II 

116TH CONGRESS 

1ST SESSION S. 1362 

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

the numbers of school nurses in public elementary schools and secondary 

schools. 

IN THE SENATE OF THE UNITED STATES 

MAY 8, 2019 

Mr. TESTER (for himself and Mr. MERKLEY) 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 increasing the numbers of school 

nurses 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’’. 


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1 SEC. 2. FINDINGS. 

2 Congress finds the following: 

3 (1) The National Association of School Nurses 

4 identifies schools as primary locations to address 

5 student health issues, since a school nurse is the 

6 health care provider that many students see on the 

7 most regular basis. 

8 (2) The American Academy of Pediatrics has 

9 recognized the crucial role that school nurses play in 

10 children’s health and has called for having a full11 time school nurse every day and in every school 

12 building. 

13 (3) The school nurse functions as the leader 

14 and coordinator of the school health services team, 

15 including by carrying out chronic disease manage16 ment and health promotion as well as facilitating ac17 cess to a medical home for each child and supporting 

18 academic achievement. 

19 (4) School nurses promote wellness and disease 

20 prevention to improve health outcomes for our Na21 tion’s children. In addition, school nurses perform 

22 early intervention services such as periodic assess23 ments for vision, hearing, and dental problems, in an 

24 effort to remove barriers to learning. 

25 (5) The American Federation of Teachers has 

26 called for a nurse in every school, as nurses are 


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1 front-line workers that address an array of health 

2 needs and their presence in a school can help to im3 prove student learning. 

4 (6) According to 2017 data from the National 

5 Association of School Nurses, only 39.3 percent of 

6 schools employ a full-time school nurse, while 35.5 

7 percent of schools employ a school nurse only part8 time, and 25.2 percent do not have a school nurse 

9 at all. 

10 (7) The National Association of School Nurses 

11 has reported that medication administration to stu12 dents is one of the most common health-related ac13 tivities performed in school. As more chronically ill 

14 and medically unstable children enter the school sys15 tem each year, the medical factors that promote and 

16 support their academic success increase, including 

17 the need for medications that enhance overall health 

18 or stabilize chronic conditions. 

19 (8) National data indicate that between 15 and 

20 20 percent of children who spend their day in school 

21 have a chronic health condition. 

22 (9) According to the American Academy of Pe23 diatrics, students today face increased social and 

24 emotional issues, which enhance the need for preven25 tive services and interventions for acute and chronic 


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1 health issues. School nurses are actively engaged 

2 members of school-based mental health teams and 

3 spend nearly 32 percent of their time providing men4 tal health services, including universal and targeted 

5 interventions, screenings to identify early warning 

6 signs and provide referrals to medical providers, and 

7 crisis planning. 

8 (10) According to the Department of Edu9 cation, during the 2013–2014 school year, 1,360,747 

10 children enrolled in public schools experienced home11 lessness. Homeless children develop increased rates 

12 of acute and chronic health conditions, and the 

13 stress of their living situation can negatively affect 

14 their development and ability to learn. As a result, 

15 schools have become the primary access to health 

16 care for many children and adolescents. School 

17 nurses serve on the front lines as a safety net for 

18 the Nation’s most vulnerable children. 

19 (11) Communicable and infectious diseases ac20 count for millions of school days lost each year. 

21 Data illustrate that when students have access to a 

22 registered nurse in school, immunization rates in23 crease. 

24 SEC. 3. INCREASING THE NUMBER OF SCHOOL NURSES. 

25 (a) DEFINITIONS.—In this section: 


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

2 school’’, ‘‘local educational agency’’, ‘‘secondary 

3 school’’, and ‘‘State educational agency’’ have the 

4 meanings given to the terms in section 8101 of the 

5 Elementary and Secondary Education Act of 1965 

6 (20 U.S.C. 7801). 

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

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

9 sickness, such as a chronic condition, which influ10 ences the need for nursing care. 

11 (3) ELIGIBLE ENTITY.—The term ‘‘eligible enti12 ty’’ means— 

13 (A) a local educational agency in which not 

14 less than 20 percent of the children are eligible 

15 to participate in the school lunch program es16 tablished under the Richard B. Russell National 

17 School Lunch Act (42 U.S.C. 1751 et seq.); 

18 (B) a consortium of local educational agen19 cies described in subparagraph (A); or 

20 (C) a State educational agency in consor21 tium with local educational agencies described 

22 in subparagraph (A). 

23 (4) HIGH-NEED LOCAL EDUCATIONAL AGEN24 CY.—The term ‘‘high-need local educational agency’’ 


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1 means a local educational agency described in para2 graph (3)(A)— 

3 (A) that serves not fewer than 15,000 chil4 dren who are eligible to participate in the pro5 gram described in such paragraph; or 

6 (B) for which not less than 40 percent of 

7 the children served by the agency are eligible to 

8 participate in the program described in such 

9 paragraph. 

10 (5) NURSE.—The term ‘‘nurse’’ means a reg11 istered nurse, as defined under State law. 

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

13 the Secretary of Education. 

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

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

16 time the nurse takes to provide care and complete 

17 the other tasks for which the nurse is responsible. 

18 (b) DEMONSTRATION GRANT PROGRAM AUTHOR19 IZED.— 

20 (1) IN GENERAL.—From amounts appropriated 

21 to carry out this section, the Secretary of Education 

22 shall award demonstration grants, on a competitive 

23 basis, to eligible entities to pay the Federal share of 

24 the costs of increasing the number of school nurses 

25 in the public elementary schools and secondary 


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1 schools served by the eligible entity, which may in2 clude hiring a school nurse to serve schools in mul3 tiple school districts. 

4 (2) SEAS.—In the case of an eligible entity de5 scribed in subsection (a)(3)(C) that receives a grant 

6 under paragraph (1), such entity shall use amounts 

7 received under the grant to award subgrants to the 

8 local educational agencies that are members of the 

9 entity, and reserve not more than 10 percent of such 

10 grant funds to support statewide activities to meet 

11 a variety of health needs, which may include hiring 

12 a nurse to provide training and technical assistance 

13 to schools statewide that meet the criteria estab14 lished in subsection (d)(2)(A). 

15 (c) APPLICATIONS.— 

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

17 grant under this section shall submit to the Sec18 retary an application at such time, in such manner, 

19 and containing such information as the Secretary 

20 may require. 

21 (2) CONTENTS.—Each application submitted 

22 under paragraph (1) shall include information with 

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

24 number of school nurses, student health acuity lev25 els, and workload of school nurses in each of the 


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1 public elementary schools and secondary schools 

2 served by the eligible entity. 

3 (d) PRIORITY.—In awarding grants under this sec4 tion, the Secretary shall give priority to each application 

5 submitted by an eligible entity that— 

6 (1) is a high-need local educational agency, a 

7 consortium composed of high-need local educational 

8 agencies, or a State educational agency in consor9 tium with high-need local educational agencies; and 

10 (2) demonstrates— 

11 (A) the greatest need for new or additional 

12 nursing services among students in the public 

13 elementary schools and secondary schools 

14 served by the agency or consortium; or 

15 (B) that the eligible entity does not have 

16 a school nurse in any of the public elementary 

17 schools and secondary schools served by the 

18 local educational agency or the consortium19 member local educational agencies. 

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

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

22 grant under this section— 

23 (A) shall not exceed 75 percent for each 

24 year of the grant; and 


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1 (B) in the case of a multiyear grant, shall 

2 decrease for each succeeding year of the grant, 

3 in order to ensure the continuity of the in4 creased hiring level of school nurses using State 

5 or local sources of funding following the conclu6 sion of the grant. 

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

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

9 or in kind, and may be provided from State re10 sources, local resources, contributions from private 

11 organizations, or a combination thereof. 

12 (3) WAIVER.—The Secretary may waive or re13 duce the non-Federal share of an eligible entity re14 ceiving a grant under this section if the eligible enti15 ty demonstrates an economic hardship. 

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

17 on which a grant is first made to a local educational agen18 cy under this section, the Secretary shall submit to Con19 gress a report on the results of the demonstration grant 

20 program carried out under this section, including an eval21 uation of— 

22 (1) the effectiveness of the program in increas23 ing the number of school nurses; and 


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1 (2) the impact of any resulting enhanced health 

2 of students on learning, such as academic achieve3 ment, attendance, and classroom time. 

4 (g) AUTHORIZATION OF APPROPRIATIONS.—There 

5 are authorized to be appropriated to carry out this section 

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

7 2020 through 2024. 

Æ 


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