Could COVID-19 make a school nurse requirement in Virginia a reality?

Legislation to mandate more nurses in Virginia’s K-12 schools has been filed — and defeated — regularly in the state’s General Assembly over the last five years.

But amid a global pandemic and continuing debate over reopening schools this fall, legislators on both sides of the aisle are hoping to rally support for the measure. Sen. Jen Kiggans, R-Virginia Beach, and Del. Dawn Adams, D-Richmond —both licensed nurse practitioners — will both submit bills during a special session in August that would require local school divisions to hire at least one registered nurse on every campus.

Currently, school nurses aren’t built into Virginia’s Standards of Quality, which outline the educational programs and services that each district is required to provide. Gina Bellamy, president of the Virginia Association of School Nurses, said that makes them an optional position for K-12 schools. In Virginia, the term “school nurse” also doesn’t have a standard definition, which means that districts often hire health workers with various levels of training.

“A school can hire a nursing assistant or a [licensed practical nurse] and call that person their school nurse,” Bellamy added. “‘School nurse’ is not defined by legislation, which is one of the things that VASN is trying to establish.”

Both bills would require that schools hire registered nurses, who can assess students, administer medication and coordinate plans for care. Kiggans has already prefiled legislation that would require local school boards to hire at least one full-time equivalent registered nursing position for every elementary, middle and high school.

Adams’ bill would require a registered nurse in every school building and also includes an enactment clause specifying that the law only applied to schools open for onsite learning — a nod to the growing majority of Virginia schools opting for remote learning for at least the first two months of the semester. 

It also includes a budget amendment that would require the state to fund 60 percent of all new nursing positions.

“I think that’s important because we have localities that are still trying to figure out their budgets,” Adams said. “This is just sort of an emergency measure — trying to catch schools up to speed quickly where there haven’t been registered nurses before.”

Data from the Virginia Department of Education shows that as of 2019, the state had the equivalent of 1,590 full-time nursing positions serving a total of 1,860 local schools. The department’s numbers don’t necessarily equate directly to the number of staff members — spokesman Charles Pyle said there are instances where local school divisions combine multiple positions into one full-time equivalent, such as when employees only work for part of the week. But it shows that some districts, including Richmond and Chesterfield, have fewer licensed nursing positions than they do public schools.

Bellamy said the state’s current reporting makes it difficult to determine how many schools in Virginia have a registered nurse on campus. In Fairfax County, for example, public health nurses are responsible for training health aides, who then work onsite at the district’s schools. While health aides can provide basic levels of care under the supervision of a school nurse, Bellamy said the system’s registered nurses often juggle four to five schools at a time, often with more than 1,000 students.

Other districts also supplement licensed nurses — which can include less-trained certified nursing assistants or LPNs — with health aides. VASN’s latest data, from 2016, shows a ratio of one registered nurse to 923 students in Virginia.

Both Kiggans and Adams said that’s a problem, especially when it comes to reopening schools during the COVID-19 pandemic (one local health director in Virginia said spreading new infections is “not a matter of ‘if,’ it’s when”). When schools do reopen, virtually all plans call for intensive disinfection and screening for students and staff. Kiggans said students, parents and administrators will undoubtedly have questions about how to follow safety protocols and what to do if someone comes down with symptoms onsite.

“As a nurse I can speak from experience about having that one person whose whole job is ensuring classrooms are following the guidelines set by the state and the [Centers for Disease Control and Prevention] and the school,” she added. “Are they distancing, are they wearing a mask, are they doing temperature checks? Everything that needs to be done to make sure that students and staff are getting the proper care. That’s their sole purpose — to monitor for COVID and prevent the spread of infection.”

Historically, though, funding has been one of the biggest barriers to similar bills. A House subcommittee killed almost identical legislation in 2017, citing the high costs for local school divisions. A fiscal analysis that same year noted it would especially impact districts with low enrollment, forcing them to fund new positions regardless of the number of students on campus.

Earlier this year, the General Assembly also rejected new Standards of Quality recommended by Virginia’s Board of Education, which would have required school districts to hire at least four “specialized student support positions” — including school nurses — for every 1,000 students. The estimated cost of the measure was $100 million, according to an analysis by VDOE.

Kiggans acknowledged it would be an uphill battle, especially with the state facing a deficit of roughly $236.5 million in general fund revenue (though the shortfall was less than what officials originally anticipated). But both she and Adams said they hoped funding school nurses would become a more urgent priority for legislators.

“Good public policy tries to appropriately allocate scarce resources,” Adams added. “It has always been an incredibly valuable thing to have a registered nurse in schools. But we should see that value and elevate that value now that we’re in a situation we have no frame of reference for — a pandemic that has wiped out our sense of safety.”