II 

113TH CONGRESS 

2D SESSION S. 2297 

To make demonstration grants to eligible local educational agencies or consortia of eligible local educational agencies for the purpose of reducing 

the student-to-school nurse ratio in public elementary schools and secondary schools. 

IN THE SENATE OF THE UNITED STATES 

MAY 7, 2014 

Mr. TESTER introduced the following bill; which was read twice and referred 

to the Committee on Health, Education, Labor, and Pensions 

A BILL 

To make demonstration grants to eligible local educational 

agencies or consortia of eligible local educational agencies 

for the purpose of reducing the student-to-school 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 ‘‘Nurses for Under5 Resourced Schools Everywhere Act’’ or the ‘‘NURSE 

6 Act’’. 

7 SEC. 2. FINDINGS. 

8 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 23:48 May 12, 2014 Jkt 039200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S2297.IS S2297

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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 Education Statistics indicate that 15 to 18 percent 

5 of the 52,000,000 students who currently spend 

6 their day in school have a chronic health condition. 

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

8 2008, the percentage of children in special education 

9 with health impairments, due to chronic or acute 

10 health problems, increased by 60 percent. School 

11 nurses use their specialized knowledge, assessment 

12 skills, and judgment to manage children’s increas13 ingly complex medical conditions and chronic health 

14 illnesses. 

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

16 the prevalence of prediabetes and diabetes increased 

17 from 9 percent to 23 percent between 1999 and 

18 2008. More than 30 percent of children aged 2 to 

19 19 years old are obese or overweight (defined as hav20 ing a body mass index of greater than the 85th per21 centile). In 2008, more than 10,000,000 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 provide referrals to medical providers, and 

11 crisis 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 7,600,000 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 1,600,000 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 front 

4 lines as a safety net for the Nation’s most vulnerable 

5 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) Determining a balanced student-to-school 

21 nurse ratio by using a formula-based approach, tak22 ing into consideration the overall health acuity of the 

23 student body and the workload of school nurses, of24 fers a reasonable means for achieving better student 

25 outcomes. 


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

2 (a) DEFINITIONS.—In this section: 

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

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

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

6 the terms in section 9101 of the Elementary and 

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

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

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

10 sickness, such as a chronic condition, which influ11 ences the need for nursing care. 

12 (3) ELIGIBLE ENTITY.—The term ‘‘eligible enti13 ty’’ means— 

14 (A) a local educational agency in which the 

15 student-to-school nurse ratio in each public ele16 mentary and secondary school served by the 

17 agency is 750 or more students to 1 school 

18 nurse; or 

19 (B) a consortium of local educational agen20 cies described in subparagraph (A). 

21 (4) HIGH-NEED LOCAL EDUCATIONAL AGEN22 CY.—The term ‘‘high-need local educational agency’’ 

23 means a local educational agency described in para24 graph (3)(A)— 


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1 (A) that serves not fewer than 10,000 chil2 dren from families with incomes below the pov3 erty line; or 

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

5 the children served by the agency are from fam6 ilies with incomes below the poverty line. 

7 (5) NURSE.—The term ‘‘nurse’’ means a li8 censed nurse, as defined under State law. 

9 (6) SECRETARY.—The term ‘‘Secretary’’ means 

10 the Secretary of Education. 

11 (7) WORKLOAD.—The term ‘‘workload’’, when 

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

13 time the nurse takes to provide care and complete 

14 the other tasks for which the nurse is responsible. 

15 (b) DEMONSTRATION GRANT PROGRAM AUTHOR16 IZED.—From amounts appropriated to carry out this sec17 tion, the Secretary of Education, in consultation with the 

18 Secretary of Health and Human Services and the Director 

19 of the Centers for Disease Control and Prevention, shall 

20 award demonstration grants, on a competitive basis, to eli21 gible entities to pay the Federal share of the costs of re22 ducing the student-to-school nurse ratios in the public ele23 mentary schools and secondary schools served by the eligi24 ble entity, which may include hiring a school nurse to 

25 serve schools in multiple school districts. 


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1 (c) APPLICATIONS.— 

2 (1) IN GENERAL.—An eligible entity desiring a 

3 grant under this section shall submit to the Sec4 retary an application at such time, in such manner, 

5 and containing such information as the Secretary 

6 may require. 

7 (2) CONTENTS.—Each application submitted 

8 under paragraph (1) shall include information with 

9 respect to the current (as of the date of application) 

10 student-to-school nurse ratio, student health acuity 

11 levels, and workload of school nurses in each of the 

12 public elementary schools and secondary schools 

13 served by the eligible entity. 

14 (d) PRIORITY.—In awarding grants under this sec15 tion, the Secretary shall give priority to each application 

16 submitted by an eligible entity that— 

17 (1) is a high-need local educational agency or a 

18 consortium composed of high-need local educational 

19 agencies; and 

20 (2) demonstrates— 

21 (A) the greatest need for new or additional 

22 nursing services among students in the public 

23 elementary schools and secondary schools 

24 served by the agency or consortium; or 


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1 (B) that the eligible entity does not have 

2 a school nurse in any of the public elementary 

3 schools and secondary schools served by the eli4 gible entity. 

5 (e) FEDERAL SHARE; NON-FEDERAL SHARE.— 

6 (1) FEDERAL SHARE.—The Federal share of a 

7 grant under this section— 

8 (A) shall not exceed 75 percent for each 

9 year of the grant; and 

10 (B) in the case of a multi-year grant, shall 

11 decrease for each succeeding year of the grant, 

12 in order to ensure the continuity of the in13 creased hiring level of school nurses using State 

14 or local sources of funding following the conclu15 sion of the grant. 

16 (2) NON-FEDERAL SHARE.—The non-Federal 

17 share of a grant under this section may be in cash 

18 or in-kind, and may be provided from State re19 sources, local resources, contributions from private 

20 organizations, or a combination thereof. 

21 (3) WAIVER.—The Secretary may waive or re22 duce the non-Federal share of an eligible entity re23 ceiving a grant under this section if the eligible enti24 ty demonstrates an economic hardship. 


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1 (f) REPORT.—Not later than 2 years after the date 

2 on which a grant is first made to a local educational agen3 cy under this section, the Secretary shall submit to Con4 gress a report on the results of the demonstration grant 

5 program carried out under this section, including an eval6 uation of— 

7 (1) the effectiveness of the program in reducing 

8 the student-to-school nurse ratios described in sub9 section (b)(1); and 

10 (2) the impact of any resulting enhanced health 

11 of students on learning, such as academic achieve12 ment, attendance, and classroom time. 

13 (g) AUTHORIZATION OF APPROPRIATIONS.—There 

14 are authorized to be appropriated to carry out this section 

15 such sums as may be necessary for each of fiscal years 

16 2015 through 2019. 

Æ 


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