School Nurses are Critical to the Health and Well-Being of Children and Families

New Mexico’s public schools serve over 330,000 children, and it is crucial to recognize the unique needs of these students in order to best support and encourage their progress. While the focus is often on the academic and social aspects of schooling, the often-complex medical needs of students must not be overlooked. 

Schools must be prepared to properly care for students experiencing medical and behavioral health emergencies, along with those who have chronic conditions like asthma and diabetes. In most schools, school nurses are an initial and essential source of health care for many young New Mexicans. Despite clear and far-reaching benefits of school nurses, many students lack access to a full-time school nurse. To safeguard students’ health and well-being, school nurse capacity must be expanded to reach all public-school students during all school hours across New Mexico. 

Caring for Students with Chronic Conditions and Health Emergencies

School nurses play an enormous role in the health and well-being of New Mexico’s students, particularly since all but one county in New Mexico is at least partially classified as medically underserved. School nurses fill the gaps of the healthcare infrastructure in the state to provide necessary and sometimes life-saving care—all New Mexico school nurses provide care for students with common chronic conditions, and nearly all school nurses manage medical or behavioral health emergencies.

The 2019 New Mexico School Nurse Workforce Survey—conducted by our research team in partnership with the New Mexico Department of Health Office of School and Adolescent Health—illustrated how common this essential care in schools is:

• Almost all nurses have at least one student in their school(s) with asthma (99.7%), food allergies (99.4%), and seizure disorders (91.9%). 
• Most have at least one student with a history of anaphylaxis (88.3%). 
• Two-thirds have at least one student with type 1 diabetes and a third with type 2 diabetes. 
• Three-quarters provided emergency management for a behavioral health concern during the 2018-19 school year, the most common of which were suicidality and self-injurious behavior.
• Three-quarters provided emergency management for an issue arising from trauma or violence during the 2018-19 school year, such as child abuse or neglect or violence at school.

With so many students with chronic conditions and special health care needs, along with the frequency of medical or behavioral health emergencies, the role of school nurses in helping students manage these conditions is vital. 

School Nurse Availability and Access to Health Care

The benefits of school nurses go beyond direct and immediate care for health concerns. Students who are able to get their health needs met by school nurses are better equipped to attend and fully participate in school, setting them up for a brighter academic future. School nurses have been shown to improve student and school district outcomes, including the general health of students and school staff, improve academic outcomes and productivity, and reduce rates of chronic absenteeism and school dropouts.

Yet, despite the broad benefits of school nurses and the medical needs of students, almost half of students in New Mexico do not have access to a school nurse during all school hours. Only 56.8% of nurses statewide said that all their schools have a school nurse during all school hours. Overall, one-third of school nurses provide care on more than one school campus, but this percentage varies geographically across the state. For example, in the central and most metropolitan region of the state, just a quarter of school nurses served more than one campus. In the more rural and mostly Native American northwest region of the state, half of school nurses served more than one campus.

This patchy and uneven coverage creates gaps in care, where schools and districts don’t have enough school nurses to provide all students with healthcare access. Some schools may simply be without a school nurse for portions of the school day, in which case schools must rely on other school staff to help with healthcare tasks and on off-site medical personnel for urgent care, emergencies and other services, which result in lost learning time and less accessibility for students. Without adequate coverage, school nurses are also stretched thin. Most school nurses reported having to delegate tasks to other school personnel, despite their hesitation— for example, two-thirds of school nurses delegate insulin administration, but only 20.2% of school nurses said that they are very comfortable delegating this task.  

Recommendations

Providing school nurses in every school in every district in New Mexico, during all school hours, is vitally important to improving the physical and behavioral health of school-age children statewide. Moreover, uniform access to school nursing services is foundational to improved equity in child and adolescent health care in our state. Increasing access to school nurses could be implemented first in rural areas with higher proportions of Native American and Hispanic students in order to reduce disparities, increase health equity, and provide a safety net that addresses the economic and social conditions that effect academic outcomes. 

Finally, many school nurse services are reimbursable through Medicaid, and all districts and schools should be supported to acquire and use capacity to bill Medicaid. With these concrete steps forward, New Mexico can safeguard the health, well-being, and academic futures of these students.