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North Carolina Needs More School Nurses to Help Students Recover from Pandemic Learning Loss


Published January 19, 2024 · 2 Min Read

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North Carolina schools illustrate what happens when rising mental health conditions couple with school nurse shortages.
North Carolina Needs More School Nurses to Help Students Recover from Pandemic Learning Loss
Image Credit: SDI Productions / E+ / Getty Images
  • Post-pandemic mental health conditions among school-aged children are on the rise.
  • Chronic absenteeism in U.S. primary and secondary school students is associated with mental health conditions.
  • Better school nurse-to-student ratios can improve mental health outcomes for children and teens.

About 1 in 6 students in the U.S. are frequently absent from school each year — and that was before COVID-19 entered the equation. The COVID-19 pandemic has led to a rise in mental health conditions among many school-aged children.

Education officials in North Carolina have linked chronic student absenteeism to mental health. Discover the role that school nurses play in improving mental health for students.

Reports Reveal the Connection Between Student Mental Health and Absenteeism

The North Carolina Department of Public Instruction released a 2023 report suggesting that student absenteeism may be directly related to mental health. Chronic absenteeism, defined as missing 15 or more excused or unexcused days in a school year, often occurs when students have multiple health conditions, unrecognized or undertreated conditions, or limited access to care.

More than 20% of high school students, over 14% of middle school students, and nearly 14% of elementary school students are chronically absent from school. Chronic absenteeism has been associated with poor outcomes in the long run, including poverty, reduced health, and involvement in the criminal justice system.

Children with a history of maltreatment or exposure to major traumas (like domestic violence and natural disasters) are more likely to be absent. Further, children who willingly miss school are more likely to be diagnosed with conduct disorder, depression, substance misuse, and oppositional defiant disorder (pattern of anger, arguing, and defiance towards authority figures).

The pandemic may have contributed to the rise of mental health conditions among youth in recent years, as multiple studies have shown that children and teens report feeling more anxious, depressed, fatigued, and distressed than prior to the pandemic.

In North Carolina, the percentage of high school students who reported persistent feelings of sadness or hopelessness rose from 28% in 2011 to 43% in 2021, and those who seriously considered attempting suicide rose from 19% in 2019 to 22% in 2021.

The NC Department of Public Instruction asserts that an adequate number of school nurses, psychologists, and social workers can help improve mental health outcomes for students and contribute to better attendance.

The ideal school nurse-to-student ratio in the U.S. is one nurse for every 750 students. In 2022, the average ratio for North Carolina schools was one nurse per 833 students. In 2023, 74% of NC schools had formal plans in place to address staffing ratios, but only 34% fully addressed the issue.

What does this mean for student mental health outcomes?

How More School Nurses Can Help Improve Student Mental Health

Pediatricians and mental health professionals are encouraged to work with schools to prevent, identify, and treat mental health conditions that contribute to poor school attendance. School nurses not only provide direct care to students, they oversee all health services within the school and serve as liaisons between the school, medical professionals, and parents/guardians.

School nurses play a vital role in ensuring that everyone is on the same page. When schools effectively communicate with parents/guardians, students have higher attendance rates. School nurses help to foster relationships with parents/guardians and are often the first point of contact.

The American Academy of Pediatrics and the National Association of School Nurses support national nurse-to-student ratio recommendations, but acknowledge that ratios can vary depending on student need. Some ratios may need to be adjusted.

During the pandemic, some school nurses in North Carolina were responsible for up to 2,000 students at one time, and the state is still struggling.

The shortage of NC school nurses has had an impact on the state’s educational system as a whole. Many schools use non-licensed staff for mental health services, including health aides and even teachers. Some teachers have been asked to do mental health checks on students to make up for staffing shortages, which limits teaching time.

In support of better mental health outcomes for students, nurses might consider a career transition or relocation to fill in the gap.

As of December 2023, school nurse salary in North Carolina ranges from $53,200 to $79,950, and the cost of living is lower than the national average, ranking at 27 out of 51 for the most affordable states to live. The state requires that school nurses obtain a North Carolina RN license and hold a bachelor’s degree or higher.


Allison, Dr. Mandy A, et al. (2019). The link between school attendance and good health. American Academy of Pediatrics

Chronic absenteeism in the nation's schools. (2016). United States Department of Education

Cost of living data series. (2023). Missouri Economic Research and Information Center

Elharake, Jad A, et al. (2022). Mental health impact of COVID-19 among children and college students: A systematic review. National Library of Medicine

Essick, Dr. Ellen. (2023). 2023 healthy active children policy report and 2023 school mental health policy report. North Carolina Department of Public Instruction

Evans, Elaina. (2021). School nurses face 'challenging' year with staff shortage. ABC News 11

Hui, Keung T. (2024). NC schools lack enough counselors, nurses, social workers and psychologist, report says. The News & Observer

In-school nurse (RN) salary in North Carolina. (2023).

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