Pertussis Resurgence: School Nurses as a Safety Net for Children

The Frontline Health Care Workers in Schools: Health Equity, the Distribution of School Nurses, and Student Access

The extent to which observed disparities in access to primary pediatric care are mirrored in student access to school nursing services is unknown. Using school employment records, we linked 1,346 nurses to school districts serving 1,141,495 students in Washington state. The percentage of students who are Black is negatively associated with the student-to-nurse ratio, while the percentage of students eligible for free-or-reduced-price lunch is positively associated, and relative to urban districts, rural districts have higher student-to-nurse ratios. Disparities in access to school nursing services mirror access gaps for pediatric care along socioeconomic status and geography. The increased number of nurses working in districts with more racial/ethnic minority students may play a protective role and ameliorate access gaps observed in pediatric primary care. States can likely use existing employment and licensing data to understand where school nurses work and therefore guide resource allocation decisions.

School Nursing Workforce Differences Between Urban and Non-Urban Areas: Implications for School Health Services and Equity

The professional experiences of school nurses who work outside of urban areas are not often described. We used data from a 2019 statewide survey of school nurses to describe differences between the urban and non-urban (urban cluster and rural) school nurse workforce in New Mexico. Non-urban school nurses were twice as likely as urban nurses to provide clinical services to multiple school campuses (P < .001) and more likely to serve both elementary and secondary school settings (P = .002). They were less likely than urban school nurses to be bachelor's prepared, or to have received recent continuing education on diabetes (P < .001), reproductive health (P = 0.02), LGBQ+ and transgender student health (P < .001, for each), and suicide risk assessment and screening (P = .012). Our findings underscore concerns about geographic differences in the school nursing workforce in terms of educational preparation and student access that could potentially limit the school nurse role in advancing child health equity.