ELC Report: School Nurse Shortage Jeopardizes Student Health and Safety

May 7, 2013 – The health and safety of Philadelphia’s public school students is in jeopardy following the elimination of more than 100 school nurse positions, according to a new report from the Education Law Center conducted with assistance from the Leadership Education in Neurodevelopmental and Related Disabilities (LEND) Program at the Children’s Hospital of Philadelphia.

Currently, 195 nurses are serving approximately 200,000 public school students. That’s one nurse per 1,025 students. National research recommends one nurse per 750 healthy students, according to the ELC report.

One of the results of the nurse shortage has been an increase during the 2012-13 school year in non-medical school personnel administering medications and treatments to students on a regular basis.

A current school nurse explained the risks of continuing that approach.

“Children who have chronic health problems such as asthma, diabetes, or food allergies are not safe in schools without a full-time school nurse. Numerous medication errors have already occurred as a result. If the District continues on the current path, we will soon realize the real cost,” said one of the school nurses who participated in the research.

Beyond the immediate health risks, the lack of school nurses places the School District of Philadelphia at risk legally.

“The District is legally obligated to provide specific nursing services to children with special education needs and those with qualifying disabilities, such as asthma and diabetes,” said Education Law Center Senior Attorney Maura McInerney, who co-authored the report. “If school nursing services are not provided to ensure that children can learn and are properly accommodated in school, they may suffer discrimination in violation of federal and state law,” she said.

ELC reviewed research on public health and school nurses, conducted in-depth interviews, and surveyed more than 70 representatives of organizations serving children with disabilities, school nurses, and families of children with healthcare needs.

Based on that research and additional research on student health and safety, ELC recommends that the District take the follow steps to fix the current crisis:

  • Conduct a cost-benefit analysis to clarify the value of nurses in the School District of Philadelphia.
  • Adopt a student-to-school nurse ratio on a “per school” basis that accounts for the impact of students with acute and chronic medical needs and special education needs. This ratio will ensure compliance with all applicable federal and state laws that protect both students with disabilities under the IDEA and those with qualifying disabilities under Section 504.
  • Eliminate reliance on untrained personnel to perform duties of a school nurse.
  • Utilize nursing students from various local universities to perform discrete tasks with supervision by a registered and licensed school nurse.

“We recognize the fiscal crisis facing the District but we cannot afford to overlook the essential and cost-effective role that school nurses play in supporting learning — from ensuring consistent attendance to identifying medical needs to ensuring that children with disabilities receive needed support.”

The School Nurse Shortage in Philadelphia: Prognosis & Prescription for Change



The Education Law Center is a non-profit, statewide legal advocacy organization, dedicated to ensuring that all of Pennsylvania’s children have access to a quality public education.

Education Law Center
Office: 215-238-6970