I 

113TH CONGRESS 

1ST SESSION H. R. 1857 

To make demonstration grants to eligible local educational agencies for the 

purpose of reducing the student-to-school nurse ratio in public elementary 

schools and secondary schools. 

IN THE HOUSE OF REPRESENTATIVES 

MAY 7, 2013 

Mrs. MCCARTHY of New York introduced the following bill; which was referred to the Committee on Education and the Workforce, and in addition 

to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such 

provisions as fall within the jurisdiction of the committee concerned 

A BILL 

To make demonstration grants to eligible local educational 

agencies for the purpose of reducing the student-toschool nurse ratio in public elementary schools and secondary schools. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Student-to-School 

5 Nurse Ratio Improvement Act of 2013’’. 

6 SEC. 2. FINDINGS. 

7 The Congress finds the following: 


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1 (1) The American Academy of Pediatrics em2 phasizes the crucial role of school nurses in the 

3 seamless provision of comprehensive health services 

4 to children and youth, as well as in the development 

5 of a coordinated school health program. 

6 (2) The school nurse functions as a leader and 

7 the coordinator of the school health services team, 

8 facilitating access to a medical home for each child 

9 and supporting academic achievement. 

10 (3) School nurses promote wellness and disease 

11 prevention to improve health outcomes for our Na12 tion’s children. In addition, school nurses perform 

13 early intervention services such as periodic assess14 ments for vision, hearing, and dental problems, in an 

15 effort to remove barriers to learning. 

16 (4) Recent national data indicates 45 percent of 

17 public schools have a school nurse all day, every day, 

18 while another 30 percent of schools have a school 

19 nurse who works part time in one or more schools. 

20 (5) The American Nurses Association has re21 ported that when there is no registered nurse on the 

22 school premises, the responsibility to administer the 

23 necessary medications and treatments, and appro24 priate monitoring of the children falls on the shoulVerDate Mar 15 2010 05:13 May 09, 2013 Jkt 029200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H1857.IH H1857

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1 ders of administrators, educators, and staff who are 

2 ill-prepared to perform these tasks. 

3 (6) Statistics from the National Center for 

4 Educational Statistics indicate that of the 

5 52,000,000 students who currently spend their day 

6 in schools, 15 to 18 percent of children and adoles7 cents have a chronic health condition. 

8 (7) A recent study indicated that from 2002 to 

9 2008, the percentage of children in special education 

10 with health impairments, due to chronic or acute 

11 health problems, increased 60 percent. School nurses 

12 use their specialized knowledge, assessment skills, 

13 and judgment to manage children’s increasingly 

14 complex medical conditions and chronic health ill15 nesses. 

16 (8) Among adolescents aged 12 to 19 years old, 

17 the prevalence of pre-diabetes and diabetes increased 

18 from 9 percent to 23 percent between 1999 and 

19 2008. More than 30 percent of children aged 2 to 

20 19 years old are obese or overweight (>85th per21 centile). In 2008, more than 10 million children in 

22 the United States had asthma. The prevalence of 

23 food allergies among children under the age of 18 

24 increased 19 percent from 1997 to 2007. 


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1 (9) According to the American Academy of Pe2 diatrics, students today face increased social and 

3 emotional issues, which enhance the need for preven4 tive services and interventions for acute and chronic 

5 health issues. School nurses are actively engaged 

6 members of school-based mental health teams and 

7 spend nearly 32 percent of their time providing men8 tal health services, including universal and targeted 

9 interventions, screenings to identify early warning 

10 signs and referrals to medical providers, and crisis 

11 planning. 

12 (10) In 2011, the Bureau of the Census re13 ported 9.7 percent of children under the age of 19, 

14 which equals 7.6 million children under the age of 

15 19, were without health insurance. Data shows that 

16 uninsured children achieve lower educational out17 comes than those with health coverage. Children who 

18 cannot afford to see a medical provider miss more 

19 days of school, experience increased severity of ill20 ness, and suffer from disparities in health. 

21 (11) More than 1.6 million children experience 

22 homelessness each year in the United States. Home23 less children develop increased rates of acute and 

24 chronic health conditions, and the stress of their liv25 ing situation can negatively affect their development 


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1 and ability to learn. As a result, schools have become 

2 the primary access to health care for many children 

3 and adolescents. School nurses serve on the 

4 frontlines as a safety net for the Nation’s most vul5 nerable children. 

6 (12) Communicable and infectious diseases ac7 count for millions of school days lost each year. 

8 Data illustrate that when students have access to a 

9 registered nurse in school, immunization rates in10 crease. 

11 (13) A 2011 study showed that a school nurse 

12 in the building saves principals, teachers, and cler13 ical staff a considerable amount of time that they 

14 would have spent addressing health concerns of stu15 dents, including saving principals almost an hour a 

16 day; saving teachers almost 20 minutes a day; and 

17 saving clerical staff more than 45 minutes a day. 

18 This would amount to a savings of about 13 hours 

19 per day in the aggregate for such school personnel. 

20 (14) Using a formula-based approach, taking 

21 into consideration the overall health acuity of the 

22 student body and the workload of school nurses, for 

23 determining a balanced student-to-school nurse ratio 

24 offers a reasonable means for achieving better stu25 dent outcomes. 


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1 SEC. 3. REDUCING STUDENT-TO-SCHOOL NURSE RATIOS. 

2 (a) DEMONSTRATION GRANTS.— 

3 (1) IN GENERAL.—The Secretary of Education, 

4 in consultation with the Secretary of Health and 

5 Human Services and the Director of the Centers for 

6 Disease Control and Prevention, may make dem7 onstration grants to eligible local educational agen8 cies for the purpose of reducing the student-to9 school nurse ratio in public elementary schools and 

10 secondary schools. 

11 (2) APPLICATION.—To receive a grant under 

12 this section, an eligible local educational agency shall 

13 submit to the Secretary of Education an application 

14 at such time, in such manner, and containing such 

15 information as the Secretary may require, which 

16 shall include information with respect to the current 

17 ratios of students-to-school nurses, student health 

18 acuity levels, and workloads of school nurses in each 

19 of the public elementary schools and secondary 

20 schools served by the agency. 

21 (3) PRIORITY.—In awarding grants under this 

22 section, the Secretary of Education shall give pri23 ority to applications submitted by high-need local 

24 educational agencies that demonstrate the greatest 

25 need for new or additional nursing services among 


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1 students in the public elementary secondary and sec2 ondary schools served by the agency. 

3 (4) MATCHING FUNDS.—The Secretary of Edu4 cation may require recipients of grants under this 

5 section to provide matching funds from non-Federal 

6 sources, and shall permit the recipients to match 

7 funds in whole or in part with in-kind contributions. 

8 (b) REPORT.—Not later than 24 months after the 

9 date on which a grant is first made to a local educational 

10 agency under this section, the Secretary of Education shall 

11 submit to the Congress a report on the results of the dem12 onstration grant program carried out under this section, 

13 including an evaluation— 

14 (1) of the effectiveness of the program in reduc15 ing the student-to-school nurse ratios described in 

16 subsection (a)(1); and 

17 (2) of the impact of any resulting enhanced 

18 health of students on learning, such as academic 

19 achievement, attendance, and classroom time. 

20 (c) DEFINITIONS.—For purposes of this section: 

21 (1) ESEA TERMS.—The terms ‘‘elementary 

22 school’’, ‘‘local educational agency’’, ‘‘poverty line’’, 

23 and ‘‘secondary school’’ have the meanings given to 

24 those terms in section 9101 of the Elementary and 

25 Secondary Education Act of 1965 (20 U.S.C. 7801). 


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1 (2) ACUITY.—The term ‘‘acuity’’, when used 

2 with respect to a level, means the level of a patient’s 

3 sickness, such as a chronic condition, which influ4 ences the need for nursing care. 

5 (3) WORKLOAD.—The term ‘‘workload’’, when 

6 used with respect to a nurse, means the amount of 

7 time the nurse takes to provide care and complete 

8 the other tasks for which the nurse may be respon9 sible. 

10 (4) ELIGIBLE LOCAL EDUCATIONAL AGENCY.— 

11 The term ‘‘eligible local educational agency’’ means 

12 a local educational agency in which the student-to13 school nurse ratio in each public elementary and sec14 ondary school served by the agency is 750 or more 

15 students to 1 school nurse. 

16 (5) HIGH-NEED LOCAL EDUCATIONAL AGEN17 CY.—The term ‘‘high-need local educational agency’’ 

18 means a local educational agency— 

19 (A) that serves not fewer than 10,000 chil20 dren from families with incomes below the pov21 erty line; or 

22 (B) for which not less than 20 percent of 

23 the children served by the agency are from fam24 ilies with incomes below the poverty line. 


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1 (6) NURSE.—The term ‘‘nurse’’ means a li2 censed nurse, as defined under State law. 

3 (d) AUTHORIZATION OF APPROPRIATIONS.—There 

4 are authorized to be appropriated such sums as may be 

5 necessary to carry out this section for each of the fiscal 

6 years 2014 through 2018. 

Æ 


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