Health Equity Strategic Plan | Department of Education

Problem statement

More than 40% of school-aged children and adolescents in the U.S. have at least one chronic health condition that may require the management of complex health and emergency response needs during school. Children with health conditions are more likely to be absent from school than those without, and some chronic conditions may be associated with lower academic achievement. Students who are chronically absent from school miss opportunities for social emotional development and access to basic needs, including a safe environment. Chronic school absenteeism also puts students at risk for poor academic achievement and school dropout.

School nursing interventions can enhance student health, well-being, and educational achievement. Data from the 2023-24 school year describe some of the challenges schools face providing nursing interventions to children. During the 2023-24 school year, Colorado’s Pre-Kindergarten - 12th grade enrollment was 881,464, and Colorado districts employed a total of 803.6 full-time-equivalent (FTE) school nurse positions. Most schools do not have a full- time school nurse, and 222 out of 1,919 schools reported having no access to a CDE Licensed school nurse during the day. Nurses are in high demand and short supply in Colorado, and schools face challenges hiring qualified individuals. Colorado’s most recent school personnel turnover data for positions categorized as “other support”, including school nurses, showed a 21.65% turnover rate. Additionally, schools typically lack adequate funding to hire a full- time school nurse and have difficulty competing with health organizations that can offer higher pay.

Retaining school nurses is also a challenge reported by many school leaders. School nurses often describe how the heavy workload, feeling unprepared, and lack of confidence to practice safely make it difficult to remain in the role. During the 2023-24 school year, the average full-time school nurse-to-student ratio was 1 RN FTE to 1,100 students, and school nurses working in rural and frontier communities report having school assignments over 100 miles apart. Additionally, the vast range of competencies required for the role are not covered in nursing education programs, including the independent management of students with high medical needs in the school setting. The lack of access to a well-planned orientation to school nursing can further increase school nurses’ lack of confidence and decrease job satisfaction.