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Half of Minnesota school districts do not employ a licensed school nurse, according to the Minnesota Department of Health's first comprehensive survey of districts' nurse staffing.

The study, based on data from 2022, revealed inequities in Minnesota students' access to nurses at school. Smaller districts, charter schools and schools serving low-income families were among the least likely to have licensed nurses on staff.

Overall, only 49% of Minnesota public school districts and charter schools had at least one licensed school nurse. One in four districts or charter schools had no staff members solely responsible for student health services.

Nurses play a critical role in student support, coordinating essential care for students with chronic conditions and working as a trusted adult for students experiencing mental health concerns. The 2022 Minnesota student survey on health and well-being shows improved student attendance and reduced chronic absences in schools staffed with a full-time nurse.

"Access to quality health care is critical for students in Minnesota, no matter their ZIP code," Minnesota Commissioner of Education Willie Jett said in a news release. "School nurses play an important role in the overall health and well-being of our young people."

School nurse staffing requirements

Minnesota requires all school districts to provide some form of health services for students, but only mandates that districts with more than 1,000 students employ a licensed school nurse. The report suggests this statute may be influencing staffing decisions at smaller districts: 93% of school districts with more than 1,000 students employed a licensed school nurse in 2022, compared to just 26% of school districts below that threshold.

School districts with high student need are often the most likely to go without a school nurse. In the 162 school districts with 40% or more students eligible for free or reduced-price lunch, students were three times less likely to have access to nursing services than other schools.

"The inequities in health and education for students that existed prior to the pandemic are now overwhelming school health resources," the report reads, "specifically the understaffed school nursing workforce."

School nurses have faced an increasing workload in recent years, caring for students with more complex medical needs, life-threatening allergies and mental health concerns.

The report, a collaboration between MDH, the University of Minnesota Prevention Research Center, the School Nurse Organization of Minnesota, Minnesota Department of Education and several other education and health-focused organizations, marks the first time the state has undertaken a complete survey of school nurses.

Based on the findings, the School Nurse Collaborative recommends re-examining the impact of state law related to school nurses, and exploring new funding strategies to support smaller districts and those with higher student need. It hopes to develop a replicable process for the report, collecting similar workforce data every two years.