‘More Than Band-Aids for Boo-Boos’: Why Every Virginia School Needs an RN

Doctor listening the lungs of a child

At a special legislative session this week, Virginia lawmakers heard from advocates about why it’s critical that school nurses – on the COVID-19 front lines as children return in person to many schools across the commonwealth – be on staff at every Virginia school.

Currently, there is no state requirement that every school have a nurse and no standard educational qualification for who may staff the school clinic. The legislature, however, is considering a bill, making its way through Senate committees, to require a full-time registered nurse in every elementary, middle and high school.

Among those helping drive the discussion about the need for school nurses is award-winning educator Vickie Southall, an assistant professor in the University of Virginia School of Nursing, a public health nurse, school nurse advocate, director of the Virginia Association of School Nurses’ Region V district and a member of its executive board.

Working closely with the association’s president, Gina Bellamy, Southall said that while final passage isn’t guaranteed, the pandemic has made the school nurse directive stronger than ever, and that it’s high time Virginians understand that school nurses offer more than just “Band-Aids for boo-boos.”

Vickie Southall headshot

Vickie Southall, an assistant professor in the University of Virginia School of Nursing, is a public health nurse and school nurse advocate. (Photo by Sanjay Suchak, University Communications)

Southall discussed the issue with UVA Today.

Q. How common are school nurses across Virginia?

A. It’s a little unclear. Between two-thirds and three-fourths of Virginia public schools have a registered nurse most of the time. However, there are a large number of schools that have an unlicensed health-care aide most of the time, and may only see an RN once a week. 

Currently, there’s no state regulation that every school has to have a nurse and no standard educational qualification that standardizes who may staff the school clinic. There are ratios for a lot of other professionals – a school counselor for every 325 students, a social worker for every 1,500 students, and so on – but none for school nurses. The national school nurse’s organization recommends that there be at least one RN for every 750 students, but we also know that ratios only take us so far. If you have a school of 500, you need a nurse; a 1,500-student school, you need a nurse, and a school of 3,000, you need a nurse. We need at least one RN at every school. 

Q. This isn’t the first time the Virginia Association of School Nurses has advocated for nurses in every school. Why is it so important now?

A. Since the early 2000s, school nurses have tried unsuccessfully six times to secure legislative funding to have a nurse in every school, but it’s never been a more serious effort than now.

If ever there was a time when you need a school nurse to be present in every school, it’s now, when we’re heading back to school during a full-blown pandemic. People think of school nurses as just being there giving out Band-Aids and ice for boo-boos, as our president Gina Bellamy likes to say, but there’s so much more they can and should do, especially in this moment.

Q. How has the job of a school nurse changed over timeand since the pandemic?

A. Before the pandemic, school nurses faced a population of children with complex physiological, mental and social needs. The Centers for Disease Control estimates 25% of kids have a chronic disease – asthma and diabetes are examples. School nurses not only help with their medication and monitoring; they educate them to take care of their condition, help to coordinate their care and get them any assistance they might need.

Mental health issues are concerns for many young people, and school nurses are often the first person kids approach when seeking help for these problems. School nurses are also great connection points: whether it’s getting students and families help from food pantries, access to free immunization clinics, insurance, clothing, even support for housing, things that are critical for lower-resourced families. School nurses also teach inside and outside the school, bridging health care and education in an equitable and culturally inclusive manner.

For some families, the school nurse may be the first and only health care professional they see.

During COVID, of course, the job has grown more expansive, and school nurses understand the many factors driving infections and deaths during the pandemic, especially within minority communities where many people are essential workers. They’re ready to teach kids, their parents, teachers and fellow school staff members how to protect themselves from COVID-19 (through the use of personal protective equipment, handwashing, masking and physical distancing), how to identify worrisome symptoms (and, alternately, when symptoms aren’t worrisome). They’re poised to develop and carry out plans for kids suspected of having the virus who need to be tested, possibly quarantined and then followed up with. The school nurse assists the health department in the initiation of contact tracing, and is the connective tissue between the school, community, and local and state health departments.

There is precedent for school nurses being essential to mitigating the spread of deadly pathogens. It was an attentive school nurse who first identified the H1N1 virus, and reacted quickly. Registered nurses know what they’re doing, what they’re seeing, and how to safely, competently, and compassionately handle it. We honestly can’t afford not to have them in every school.

Q. What’s the educational requirement to be a school nurse?

A. In Virginia, there currently isn’t one. At the moment, many parents think their child has a professional school nurse, but the person in the clinic may have just a week of health training, or less.

“It was an attentive school nurse who first identified the H1N1 virus, and reacted quickly.”

- Vickie Southall

It’s our position that every school nurse should be a licensed registered nurse: that implies a college-level education and having passed a rigorous state board licensing exam. With this legislation, we also hope to standardize who, exactly, can be called a school nurse. According to Virginia Board of Nursing regulations, only a registered nurse can legally make nursing assessments. School nurses need to make nursing assessments every day, especially in this time of COVID-19. Aides and practical nurses can collect data for assessments, but only the registered nurse can legally make nursing assessments and approve individualized health care plans for students. Registered nurses have a broader knowledge base and the experience to educate, assess, react and make decisions. Having RNs in these roles actually saves money in the long run.

Q. There’s an economic case for school nurses being RNs?

A. Yes. 2018 data from the state showed that aides are actually 2.5 to 3.5 times more likely than RNs to send kids home due to illness, which creates an even more significant burden on already tapped families, costing parents money when kids don’t need to be sent home. Research has demonstrated that having an RN helps to decrease absences, thereby increasing instructional time and improving test scores.

RNs are better at assessing when it’s truly an emergency. Yes, RNs command a higher salary, but they save you more, too.

No matter what, kids will get sick and injured at some point during school. A 2014 study done in Massachusetts found that for every dollar spent on a school nurse, the school saved $2. Another cost analysis study found that when a school lacks an RN, teachers, assistant principals and secretaries spend time addressing health problems. That model costs a school $133,000 a year in their time – a significantly greater cost than what it would take to fund a full-time registered nurse.

Q. What happens now?

A. On Aug. 19, the bill SB 5004 passed the Senate Health and Education Committee; next it heads to the Senate Finance Committee. It’s a little unclear what will happen in this special legislative session, and when, but if the bill doesn’t pass, it has a better chance of passing at the next session of the General Assembly in January.

We’re waiting, though, with great hope. It’s always been important to have registered school nurses on site, but never before in my lifetime has the need been so acute.

Media Contact

Christine Phelan Kueter

School of Nursing