North Carolina would have to spend $45 million annually to meet the State Board of Education’s recommended ratio of one school nurse for every 750 students. The National Association of School Nurses recommends every school have access to one school nurse, but that could cost state taxpayers $79 million a year.

The General Assembly’s Program Evaluation Division released a report Jan. 22 on meeting current standards for school nurses statewide. The report was discussed briefly during a Joint Legislative Program Evaluation Oversight Committee meeting.

North Carolina isn’t alone. Terry Stoops, the vice president of research and director of education studies at the John Locke Foundation, said the report’s findings are not surprising.

“According to the National Association of School Nurses, one out of four schools in the United States did not employ a school nurse last year. Only 39 percent of schools employed a full-time nurse,” Stoops said.

North Carolina school districts are struggling to meet the ratio outlined in the report as schools legally must assume an increasing amount of health care responsibilities. Over the past 15 years, the General Assembly has passed legislation requiring schools to provide care for chronic conditions including asthma, diabetes, and severe allergies. Further complicating the issues is the growing number of students with chronic illnesses or special needs.

“As the demand for nurses exceeds supply, those with nursing credentials are more likely to gravitate toward higher-paying health care jobs in hospitals, clinics, and private practices, rather than public schools,” Stoops said.

According to the report, 46 of 115 local education agencies now meet the school nurse-to-student ratio recommended by SBE in 2004. Only five LEAs have one school nurse in every school.

On average, North Carolina has one school nurse for every 1,068 students. Pamlico County has the lowest ration at 1:320, while Cumberland County has the highest ratio at 1:2,242. While a majority of school nurses — 41.6 percent — serve only one school, about 22 percent are serving three or more schools.

Currently, 1,318 full-time school nurses are serving 2,313 schools, with 86 LEAs operating their own school nurse programs. Local health departments operate school nurse programs in 16 LEAs, while two LEAs work with a not-for-profit hospital to provide school nurse services. The remaining 11 LEAs either work with nonprofit groups or a combination of entities to operate a school nurse program.

The report also found around 60 percent of medical procedures conducted in schools are not done by a registered school nurse, but by a secretary, a teacher, or an assistant principal with some basic first aid training.

PED called on the General Assembly to direct the SBE to develop a new strategic plan for school nursing staff levels. Legislators should also direct the Department of Health and Human Services and the Department of Public Instruction to consolidate two state programs: the Child and Family Support Teams and the School Nurse Funding Initiative, PED said.

Stoops said school districts should pursue private and nonprofit sector options to provide needed medical services because of budgetary pressures.

“The market for nurses is particularly competitive in rural communities, which face persistent shortages for qualified health care providers,” Stoops said. “Perhaps our elected officials should consider measures to address shortages in these communities first.”