The School Nurse Problem In NC, And What One Parent Is Doing About It

Sep 5, 2014

The school nurse-to-student ratio in NC is well above the level recommended by the CDC.
Credit NC Parents Advocating For School Health

Teri Saurer is a parent, and like any parent she got a little anxious a few years ago when her daughter, Hannah, was about to head off to kindergarten.

“Hannah had a prior history of epilepsy and she now has life-threatening food allergies,” Saurer explains. “I was very concerned sending her to school. So I looked into the nurse situation and I was very surprised to find out that there was not a nurse in her school every day.”

Saurer lives in Charlotte, but it’s true across North Carolina. Not only is there not a nurse in every school, in some places, three, four, or more schools share a single nurse.

The job of school nurse has changed dramatically. No longer is a school nurse just handing out ice packs and aspirin. They have to develop detailed health plans for students with special needs, train school personnel, as well as manage student medication schedules and immunizations, among many other duties.

“Over the years the medical conditions that the nurses are working with, they are getting more severe,” says Cheryl Blake, president of the School Nurse Association of North Carolina and a school nurse herself. “Because they don’t keep sick students in the hospital. They send them home and then send them back to school. And there’s such an increase in asthma and severe food allergies and diabetes. We’re seeing that increase every single year. And school nurses have to deal with these conditions.”

According to the Centers For Disease Control and Prevention, 19 percent of all students have health conditions like these.

A map shows the school nurse-to-student ratio in all of North Carolina's school districts.
Credit NC DHHS

But as the health issues and job responsibilities have increased, the ratio of school nurses to students has decreased. The CDC recommends a nurse-to-student ratio of 1:750. North Carolina’s ratio is about 1:1,200  (pdf).

In some individual districts, it’s much worse. Davidson County holds the distinction of having the worst school nurse ratio in the state, at 1 nurse for every 3,000 students.

But much wealthier districts also rank near the bottom. Wake County’s ratio is around 1:2,300. That will be improved somewhat with the passing of the most recent Wake County budget.

“I think it is imperative that we increase the presence of school nurses in our schools,” Wake County Commissioner Caroline Sullivan said at the June meeting, just before the budget passed that included funding for 10 new school nurses. “I think we should have the goal that Mecklenburg just got to, where they have a nurse in every school.”

That goal, the one Charlotte Mecklenburg achieved, of a nurse in every school, came about largely because of the work of parent Teri Saurer.

Two years ago, she launched a grass-roots organization, North Carolina Parents Advocating For School Health, that put the pressure on the Mecklenburg County Commissioners.

“It’s always about funding,” she says. “And there’s always lots of wonderful causes that need more funding. So it wasn’t necessarily that anybody thought we didn’t need it, it was just they were concerned there were other priorities or they were concerned about how to fund it.”

This past summer, Saurer finally convinced the Commissioners that school nurses were worth it.

For the past two months, Charlotte Mecklenburg has been on a school nurse hiring spree. But it will take a while before parents like Saurer will feel at ease with the situation.

Saurer’s daughter is still going to school in a building where a nurse is physically present just two-and-a-half days a week. Saurer has heard that a full-time nurse is likely to be in place by March, 2015.