I 
117TH CONGRESS 
1ST SESSION H. R. 3166 
To make demonstration grants to eligible local educational agencies or con-
sortia 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 Speak-
er, in each case for consideration of such provisions as fall within the ju-
risdiction 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. 
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 ‘‘Nurses for Under- 
Resourced Schools Everywhere Act’’ or the ‘‘NURSE 
Act’’. 
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SEC. 2. FINDINGS. 
Congress finds the following: 
(1) The National Association of School Nurses 
identifies schools as primary locations to address 
student health issues, since a school nurse is the 
health care provider that many students see on the 
most regular basis. 
(2) The American Academy of Pediatrics has 
recognized the crucial role that school nurses play in 
children’s health and has called for having a full- 
time school nurse every day and in every school 
building. 
(3) The school nurse functions as the leader 
and coordinator of the school health services team, 
including by carrying out chronic disease manage-
ment and health promotion as well as facilitating ac-
cess to a medical home for each child and supporting 
academic achievement. 
(4) 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. 
(5) The American Federation of Teachers has 
called for a nurse in every school, as nurses are 
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front-line workers that address an array of health 
needs and their presence in a school can help to im-
prove student learning. 
(6) According to 2017 data from the National 
Association of School Nurses, only 39.3 percent of 
schools employ a full-time school nurse, while 35.5 
percent of schools employ a school nurse only part- 
time, and 25.2 percent do not have a school nurse 
at all. 
(7) The National Association of School Nurses 
has reported that medication administration to stu-
dents is one of the most common health-related ac-
tivities performed in school. As more chronically ill 
and medically unstable children enter the school sys-
tem each year, the medical factors that promote and 
support their academic success increase, including 
the need for medications that enhance overall health 
or stabilize chronic conditions. 
(8) National data indicate that between 15 and 
20 percent of children who spend their day in school 
have a chronic health condition. 
(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 
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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 provide referrals to medical providers, and 
crisis planning. 
(10) According to the Department of Edu-
cation, during the 2013–2014 school year, 1,360,747 
children enrolled in public schools experienced home-
lessness. Homeless children develop increased rates 
of acute and chronic health conditions, and the 
stress of their living situation can negatively affect 
their development 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 front lines as a safety net for 
the Nation’s most vulnerable children. 
(11) 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. 
(12) Throughout the COVID–19 pandemic, 
school nurses have played an important role helping 
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students and coordinating activities such as contact 
tracing and symptom screening. 
SEC. 3. INCREASING THE NUMBER OF SCHOOL NURSES. 
(a) DEFINITIONS.—In this section: 
(1) ESEA TERMS.—The terms ‘‘elementary 
school’’, ‘‘local educational agency’’, ‘‘secondary 
school’’, and ‘‘State educational agency’’ have the 
meanings given to the terms in section 8101 of the 
Elementary and Secondary Education Act of 1965 
(20 U.S.C. 7801). 
(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) ELIGIBLE ENTITY.—The term ‘‘eligible enti-
ty’’ means— 
(A) a local educational agency in which not 
less than 20 percent of the children are eligible 
to participate in the school lunch program es-
tablished under the Richard B. Russell National 
School Lunch Act (42 U.S.C. 1751 et seq.); 
(B) a consortium of local educational agen-
cies described in subparagraph (A); or 
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(C) a State educational agency in consor-
tium with local educational agencies described 
in subparagraph (A). 
(4) HIGH-NEED
LOCAL
EDUCATIONAL
AGEN-
CY.—The term ‘‘high-need local educational agency’’ 
means a local educational agency described in para-
graph (3)(A)— 
(A) that serves not fewer than 15,000 chil-
dren who are eligible to participate in the pro-
gram described in such paragraph; or 
(B) for which not less than 40 percent of 
the children served by the agency are eligible to 
participate in the program described in such 
paragraph. 
(5) NURSE.—The term ‘‘nurse’’ means a reg-
istered nurse, as defined under State law. 
(6) SECRETARY.—The term ‘‘Secretary’’ means 
the Secretary of Education. 
(7) 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 is responsible. 
(b) DEMONSTRATION GRANT PROGRAM AUTHOR-
IZED.— 
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(1) IN GENERAL.—From amounts appropriated 
to carry out this section, the Secretary of Education 
shall award demonstration grants, on a competitive 
basis, to eligible entities to pay the Federal share of 
the costs of increasing the number of school nurses 
in the public elementary schools and secondary 
schools served by the eligible entity, which may in-
clude hiring a school nurse to serve schools in mul-
tiple school districts. 
(2) SEAS.—In the case of an eligible entity de-
scribed in subsection (a)(3)(C) that receives a grant 
under paragraph (1), such entity shall use amounts 
received under the grant to award subgrants to the 
local educational agencies that are members of the 
entity, and reserve not more than 10 percent of such 
grant funds to support statewide activities to meet 
a variety of health needs, which may include hiring 
a nurse to provide training and technical assistance 
to schools statewide that meet the criteria estab-
lished in subsection (d)(2)(A). 
(c) APPLICATIONS.— 
(1) IN GENERAL.—An eligible entity desiring a 
grant under this section shall submit to the Sec-
retary an application at such time, in such manner, 
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and containing such information as the Secretary 
may require. 
(2) CONTENTS.—Each application submitted 
under paragraph (1) shall include information with 
respect to the current (as of the date of application) 
number of school nurses, student health acuity lev-
els, and workload of school nurses in each of the 
public elementary schools and secondary schools 
served by the eligible entity. 
(d) PRIORITY.—In awarding grants under this sec-
tion, the Secretary shall give priority to each application 
submitted by an eligible entity that— 
(1) is a high-need local educational agency, a 
consortium composed of high-need local education 
agencies, or a State educational agency in consor-
tium with high-need local education agencies; and 
(2) demonstrates— 
(A) the greatest need for new or additional 
nursing services among students in the public 
elementary schools and secondary schools 
served by the agency or consortium; or 
(B) that the eligible entity does not have 
a school nurse in any of the public elementary 
schools and secondary schools served by the 
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local educational agency or the consortium- 
member local educational agencies. 
(e) FEDERAL SHARE; NON-FEDERAL SHARE.— 
(1) FEDERAL SHARE.—The Federal share of a 
grant under this section— 
(A) shall not exceed 75 percent for each 
year of the grant; and 
(B) in the case of a multiyear grant, shall 
decrease for each succeeding year of the grant, 
in order to ensure the continuity of the in-
creased hiring level of school nurses using State 
or local sources of funding following the conclu-
sion of the grant. 
(2) NON-FEDERAL
SHARE.—The non-Federal 
share of a grant under this section may be in cash 
or in-kind, and may be provided from State re-
sources, local resources, contributions from private 
organizations, or a combination thereof. 
(3) WAIVER.—The Secretary may waive or re-
duce the non-Federal share of an eligible entity re-
ceiving a grant under this section if the eligible enti-
ty demonstrates an economic hardship. 
(f) REPORT.—Not later than 2 years after the date 
on which a grant is first made to a local educational agen-
cy under this section, the Secretary shall submit to Con-
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gress a report on the results of the demonstration grant 
program carried out under this section, including an eval-
uation of— 
(1) the effectiveness of the program in increas-
ing the number of school nurses; and 
(2) the impact of any resulting enhanced health 
of students on learning, such as academic achieve-
ment, attendance, and classroom time. 
(g) AUTHORIZATION
OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this section 
such sums as may be necessary for each of fiscal years 
2022 through 2026. 
Æ 
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