When I was a kid, the major duties of the school nurse, as far as I knew, were to patch up a skinned knee after recess, take the temperature of the kid who threw up in the cafeteria, and make sure we were screened for scoliosis. Similarly, I thought the guidance counselor’s role was limited to helping students decide our career pathways and possibly assisting with college applications.
Obviously, the roles of the school nurse and guidance counselor — now more often called the school counselor — were more expansive than what I perceived them to be from my own experience. Had I been among lots of other kids who needed more extensive, specialized care and guidance, my perceptions would have been shaped differently.
Until recently, I hadn’t really given it much thought, despite the harrowing call from the nurse at my son’s elementary school to tell me that he had fallen from the monkey bars and likely broken his arm (he did). The prolonged pandemic along with several recent events, though, have drawn my attention to these critical roles.
Over the last two school years, school nurses and counselors were heavily if not wholly devoted to COVID-19 emergency response efforts, including contact tracing, quarantine, and parent/guardian communication. For many, these efforts were shouldered on top of their regular duties, enlisting them into frequent weekend and evening work hours.
Hopefully that will change as we head into the new school year, but school nurses and counselors will continue to be on the front lines alongside our teachers in countering the mental distress among students and their families and the loss of learning that has occurred during the pandemic. The federal American Rescue Plan set aside $500 million to enhance school-based health services, and the recent Bipartisan Safer Communities Act targets additional funds for school-based mental health services, trauma support, and suicide prevention. A $50 million grant program for school safety that was signed into law by Gov. Asa Hutchinson during the recent special legislative session will allow schools to seek funds to enhance mental health services, including mental health training for school personnel.
At the same time, however, health workforce shortages — particularly among nurses — and competition from hospitals and clinics in Arkansas and other states could impact the ability of schools to recruit and retain staff to perform these critical functions. A Pew Research Center report indicates that school nurses make $10,000 to $20,000 less than their hospital counterparts. Arkansas law requires school districts to have one school nurse per 750 students “or, if feasible, one school nurse on each public school campus.” In districts with a high concentration of disabling conditions, a lower ratio may be required. Notably, however, these ratios are required only “upon the availability of state funds.”
Demand from all sectors for qualified counselor services is equally troubling. An analysis by Education Week of federal data showed that while most school districts nationwide had a school counselor in the 2020-21 school year, only 14% met the ratio of one school counselor to 250 students recommended by the American School Counselor Association. The analysis showed that less than 4% of Arkansas school districts met that ratio.
Much of the focus of recent political debate has (appropriately) been about teacher pay raises. As the debate continues, we should not ignore the environmental demands and competition for our school nurses and counselors and the need for their wages to keep pace with the market. They are doing a heck of a lot more than patching up skinned knees and assisting with personal essays for college applications these days. More than ever, they are the lynchpins in schools who will provide critical health and wellness support for students to succeed in the classroom.
Editor’s note: Craig Wilson, J.D., M.P.A., is the director of health policy for the Arkansas Center for Health Improvement, an independent, nonpartisan health policy center in Little Rock. The opinions expressed are those of the author. A video interview on the subject can be viewed below.