[Congressional Bills 113th Congress]
[From the U.S. Government Publishing Office]
[S. 2297 Introduced in Senate (IS)]
113th CONGRESS
2d Session
S. 2297
To make demonstration grants to eligible local educational agencies or
consortia of eligible local educational agencies for the purpose of
reducing the student-to-school nurse ratio in public elementary schools
and secondary schools.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
May 7, 2014
Mr. Tester introduced the following bill; which was read twice and
referred to the Committee on Health, Education, Labor, and Pensions
_______________________________________________________________________
A BILL
To make demonstration grants to eligible local educational agencies or
consortia of eligible local educational agencies for the purpose of
reducing the student-to-school nurse ratio in public elementary schools
and secondary schools.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Nurses for Under-Resourced Schools
Everywhere Act'' or the ``NURSE Act''.
SEC. 2. FINDINGS.
Congress finds the following:
(1) The American Academy of Pediatrics emphasizes the
crucial role of school nurses in the seamless provision of
comprehensive health services to children and youth, as well as
in the development of a coordinated school health program.
(2) The school nurse functions as a leader and the
coordinator of the school health services team, facilitating
access to a medical home for each child and supporting academic
achievement.
(3) School nurses promote wellness and disease prevention
to improve health outcomes for our Nation's children. In
addition, school nurses perform early intervention services
such as periodic assessments for vision, hearing, and dental
problems, in an effort to remove barriers to learning.
(4) Recent national data indicates 45 percent of public
schools have a school nurse all day, every day, while another
30 percent of schools have a school nurse who works part time
in one or more schools.
(5) The American Nurses Association has reported that when
there is no registered nurse on the school premises, the
responsibility to administer the necessary medications and
treatments, and appropriate monitoring of the children, falls
on the shoulders of administrators, educators, and staff who
are ill-prepared to perform these tasks.
(6) Statistics from the National Center for Education
Statistics indicate that 15 to 18 percent of the 52,000,000
students who currently spend their day in school have a chronic
health condition.
(7) A recent study indicated that from 2002 to 2008, the
percentage of children in special education with health
impairments, due to chronic or acute health problems, increased
by 60 percent. School nurses use their specialized knowledge,
assessment skills, and judgment to manage children's
increasingly complex medical conditions and chronic health
illnesses.
(8) Among adolescents aged 12 to 19 years old, the
prevalence of prediabetes and diabetes increased from 9 percent
to 23 percent between 1999 and 2008. More than 30 percent of
children aged 2 to 19 years old are obese or overweight
(defined as having a body mass index of greater than the 85th
percentile). In 2008, more than 10,000,000 children in the
United States had asthma. The prevalence of food allergies
among children under the age of 18 increased 19 percent from
1997 to 2007.
(9) According to the American Academy of Pediatrics,
students today face increased social and emotional issues,
which enhance the need for preventive services and
interventions for acute and chronic health issues. School
nurses are actively engaged members of school-based mental
health teams and spend nearly 32 percent of their time
providing mental health services, including universal and
targeted interventions, screenings to identify early warning
signs and provide referrals to medical providers, and crisis
planning.
(10) In 2011, the Bureau of the Census reported 9.7 percent
of children under the age of 19, which equals 7,600,000
children under the age of 19, were without health insurance.
Data shows that uninsured children achieve lower educational
outcomes than those with health coverage. Children who cannot
afford to see a medical provider miss more days of school,
experience increased severity of illness, and suffer from
disparities in health.
(11) More than 1,600,000 children experience homelessness
each year in the United States. Homeless children develop
increased rates of acute and chronic health conditions, and the
stress of their living situation can negatively affect their
development and ability to learn. As a result, schools have
become the primary access to health care for many children and
adolescents. School nurses serve on the front lines as a safety
net for the Nation's most vulnerable children.
(12) Communicable and infectious diseases account for
millions of school days lost each year. Data illustrate that
when students have access to a registered nurse in school,
immunization rates increase.
(13) A 2011 study showed that a school nurse in the
building saves principals, teachers, and clerical staff a
considerable amount of time that they would have spent
addressing health concerns of students, including saving
principals almost an hour a day, saving teachers almost 20
minutes a day, and saving clerical staff more than 45 minutes a
day. This would amount to a savings of about 13 hours per day
in the aggregate for such school personnel.
(14) Determining a balanced student-to-school nurse ratio
by using a formula-based approach, taking into consideration
the overall health acuity of the student body and the workload
of school nurses, offers a reasonable means for achieving
better student outcomes.
SEC. 3. REDUCING STUDENT-TO-SCHOOL NURSE RATIOS.
(a) Definitions.--In this section:
(1) ESEA terms.--The terms ``elementary school'', ``local
educational agency'', ``poverty line'', and ``secondary
school'' have the meanings given to the terms in section 9101
of the Elementary and Secondary Education Act of 1965 (20
U.S.C. 7801).
(2) Acuity.--The term ``acuity'', when used with respect to
a level, means the level of a patient's sickness, such as a
chronic condition, which influences the need for nursing care.
(3) Eligible entity.--The term ``eligible entity'' means--
(A) a local educational agency in which the
student-to-school nurse ratio in each public elementary
and secondary school served by the agency is 750 or
more students to 1 school nurse; or
(B) a consortium of local educational agencies
described in subparagraph (A).
(4) High-need local educational agency.--The term ``high-
need local educational agency'' means a local educational
agency described in paragraph (3)(A)--
(A) that serves not fewer than 10,000 children from
families with incomes below the poverty line; or
(B) for which not less than 20 percent of the
children served by the agency are from families with
incomes below the poverty line.
(5) Nurse.--The term ``nurse'' means a licensed nurse, as
defined under State law.
(6) Secretary.--The term ``Secretary'' means the Secretary
of Education.
(7) Workload.--The term ``workload'', when used with
respect to a nurse, means the amount of time the nurse takes to
provide care and complete the other tasks for which the nurse
is responsible.
(b) Demonstration Grant Program Authorized.--From amounts
appropriated to carry out this section, the Secretary of Education, in
consultation with the Secretary of Health and Human Services and the
Director of the Centers for Disease Control and Prevention, shall award
demonstration grants, on a competitive basis, to eligible entities to
pay the Federal share of the costs of reducing the student-to-school
nurse ratios in the public elementary schools and secondary schools
served by the eligible entity, which may include hiring a school nurse
to serve schools in multiple school districts.
(c) Applications.--
(1) In general.--An eligible entity desiring a grant under
this section shall submit to the Secretary an application at
such time, in such manner, and containing such information as
the Secretary may require.
(2) Contents.--Each application submitted under paragraph
(1) shall include information with respect to the current (as
of the date of application) student-to-school nurse ratio,
student health acuity levels, and workload of school nurses in
each of the public elementary schools and secondary schools
served by the eligible entity.
(d) Priority.--In awarding grants under this section, the Secretary
shall give priority to each application submitted by an eligible entity
that--
(1) is a high-need local educational agency or a consortium
composed of high-need local educational agencies; and
(2) demonstrates--
(A) the greatest need for new or additional nursing
services among students in the public elementary
schools and secondary schools served by the agency or
consortium; or
(B) that the eligible entity does not have a school
nurse in any of the public elementary schools and
secondary schools served by the eligible entity.
(e) Federal Share; Non-Federal Share.--
(1) Federal share.--The Federal share of a grant under this
section--
(A) shall not exceed 75 percent for each year of
the grant; and
(B) in the case of a multi-year grant, shall
decrease for each succeeding year of the grant, in
order to ensure the continuity of the increased hiring
level of school nurses using State or local sources of
funding following the conclusion of the grant.
(2) Non-federal share.--The non-Federal share of a grant
under this section may be in cash or in-kind, and may be
provided from State resources, local resources, contributions
from private organizations, or a combination thereof.
(3) Waiver.--The Secretary may waive or reduce the non-
Federal share of an eligible entity receiving a grant under
this section if the eligible entity demonstrates an economic
hardship.
(f) Report.--Not later than 2 years after the date on which a grant
is first made to a local educational agency under this section, the
Secretary shall submit to Congress a report on the results of the
demonstration grant program carried out under this section, including
an evaluation of--
(1) the effectiveness of the program in reducing the
student-to-school nurse ratios described in subsection (b)(1);
and
(2) the impact of any resulting enhanced health of students
on learning, such as academic achievement, attendance, and
classroom time.
(g) Authorization of Appropriations.--There are authorized to be
appropriated to carry out this section such sums as may be necessary
for each of fiscal years 2015 through 2019.
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