Why School Nurses Are Leaving the Career
- Inadequate salary, misconception of the school nurse's role, and burnout contribute to why school nurses leave the profession.
- A 2017 National Association of School Nurses survey reports that fewer than 40% of public schools have full-time school nurses.
- The nursing shortage is a national and global crisis. According to the American Hospital Association, federal data shows that 500,000 nurses will leave the profession this year. Most nurses are leaving through retirement, bringing the shortage to 1.1 million.
School nurses provide healthcare to students with chronic and acute health problems. They are a vital part of public, private, and charter schools, caring for hundreds of students and keeping teachers and faculty safe.
There has been a steady decline in the number of school nurses. A 2017 National Association of School Nurses (NASN) survey reports that fewer than 40% of public schools have full-time school nurses. There are many reasons for the decline; lack of funding and low salary are among them.
On average, a school nurse makes about $20,000 less than a registered nurse (RN) working in a hospital. According to an open letter from New York-based school nurses, this is the cause of low retention and why 50% of nurses leave school nursing in 3-6 months.
However, becoming a school nurse can be very rewarding.
"It provides a work/life balance not always found in the hospital setting," says Judith Jeanty, MSN, RN, a former school nurse.
But many nurses report the average salary of school nurses isn't comparable to what nurses make in a hospital. This is why Jeanty left school nursing after four years to pursue a nursing role outside of the school setting.
Other factors like nurse burnout and school nurses' inability to exercise their clinical judgment are deal breakers. Discover why nurses are leaving the profession and what can be done to combat the school nursing shortage.
The School Nursing Shortage
The nursing shortage is a national and global crisis. According to the American Hospital Association, federal data shows that 500,000 nurses will leave the profession this year. Most nurses are retiring, bringing the shortage to 1.1 million.
In 2018, the World Health Organization reported a global shortage of 5.9 million nurses.
Many novice and experienced nurses are leaving the profession altogether. One of the causes is the lack of support from administration after the COVID-19 pandemic. But many nurses say the pandemic only revealed pain points they were already experiencing. These pain points include:
- Poor staffing ratios for nurses
- Poor nurse-to-patient ratios
- Nurse bullying
- Inadequate salary
- Nurse burnout
Naturally, the nursing shortage also impacts school nurses.
In public schools, 35% share part-time nurses with multiple school districts and 25% don't have a nurse at all.
The American Academy of Pediatrics, Centers for Disease Control and Prevention (CDC), and the NASN recommend having at least one registered nurse in every school.
Nurse Staffing Models in Public Schools (SN FTE)
The CDC advises schools to have one full-time nurse for every 750 students. If 1% of students have a chronic condition, the school nurse can be responsible for monitoring and treating the conditions of around 7.5 students. Oftentimes, a school nurse's salary does not reflect the responsibilities they have for these students.
"It is a huge responsibility to be the only clinical professional in the building and to maintain the safety of all the students," Jeanty says. This is one of the main reasons why Jeanty left school nursing.
Why Are School Nurses Leaving Their Jobs?
Retirement is one of the main reasons school nurses are leaving the profession. Other factors include:
Jeanty has been a nurse for 13 years. As with many healthcare workers, the pandemic required Jeanty to search for a position that aligned better with her young daughter's schedule. That position was school nursing.
"I ha[d] very limited childcare options," she says.
When she first left the hospital, the COVID-19 pandemic was at its peak. At first, the decrease in pay was not as much of a factor because Jeanty would have the same schedule as her daughter.
Two years later, with children back in school and with no possibility of another pay increase at the school, Jeanty was forced to resign although she loved her role.
"I had to make the hard decision to start looking for other employment," she says.
Salary is why nurses either leave or don't pursue school nursing altogether. The NASN reports the national average salary of a school nurse ranges from $63,940-$66,970. This is $10,000-$20,000 less than the median salary for registered nurses in the hospital setting.
Also, school nurses are typically responsible for a large number of students.
"[Our] salary does not reflect all the responsibility a school nurse [has]," Jeanty says.
The Misconception of a School Nurse's Role and Responsibilities
Although it can be intimidating to work as the sole clinician in a school, many nurses are very confident in their role and assessment skills. Many school nurses have advanced degrees. The NASN reports that 12.5% of school nurses have a master's degree compared to 10.3% of RNs nationally.
The role of a school nurse is complex and multifaceted. Many nonclinicians aren't aware of a school nurse's full scope of practice.
For example, Jeanty had 10 years of experience as a respiratory therapist before pursuing nursing as a second-degree nursing student. She also has critical care, emergency room, and management experience.
"My clinical expertise was not always respected," Jeanty says. "The school nurse is often seen as someone who offers Band-Aids and ice packs, not a professional with many years of critical care experience."
According to the NASN, the scope of practice of a school nurse includes:
- Giving out medications
- Developing student care plans
- Conducting screenings
- Communicating with family members, teachers, and building administrators
- Writing health referrals
- Providing safety
- Decreasing communicable disease outbreaks
- Offering health education to students and families
- Participating in advocacy and policy making
School nurses want to use their skills to their full potential, but often due to lack of time and misconceptions they are not used to their full capacity.
School nurses report burnout, especially during the pandemic. Many were responsible for contract tracing, educating, and identifying children that may be too sick to attend school. But with a school nursing shortage, limited resources can make it very difficult. This can cause burnout.
"School nursing can be difficult. For nurses used to working in a hospital setting, it is a huge adjustment being the only clinical person in the building with 300+ students," Jeanty says.
The school nurse also plays a role in counseling, supporting, and referring students experiencing mental health issues, such as:
One study reports that although it is in school nurses' scope of practice to support these students, they often don't have enough resources to do so.
What Can Be Done to Combat the School Nursing Shortage?
Improving school nurse retention would require a salary increase. Increasing the salary to a median RN salary would attract more nurses into the profession. It would also appeal to nurses who otherwise would not have thought to become school nurses.
School nurses are typically employed by the Department of Education, and 76.7% of school nurse funding comes from local education dollars. The remainder of the funding comes from:
- The state
- Hospital systems
- Health departments
- The federal government
Schools also can bill Medicaid for certain services school nurses provide to their students. Schools receive only 1% of the overall Medicaid budget. But they can use these funds to help support school nursing services.
Knowing how school nurses are funded and how the funds are distributed can help to advocate and promote more pay for school nurses. Getting involved on a local level or joining nurse advocacy groups can help nurses have an idea of how to allocate more funds for school nurses.
Initiatives, such as joining the NASN, are other ways to combat the school nursing shortage.
There are also many benefits to becoming a school nurse. Highlighting the benefits front and center will improve nurse retention. Jeanty points out that having the same schedule as her daughter greatly benefited their family. Other benefits are having:
- Summers off
- Weekends off
- Holiday breaks off
- Snow days off
More reasons why she took the school nurse position, Jeanty says.
School nurses advocate for their student's health needs. They also develop policies and procedures to keep students healthy, safe, and learning in school.
With these skills, school nurses should feel empowered to advocate for themselves and on behalf of other school nurses. These skills can help combat the school nursing shortage and make it more attractive for nurses to pursue.
"School nurses are providing a safe environment for school-aged children, many with chronic health conditions, and should be paid accordingly. Empowering school nurses to exercise their clinical judgment would also improve retention," Jeanty says.
Meet Our Contributor
Judith Jeanty, MSN, RN
Judith Jeanty is a former school nurse. She currently works as an RN trauma registrar at a level one adult trauma center in Long Island. She has an MSN specializing in nursing education and a master of public health specializing in community health education.
Hoskote A., et al. (2022). The evolution of the role of U.S. school nurses in adolescent mental health at the individual, community, and systems level: An integrative review.
How school nursing is funded. (2018). https://www.nasn.org/research/school-nurse-workforce
Lawson M. et al. (2021). We deserve equal pay for equal work and students deserve good care: An open letter from school nurses. https://www.gothamgazette.com/130-opinion/10503-nyc-students-health-open-letter-from-school-nurses
Pollack R. (2022). Hospital workforce shortage crisis demands immediate action. https://www.aha.org/lettercomment/2022-01-27-hospital-workforce-shortage-crisis-demands-immediate-action
School nurses in the U.S. (2018). https://www.nasn.org/research/school-nurse-workforce
School nursing practice in U.S. public schools. (2018). https://www.nasn.org/research/school-nurse-workforce
U.S. Bureau of Labor Statistics, Occupational Outlook Handbook. (2022). Registered nurses. https://www.bls.gov/ooh/healthcare/registered-nurses.htm
Vestal C. (2021). School nurse deficit deepens as states seek relief. https://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2021/10/26/school-nurse-deficit-deepens-as-states-seek-relief
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