The School Nurse Shortage and Food Allergies

Teachers are trained to act as school nurses in some schools. by Woodleywonderworks/Flickr

My children went to a small private religious school at one point, and this little school didn’t have a school nurse. Thankfully, by the time is was my son's turn to go to school, a school nurse had been hired, and rightly so. My son wasn’t the only child with a food allergy. There were two children with insulin-dependent diabetes, and one child with celiac disease.

There are nearly 6 million children with food allergies, many of which attend school.

It’s estimated that sixteen percent of students in the U.S. have a medical condition needing a skilled professional. While it may seem archaic in today’s modern world for a school not to have a school nurse, the truth is that some schools don’t.

According to a 2008 report from the National Association of School Nurses (NASN), only 45% of public schools have a full-time registered nurse. Thirty percent of schools have a part-time nurse who works in one or more schools, meaning she (or he) spreads herself among more than one school, and 25% have no nurse at all.

The ideal ratio of student to nurse is 750 students without a chronic medical condition for every nurse. For those children with a chronic medical condition, a desirable ratio would be one nurse for every child. Some schools are nowhere near this ratio, with some schools reporting up to 3,000 students per nurse, and that doesn’t bode well for children who have chronic medical conditions like food allergies.

In 2011, 40% of states saw an improvement in the nurse to student ratio, but there’s more work to be done.

Budget cuts in school districts leave many schools choosing teachers over a school nurse. Those nurses that work in schools are feeling the demands and responsibilities of the job, such as managing multiple children with food allergies, diabetes, ADHD and other conditions that require medication administration and careful attention, all alone.

As a result, some nurses are seeking other employment where they have more support. Competition for nursing jobs also draws nurses away from the school environment. All of these barriers get in the way of improving the availability of school nurses to schools.

A health and liability risk

Due to the nursing shortage, school nurses are training teachers and other support staff to administer medications, and there is a move in some states to include the administration of epinephrine. This adds extra responsibility, and liability, to staff, especially teachers.

Because of the serious levels of chronic medical conditions, including life-threatening food allergies, school personnel face a real liability in the event a child experiences an anaphylactic reaction. Some school nurses are leaving their jobs due to the heightened risk of caring for numerous children with serious medical conditions and the lack of support they receive.

The risk for children with life-threatening food allergies, where swift treatment is of utmost concern, is increased.

Families may face the real risk of delayed medical treatment for their child.

Food allergic families not keeping pace

In a 2008 survey conducted by NASN, 72% of school nurses had students with a severe food allergy requiring, or previously utilizing, epinephrine for treatment, yet these students did not have injectable epinephrine available to them in school. Their parents had failed to send in medications.

Further, a small study out of Nationwide Children’s Hospital in Columbus, Ohio, showed that 40% of parents did not have epinephrine with them at their child’s medical appointment with the allergist, and 50% of those who did have epinephrine with them, had expired product.

It’s clear that families with food allergies need to get on board with the food allergy management basics also, such as carrying up-to-date medication, and providing schools with medication and food allergy action plans.

What can you do if there isn’t a school nurse?

Educate key players at school. Talk with teachers, food service staff, and leaders in the school about the dangers and liability to the school without a nurse. Help build awareness of what a nurse can do for children with chronic medical conditions, such as treat an allergic reaction, administer medication, help individual kids stay healthy, and keeping students in school and learning.

Advocate for a nurse. Get your pediatrician to vouch for a nurse, writing a letter of support to the school administration. Meet with school leaders and gather like-minded parents to advocate together. Use resources such as this article and resources from NASN to provide statistics and research, include real stories of children in your school or community who need or needed a nurse. Reach out to legislators in your community, district or state. Grassroots advocacy is what makes change happen.

Give extra attention and support to your child’s teacher. If your school doesn’t have a nurse, or has limited school nurse availability, support your teacher so your child stays safe. In this situation, the safety of your child relies on the comfort level and knowledge of the teacher.



The impact of the school nurse shortage. 2008.

Lack of school nurses impacts student's health, academics. 2012.

School nurse shortage may imperil some children. 2013. The Robert Wood Johnson Foundation. 

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