I 

117TH CONGRESS 

1ST SESSION H. R. 3166 

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 HOUSE OF REPRESENTATIVES 

MAY 12, 2021 

Ms. TITUS introduced the following bill; which was referred to the Committee 

on Education and Labor, 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 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 (12) Throughout the COVID–19 pandemic, 

25 school nurses have played an important role helping 


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1 students and coordinating activities such as contact 

2 tracing and symptom screening. 

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

4 (a) DEFINITIONS.—In this section: 

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

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

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

8 meanings given to the terms in section 8101 of the 

9 Elementary and Secondary Education Act of 1965 

10 (20 U.S.C. 7801). 

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

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

13 sickness, such as a chronic condition, which influ14 ences the need for nursing care. 

15 (3) ELIGIBLE ENTITY.—The term ‘‘eligible enti16 ty’’ means— 

17 (A) a local educational agency in which not 

18 less than 20 percent of the children are eligible 

19 to participate in the school lunch program es20 tablished under the Richard B. Russell National 

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

22 (B) a consortium of local educational agen23 cies described in subparagraph (A); or 


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1 (C) a State educational agency in consor2 tium with local educational agencies described 

3 in subparagraph (A). 

4 (4) HIGH-NEED LOCAL EDUCATIONAL AGEN5 CY.—The term ‘‘high-need local educational agency’’ 

6 means a local educational agency described in para7 graph (3)(A)— 

8 (A) that serves not fewer than 15,000 chil9 dren who are eligible to participate in the pro10 gram described in such paragraph; or 

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

12 the children served by the agency are eligible to 

13 participate in the program described in such 

14 paragraph. 

15 (5) NURSE.—The term ‘‘nurse’’ means a reg16 istered nurse, as defined under State law. 

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

18 the Secretary of Education. 

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

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

21 time the nurse takes to provide care and complete 

22 the other tasks for which the nurse is responsible. 

23 (b) DEMONSTRATION GRANT PROGRAM AUTHOR24 IZED.— 


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1 (1) IN GENERAL.—From amounts appropriated 

2 to carry out this section, the Secretary of Education 

3 shall award demonstration grants, on a competitive 

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

5 the costs of increasing the number of school nurses 

6 in the public elementary schools and secondary 

7 schools served by the eligible entity, which may in8 clude hiring a school nurse to serve schools in mul9 tiple school districts. 

10 (2) SEAS.—In the case of an eligible entity de11 scribed in subsection (a)(3)(C) that receives a grant 

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

13 received under the grant to award subgrants to the 

14 local educational agencies that are members of the 

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

16 grant funds to support statewide activities to meet 

17 a variety of health needs, which may include hiring 

18 a nurse to provide training and technical assistance 

19 to schools statewide that meet the criteria estab20 lished in subsection (d)(2)(A). 

21 (c) APPLICATIONS.— 

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

23 grant under this section shall submit to the Sec24 retary an application at such time, in such manner, 


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1 and containing such information as the Secretary 

2 may require. 

3 (2) CONTENTS.—Each application submitted 

4 under paragraph (1) shall include information with 

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

6 number of school nurses, student health acuity lev7 els, and workload of school nurses in each of the 

8 public elementary schools and secondary schools 

9 served by the eligible entity. 

10 (d) PRIORITY.—In awarding grants under this sec11 tion, the Secretary shall give priority to each application 

12 submitted by an eligible entity that— 

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

14 consortium composed of high-need local education 

15 agencies, or a State educational agency in consor16 tium with high-need local education agencies; and 

17 (2) demonstrates— 

18 (A) the greatest need for new or additional 

19 nursing services among students in the public 

20 elementary schools and secondary schools 

21 served by the agency or consortium; or 

22 (B) that the eligible entity does not have 

23 a school nurse in any of the public elementary 

24 schools and secondary schools served by the 


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1 local educational agency or the consortium2 member local educational agencies. 

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

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

5 grant under this section— 

6 (A) shall not exceed 75 percent for each 

7 year of the grant; and 

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

9 decrease for each succeeding year of the grant, 

10 in order to ensure the continuity of the in11 creased hiring level of school nurses using State 

12 or local sources of funding following the conclu13 sion of the grant. 

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

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

16 or in-kind, and may be provided from State re17 sources, local resources, contributions from private 

18 organizations, or a combination thereof. 

19 (3) WAIVER.—The Secretary may waive or re20 duce the non-Federal share of an eligible entity re21 ceiving a grant under this section if the eligible enti22 ty demonstrates an economic hardship. 

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

24 on which a grant is first made to a local educational agen25 cy under this section, the Secretary shall submit to ConVerDate Sep 11 2014 03:21 Jun 12, 2021 Jkt 019200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H3166.IH H3166

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1 gress a report on the results of the demonstration grant 

2 program carried out under this section, including an eval3 uation of— 

4 (1) the effectiveness of the program in increas5 ing the number of school nurses; and 

6 (2) the impact of any resulting enhanced health 

7 of students on learning, such as academic achieve8 ment, attendance, and classroom time. 

9 (g) AUTHORIZATION OF APPROPRIATIONS.—There 

10 are authorized to be appropriated to carry out this section 

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

12 2022 through 2026. 

Æ 


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