to recognize factors like bullying and mental-health issues that increase the risk of a student becoming a perpetrator or a victim of school violence.

She also stressed that school safety is more than just preventing violence: "When we have children with food allergies and children with asthma, children with diabetes in our schools, they have the potential to face life threatening emergencies during the school day, and a nurse can prevent these life threatening emergencies from happening."

During the 2018-19 school year, according to Tahger's slides, 21,074 Kentucky students had food allergies, 47,805 had asthma, and 1,507 had Type I diabetes.

Patricia Burkhart, co-chair of the task force said in an e-mail, "Legislators need to prioritize school nurses just as they did school safety. We would argue that health and safety go hand-in-hand."

Tagher said funding is often the reason given for a district's inability to have a full-time nurse in every school. With an annual salary for a full time nurse, including benefits, estimated at $52,406 a year, it would cost about $65 million for every school to have a full time nurse, according to task-force calculations.

To fund a full-time nurses in every school, the task force offered three solutions, including:

• New rules that allow Kentucky schools to bill Medicaid for "medically necessary" care for students who qualify for the program; 
• Partnerships with community agencies, like local health departments, federally qualified health centers or local health systems, who can share the cost of full-time nurses in each school; or
• Kentucky's share of funds from the Every Student Succeeds Act, the main source of federal money for elementary and secondary education.

The task force has talked about funding sources since it started asking for a full-time nurse in every school, but this year for the first time it is asking legislators to fund a $3 million pilot program that would allow it to place 56 school nurses in schools with the greatest need and measure the impact.

"A nurse in every school all day every day is an integral part of ensuring the health of our children and the future of our state," said Tagher. "We cannot afford to not fund school nurses right now."

There was no public reaction from legislators at the meeting because time ran out as Tagher concluded her presentation.