Title: An act relating to school nurses.

Brief Description: Increasing the number of school nurses.

Sponsors: Representatives Seaquist, Priest, Sullivan, Haigh, Green, Quall, Haler, Jarrett, Santos, Kenney, Appleton, Moeller, Morrell, Barlow, Roberts, Liias, Simpson, Goodman, Lantz, McIntire, VanDeWege, Conway and Nelson; by request of Superintendent of Public Instruction.

Brief History:

Education: 1/31/08, 2/5/08 [DP].

HOUSE COMMITTEE ON EDUCATION

Majority Report: Do pass. Signed by 8 members: Representatives Quall, Chair; Barlow, Vice Chair; Priest, Ranking Minority Member; Haigh, Liias, Roach, Santos and Sullivan.

Minority Report: Do not pass. Signed by 1 member: Representative Anderson, Assistant Ranking Minority Member.

Staff: Cece Clynch (786-7195).

Background:

Staffing Levels. The U.S. Department of Health and Human Services includes, in "Healthy People 2010," a goal of a school nurse to student ratio of 1:750. The January 11, 2008, report on funding of school health services, "How the K through 12 Public Schools Budget Funds School Health Services," prepared by legislative fiscal staff, finds the nurse to student ratio in Washington public schools is 1:2,269. This figure does not include contributions through the School Nurse Corps (SNC) or nurses that have been hired by school districts as consultants.

School Nurse Corps Program. The SNC was designed in response to findings that many small school districts did not provide nursing services and that even where some nursing services were provided, the nurse to student ratio was quite high. The SNC places a school nurse supervisor in each Educational Service District (ESD) and supplies a pool of nurses that districts may share. Each ESD SNC program is designed and implemented based on the identified needs of the communities and schools within that ESD. Since its inception, the SNC has been administered through the Office of the Superintendent of Public Instruction (OSPI).

Basic Education Funding. By statute, the formula for distributing Basic Education funds to school districts is based on a staffing ratio of 49 Certificated Instructional Staff (CIS) per 1,000 average annual full-time equivalent (FTE) students in grades K through three and 46 CIS per 1,000 FTE students in grades four through 12. This is equal to one CIS for every 20.4 students in grades K through three, and one CIS for every 21.7 students in grades four through 12.

The term CIS includes teachers, counselors, librarians, nurses, school psychologists, and other individuals who must be certified by the state to provide instruction and instructional support services in public schools. The formulas do not distinguish between the various types of CIS, and there is no statement of legislative intent or direction to school districts about prioritizing among the various staff.

The formula in the Operating Budget for the General Apportionment Program provides an enhanced staffing ratio for grades K through four of 53.2 CIS per 1,000 FTE students, or one CIS for every 18.8 students. The enhancement is not considered part of Basic Education and school districts must document actual staffing ratios at least equal to the allocation in order to receive those funds.

Summary of Bill:

The following findings are made:

• the statewide average of school nurses to students is 1:2,650;
• the need for school nurses is increasing with the increasing incidence of various medical problems, including peanut allergies, asthma, and diabetes type two;
• each school district has its own unique challenges to providing the level of support needed to meet the health needs of students at school;
• unless students are healthy, they cannot learn; and
• studies show that an adequate nurse-to-student ratio is 1:750.

The Basic Education formula must reflect by the 2013-14 school year, a ratio of one certificated nurse for every 750 FTE students. This new requirement is to be phased in over five years, commencing with the 2008-09 school year, in accordance with distribution provisions specified in the Omnibus State Appropriations Act. Public school districts are required to provide for professional registered nurse services to manage the student and school health services in accord with the new school nurse to student ratio found in the revisions to the Basic Education formula.

A new section is added codifying the SNC and its purposes. Subject to funding, the OSPI is to establish the SNC with the purpose of providing a regional school health service system directed toward improving the health, wellness, and safety of students. The SNC shall assign a school nurse to each ESD.

The SNC shall provide health services to students in the neediest school districts. The OSPI shall establish a process for school districts to receive additional health services, however, the resources provided through the SNC shall not supplant funding already being used by the school districts for health services. To the extent funding is provided, the SNC shall assist in conducting annual school health service district assessments, provide technical assistance, offer school nurse professional development, and assist in orienting and mentoring new school nurses.

Appropriation: None.

Fiscal Note: Requested on January 17, 2008.

Effective Date: The bill takes effect 90 days after adjournment of session in which bill is passed.

Staff Summary of Public Testimony:

(In support) The OSPI has requested this bill in order to gradually improve the ratio of nurses to students until the ratio is 1:750. The ratio at this time is nowhere near 1:750. Currently, students have so many needs and there are so few nurses that nurses are unable to meet some of the needs which the law mandates must be met. The need for school nurses is very great and cannot wait until the taskforces considering basic education funding and school healthcare have completed their work. While there is a nursing shortage in the state, there are nurses that want to work for the schools if the nurse to student ratio is lowered. The School Nurse Corps (SNC) has, over the last nine years, provided technical services to all 295 school districts. The SNC also allows small, rural districts to pool resources and has provided nurse mentors to rural school nurses. In one district with over 20,000 students, there are only enough nurses to provide a nurse one day per week for each school. In another, the ratio is 1:1,800. Students have many complex medical issues, including diabetes, asthma, and allergies which require nursing care at school. School staff are reluctant to take on some of these tasks. At the same time, nurses have left school employment because of worries that the high ratios create impossible situations which jeopardize their licenses.

(Opposed) None.

Persons Testifying: Representative Seaquist, prime sponsor; Lucinda Young, Nancy Sutherland, and Cheryl Sampson, Washington Education Association; Gayle Thronson, Office of the Superintendent of Public Instruction; Lynn Nelson, School Nurse Corps; Donna Christensen, American Diabetes Association; and Sue Overton.

Persons Signed In To Testify But Not Testifying: None.