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 re-
ferred to the Committee on Education and the Workforce, and in addition 
to the Committee on Energy and Commerce, for a period to be subse-
quently 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-to- 
school nurse ratio in public elementary schools and sec-
ondary schools. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Student-to-School 
Nurse Ratio Improvement Act of 2013’’. 
SEC. 2. FINDINGS. 
The Congress finds the following: 
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(1) The American Academy of Pediatrics em-
phasizes the crucial role of school nurses in the 
seamless provision of comprehensive health services 
to children and youth, as well as in the development 
of a coordinated school health program. 
(2) The school nurse functions as a leader and 
the coordinator of the school health services team, 
facilitating access to a medical home for each child 
and supporting academic achievement. 
(3) School nurses promote wellness and disease 
prevention to improve health outcomes for our Na-
tion’s children. In addition, school nurses perform 
early intervention services such as periodic assess-
ments for vision, hearing, and dental problems, in an 
effort to remove barriers to learning. 
(4) Recent national data indicates 45 percent of 
public schools have a school nurse all day, every day, 
while another 30 percent of schools have a school 
nurse who works part time in one or more schools. 
(5) The American Nurses Association has re-
ported that when there is no registered nurse on the 
school premises, the responsibility to administer the 
necessary medications and treatments, and appro-
priate monitoring of the children falls on the shoul-
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ders of administrators, educators, and staff who are 
ill-prepared to perform these tasks. 
(6) Statistics from the National Center for 
Educational 
Statistics 
indicate 
that 
of 
the 
52,000,000 students who currently spend their day 
in schools, 15 to 18 percent of children and adoles-
cents have a chronic health condition. 
(7) A recent study indicated that from 2002 to 
2008, the percentage of children in special education 
with health impairments, due to chronic or acute 
health problems, increased 60 percent. School nurses 
use their specialized knowledge, assessment skills, 
and judgment to manage children’s increasingly 
complex medical conditions and chronic health ill-
nesses. 
(8) Among adolescents aged 12 to 19 years old, 
the prevalence of pre-diabetes and diabetes increased 
from 9 percent to 23 percent between 1999 and 
2008. More than 30 percent of children aged 2 to 
19 years old are obese or overweight (>85th per-
centile). In 2008, more than 10 million children in 
the United States had asthma. The prevalence of 
food allergies among children under the age of 18 
increased 19 percent from 1997 to 2007. 
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(9) According to the American Academy of Pe-
diatrics, students today face increased social and 
emotional issues, which enhance the need for preven-
tive services and interventions for acute and chronic 
health issues. School nurses are actively engaged 
members of school-based mental health teams and 
spend nearly 32 percent of their time providing men-
tal health services, including universal and targeted 
interventions, screenings to identify early warning 
signs and referrals to medical providers, and crisis 
planning. 
(10) In 2011, the Bureau of the Census re-
ported 9.7 percent of children under the age of 19, 
which equals 7.6 million children under the age of 
19, were without health insurance. Data shows that 
uninsured children achieve lower educational out-
comes than those with health coverage. Children who 
cannot afford to see a medical provider miss more 
days of school, experience increased severity of ill-
ness, and suffer from disparities in health. 
(11) More than 1.6 million children experience 
homelessness each year in the United States. Home-
less children develop increased rates of acute and 
chronic health conditions, and the stress of their liv-
ing situation can negatively affect their development 
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and ability to learn. As a result, schools have become 
the primary access to health care for many children 
and adolescents. School nurses serve on the 
frontlines as a safety net for the Nation’s most vul-
nerable children. 
(12) Communicable and infectious diseases ac-
count for millions of school days lost each year. 
Data illustrate that when students have access to a 
registered nurse in school, immunization rates in-
crease. 
(13) A 2011 study showed that a school nurse 
in the building saves principals, teachers, and cler-
ical staff a considerable amount of time that they 
would have spent addressing health concerns of stu-
dents, including saving principals almost an hour a 
day; saving teachers almost 20 minutes a day; and 
saving clerical staff more than 45 minutes a day. 
This would amount to a savings of about 13 hours 
per day in the aggregate for such school personnel. 
(14) Using a formula-based approach, taking 
into consideration the overall health acuity of the 
student body and the workload of school nurses, for 
determining a balanced student-to-school nurse ratio 
offers a reasonable means for achieving better stu-
dent outcomes. 
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SEC. 3. REDUCING STUDENT-TO-SCHOOL NURSE RATIOS. 
(a) DEMONSTRATION GRANTS.— 
(1) IN GENERAL.—The Secretary of Education, 
in consultation with the Secretary of Health and 
Human Services and the Director of the Centers for 
Disease Control and Prevention, may make dem-
onstration grants to eligible local educational agen-
cies for the purpose of reducing the student-to- 
school nurse ratio in public elementary schools and 
secondary schools. 
(2) APPLICATION.—To receive a grant under 
this section, an eligible local educational agency shall 
submit to the Secretary of Education an application 
at such time, in such manner, and containing such 
information as the Secretary may require, which 
shall include information with respect to the current 
ratios of students-to-school nurses, student health 
acuity levels, and workloads of school nurses in each 
of the public elementary schools and secondary 
schools served by the agency. 
(3) PRIORITY.—In awarding grants under this 
section, the Secretary of Education shall give pri-
ority to applications submitted by high-need local 
educational agencies that demonstrate the greatest 
need for new or additional nursing services among 
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students in the public elementary secondary and sec-
ondary schools served by the agency. 
(4) MATCHING FUNDS.—The Secretary of Edu-
cation may require recipients of grants under this 
section to provide matching funds from non-Federal 
sources, and shall permit the recipients to match 
funds in whole or in part with in-kind contributions. 
(b) REPORT.—Not later than 24 months after the 
date on which a grant is first made to a local educational 
agency under this section, the Secretary of Education shall 
submit to the Congress a report on the results of the dem-
onstration grant program carried out under this section, 
including an evaluation— 
(1) of the effectiveness of the program in reduc-
ing the student-to-school nurse ratios described in 
subsection (a)(1); and 
(2) of the impact of any resulting enhanced 
health of students on learning, such as academic 
achievement, attendance, and classroom time. 
(c) DEFINITIONS.—For purposes of this section: 
(1) ESEA TERMS.—The terms ‘‘elementary 
school’’, ‘‘local educational agency’’, ‘‘poverty line’’, 
and ‘‘secondary school’’ have the meanings given to 
those terms in section 9101 of the Elementary and 
Secondary Education Act of 1965 (20 U.S.C. 7801). 
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(2) ACUITY.—The term ‘‘acuity’’, when used 
with respect to a level, means the level of a patient’s 
sickness, such as a chronic condition, which influ-
ences the need for nursing care. 
(3) WORKLOAD.—The term ‘‘workload’’, when 
used with respect to a nurse, means the amount of 
time the nurse takes to provide care and complete 
the other tasks for which the nurse may be respon-
sible. 
(4) ELIGIBLE LOCAL EDUCATIONAL AGENCY.— 
The term ‘‘eligible local educational agency’’ means 
a local educational agency in which the student-to- 
school nurse ratio in each public elementary and sec-
ondary school served by the agency is 750 or more 
students to 1 school nurse. 
(5) HIGH-NEED
LOCAL
EDUCATIONAL
AGEN-
CY.—The term ‘‘high-need local educational agency’’ 
means a local educational agency— 
(A) that serves not fewer than 10,000 chil-
dren from families with incomes below the pov-
erty line; or 
(B) for which not less than 20 percent of 
the children served by the agency are from fam-
ilies with incomes below the poverty line. 
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(6) NURSE.—The term ‘‘nurse’’ means a li-
censed nurse, as defined under State law. 
(d) AUTHORIZATION
OF APPROPRIATIONS.—There 
are authorized to be appropriated such sums as may be 
necessary to carry out this section for each of the fiscal 
years 2014 through 2018. 
Æ 
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