About School Nurses
What is a school nurse?
School nurses are Registered Nurses (RN’s) who also demonstrate the special skills needed to work with children in school. Many have national certification achieved with advanced study and testing. They have experience, typically in pediatrics, public health or both.
How many nurses work in Guilford County Schools (GCS)?
Currently there are 33 nurses and 3 supervisors serving 73,000 students in 125 schools.
This sounds like a lot. Is it enough?
For many years recommendations were “one school nurse for every 750 students”. The number of nurses and students in GCS means that Guilford County now has a ratio three times that recommendation: 1 to every 2,200 students! Each nurse is assigned between 3 to 5 schools, which means they spend only a day or a day and a half in each school assigned.
In June 2016, the American Academy of Pediatrics and others recommended that rather than using ratios to determine how many nurses to hire, school systems establish the goal of one nurse in every school. One nurse per school is the goal for Guilford County. To reach that number we will have to secure funding for 60+ school nurse positions and several more supervisors.
With so few nurses, who takes care of the children when nurses are not there?
Nurses train staff so that when they are not in the school, medications can be administered as prescribed by a physician or other health care provider. Nurses also train and monitor school staff to do procedures that students need: everything from urinary catheterization to tube feedings, blood sugar checks, asthma medications and emergency EpiPen administration.
Asking school staff to do the work of a nurse is far from ideal. Staff, while willing to help, may not be comfortable doing what is asked of them, and it takes them away from other duties. It also means that crucial information, such as worsening symptoms, could be overlooked or even lost if the task is being performed by personnel who do not have the education and clinical judgment of a professional nurse.
School nurse are the health professional in the school who can identify health needs, link students to the most appropriate services for their needs, and apply knowledge of community resources to ensure the needs are met.
Good health is necessary for academic success and nurses make good health happen!
About Project ONE
What is Project ONE?
Project ONE is the name given to the collaborative work of community volunteers. We are working to educate our community about the role of the professional school nurse (RN) and the need for at least one RN in every school.
How long has Project ONE been in existence?
The volunteers began to meet in the spring of 2016 following a presentation to the Guilford County Health and Human Services Advisory Committee (Advisory Committee) by staff of the Guilford County Department of Public Health, the agency that is in charge of school health nursing in Guilford County.
Who are the members of the Project ONE committee?
The original committee was made up of volunteers from the Advisory Committee. When the group determined a need for broader community participation, additional members came on board. A list of current members of the committee can be found on our web page. Please visit the webpage to see how you can help.
Is Project One part of the School Health Aide (SHA) Pilot Project?
No, this is a separate initiative.
Why do you want one RN in every school?
The use of ratios for nursing workload determination is now considered by experts, such as the American Academy of Pediatrics, to be “inadequate to meet the complex needs of today’s students.” New recommendations are to have at least one nurse (RN) in every school. In the 2016-17 school year, Guilford County nurses serve between 3 and 6 schools. At least one large county in NC (Mecklenburg) has already reached our goal of one RN for each school. We believe Guilford County can too!
What is your timeline for meeting the goal?
We have not determined a specific date. But we know we have a lot of work to do to move beyond present staffing. We are in the process of gathering data and perspectives from parents, advocates and community leaders. We invite you to contribute your suggestions.
About Every Student Succeeds Act (ESSA) (adapted from “Essa Talking Points for School Nurses”)1
What is ESSA?
The “Every Student Succeeds Act” known as ESSA, is a federal law, signed in December of 2015. It replaces No Child Left Behind and transfers most decision-making from the US Department of Education to state and local education agencies (LEA’S).
How do nurses support ESSA goals?
ESSA uses the term “Specialized Instructional Support Personnel” or SISP to refer to school personnel who are key to keeping students healthy, in school, ready and able to learn. School nurses are defined as a SISP along with school social workers, school psychologists, school counselors, school speech language pathologists, school librarians and others. Notably, ESSA recognizes school nurses as providing a critical link between student health and learning.
What are the implications for school nurse staffing?
ESSA directly refers to the school nurse’s role in leading the management of children with chronic disease. Some 25% of children have chronic health issues. A professional nurse must be readily available if students are to have access to the care they need, not only for physical illness but also for help with bullying and mental health issues.
Does ESSA have any implications for funding school nurse positions?
Yes! ESSA funding helps school districts (LEA’s) fund health related programs. For example, Title I dollars (for schools with low income families making up at least 40 percent of student body) are available for hiring a school nurse. In addition, ESSA funds the development of programs (nutrition, physical education and bullying prevention) that depend on professional nursing input.
What else should school nurse advocates know about ESSA?
“ESSA recognizes that children who live in poverty are at greater risk of having a chronic condition and unmet health needs affecting their ability to learn. Adverse health conditions can lead to an increase in chronic absenteeism…When school nurses are present in schools there are higher rates of attendance, graduation, and immunization compliance.”
About Whole School, Whole Community, Whole Child (WSCC)
What is WSCC?
This is an expansion of a decades old model that brought important
parts of the student’s school experience together in one model that supports both learning and health. According to the CDC’s description of WSCC, the model “focuses its attention on the child, emphasizes a school-wide approach, and acknowledges learning, health and the school as being a part and reflection of the local community.”
Read more at
What makes up this model?
The child is in the center of WSCC surrounded by coordinated activity to keep the child “healthy, safe, engaged, supported and challenged.”2 Critical service components in the model are: health education, physical education and activity, nutrition environment and services, health services including presence of a school nurse, social and emotional climate, counseling and psychological & social services, a healthy physical environment, employee wellness, family engagement and community involvement.
Read more at
This is a national model. Is North Carolina using it?
Yes. NC Healthy Schools, a division of the Department of Public Instruction and the State Board of Education, uses WSCC to guide the work it does in our public schools.
Does Guilford County have a community group to help implement this in our schools?
Yes. The General Assembly of the State of NC requires each county to form a School Health Advisory Council or SHAC. These councils are made up of leaders of community agencies and school representatives. They are charged with serving as a collective voice in an advisory capacity to the local schools system. SHAC members represent each of the critical components of WSCC.
Are school nurses represented in our local SHAC?
Yes. The Guilford County Department of Health & Human Services School Health Nursing Supervisor is an active member.