As some California schools return to in-person instruction, school nurses can play a vital role in helping keep students and staff healthy. But some districts don’t have a nurse at all, and in others a single nurse may be responsible for several thousand students across multiple schools. Recruiting and retaining more nurses could help schools weather the coronavirus crisis and lay groundwork for student health and achievement.

School nurses generally provide a range of services, including administering medicine, helping students manage asthma or other chronic diseases, and developing student care plans. In addition, they engage in public health activities such as screening for oral health and scoliosis, referring families to other providers, and preventing the spread of conditions like head lice.

During this public health crisis, school nurses are needed more than ever. Nurses can help develop protocols for handwashing, temperature checks, and mask-wearing to prevent the spread of the coronavirus. They can screen students and isolate those exhibiting coronavirus symptoms until they can be transported home. Nurses can also serve as in-house health experts, providing accurate information about the pandemic to students, parents, and staff. And their ongoing work on chronic disease management can help children especially at risk of COVID-19 complications.

Before the pandemic, the American Academy of Pediatrics recommended staffing each K–12 school with a full-time nurse to address the fact that students’ medical needs have grown over time, due in part to the increasing prevalence of chronic diseases, food allergies, and other conditions. California schools do not meet the academy’s 2001 guidelines to staff one nurse for every 750 students, let alone the updated recommendation.

Statewide, there is one school nurse for every 2,410 students, one of the highest student-to-nurse ratios in the country. In addition, no county meets current guidelines. There is one school nurse for about 890 students in Siskiyou County, which has the lowest overall student-to-nurse ratio. Yuba County has the highest ratio, with one nurse for more than 14,700 students. Alpine, Mono, and Sierra Counties report no school nurses at all. Even in counties that have lower student-to-nurse ratios, students may still lack access, since not all school districts have nurses on staff.

In the past, districts have struggled to hire nurses due to low pay and the complex logistics of traveling to multiple schools. Ongoing budget worries and heavier workloads due to coronavirus prevention, screening, education, and contact tracing may make recruitment even more difficult.

Some states are using their Governor’s Emergency Educational Relief (GEER) Fund, part of the federal CARES Act, to hire more school nurses. California has received approximately $335 million in these funds. The state is asking school districts to use the money to support student achievement and reduce learning loss due to COVID-19. For schools that resume in-person instruction, recruiting and retaining more nurses to help plan and implement safe procedures will be critical to safeguard the health of students, school staff, and local communities.