NURSE Act
Bill: H.R.3166 | Sponsor: Rep. Titus, Dina (D-NV)
Policy area: Education

Summary:
Nurses for Under-Resourced Schools Everywhere Act or the NURSE Act
This bill establishes a demonstration grant program through which the Department of Education must award matching funds to increase the number of school nurses in public elementary and secondary schools served by a local educational agency in which at least 20% of students are eligible to participate in the school lunch program.

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 Representatives 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''.

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 management and health promotion as 
        well as facilitating access 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 Nation's children. In 
        addition, school nurses perform early intervention services 
        such as periodic assessments 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 front-line workers that 
        address an array of health needs and their presence in a school 
        can help to improve 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 students is one of the most 
        common health-related activities performed in school. As more 
        chronically ill and medically unstable children enter the 
        school system 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 Pediatrics, 
        students today face increased social and emotional issues, 
        which enhance the need for preventive 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 mental 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 Education, during the 
        2013-2014 school year, 1,360,747 children enrolled in public 
        schools experienced homelessness. 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 account for 
        millions of school days lost each year. Data illustrate that 
        when students have access to a registered nurse in school, 
        immunization rates increase.
            (12) Throughout the COVID-19 pandemic, school nurses have 
        played an important role helping 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 influences the need for nursing care.
            (3) Eligible entity.--The term ``eligible entity'' 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 established 
                under the Richard B. Russell National School Lunch Act 
                (42 U.S.C. 1751 et seq.);
                    (B) a consortium of local educational agencies 
                described in subparagraph (A); or
                    (C) a State educational agency in consortium with 
                local educational agencies described in subparagraph 
                (A).
            (4) High-need local educational agency.--The term ``high-
        need local educational agency'' means a local educational 
        agency described in paragraph (3)(A)--
                    (A) that serves not fewer than 15,000 children who 
                are eligible to participate in the program 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 registered 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 Authorized.--
            (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 
        include hiring a school nurse to serve schools in multiple 
        school districts.
            (2) SEAs.--In the case of an eligible entity described 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 established in subsection (d)(2)(A).
    (c) Applications.--
            (1) In general.--An eligible entity desiring a grant under 
        this section shall submit to the Secretary an application at 
        such time, in such manner, 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 levels, 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 section, 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 consortium 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 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 increased hiring 
                level of school nurses using State or local sources of 
                funding following the conclusion 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 resources, local resources, contributions 
        from private organizations, or a combination thereof.
            (3) Waiver.--The Secretary may waive or reduce the non-
        Federal share of an eligible entity receiving a grant under 
        this section if the eligible entity 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 agency under this section, the 
Secretary shall submit to Congress a report on the results of the 
demonstration grant program carried out under this section, including 
an evaluation of--
            (1) the effectiveness of the program in increasing the 
        number of school nurses; and
            (2) the impact of any resulting enhanced health of students 
        on learning, such as academic achievement, 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.
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