Skip Navigation LinksAAP-Policy-Statement-Recommends-Full-Time-Nurse-in-Every-School

aaa print

AAP Policy Statement Recommends Full Time Nurse in Every School

The role of the school nurse has evolved and become increasingly important since first introduced in the United States more than a century ago, yet school district policies regarding school nurses lack uniformity and should be updated, according to a policy statement issued by the American Academy of Pediatrics.

The policy statement, published in the June 2016 issue of Pediatrics (published online May 23), calls for a minimum of one full-time registered nurse in every school. The policy replaces a prior version published in 2008.

Previously, the AAP had supported ratios of 1 school nurse to 750 students in the healthy student population, and a 1:225 ratio for student populations who need daily professional nursing assistance. According to the updated policy statement, the use of a ratio for workload determination in school nursing is inadequate to fill the increasingly complex health needs of students.

“School nursing is one of the most effective ways to keep children healthy and in school and to prevent chronic absenteeism,” said Breena Welch Holmes, MD, FAAP, a lead author of the policy statement and chair of the AAP Council on School Health. “Pediatricians who work closely with school nurses will serve all of their patients better.”

The school nurse’s job comprises much more than just health services. School nurses provide surveillance, chronic disease management, emergency preparedness, behavioral assessment, ongoing health education and extensive case management, among other duties. The policy statement notes that school nurses today monitor more children with special needs, and help with medical management in areas such as attention-deficit/hyperactivity disorder, diabetes, life-threatening allergies, asthma and seizures.

School nurses participate in public health arenas such as immunization, obesity prevention and substance abuse assessment. The policy statement notes that collaboration among pediatricians, families and the school medical team is increasingly critical to optimal health care in both office and community settings. Yet, school nurse staffing patterns vary widely across the United States.

Besides advocating for a full-time nurse in every school, the American Academy of Pediatrics recommends that pediatricians ask their patients school-related questions, such as whether health problems contribute to chronic absenteeism. Pediatricians are encouraged to include school contact information within the student’s electronic health record and share relevant information with the school nurse.

“As student health needs became more complex, the school nursing role has expanded to include additional responsibilities,” said co-author Anne Sheetz, MPH, RN, NEA-BC. “By establishing working relationships with the pediatrician, school nurses can help manage chronic conditions and develop individualized health care plans for each student.”


The American Academy of Pediatrics is an organization of 64,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit

 AAP Media Contacts