The Role of School Nurses in Student Mental Health

May 2021

School nurses are on the front lines of protecting our children’s physical and mental health. They save school districts money by keeping teachers focused on education, and play a key role in ensuring students are well enough to thrive in the classroom.

The COVID-19 pandemic has tested all of us – particularly our children. Our young people have endured school closures, the loss of employment in their families, and a strained ability to connect with teachers, loved ones, and friends.

The importance of having health personnel in every school building has never been more critical. Yet in some North Carolina school districts, one nurse splits their time among two, three or even five different schools.

This is a critical time for our state’s leaders to put children’s mental health at the top of their agendas. School nurses play a critical role in supporting both the physical and mental health of our youth.

Preventing Harm to Self and Others 

In 2020, the NC legislature passed Senate Bill 476. This important legislation requires the State Board of Education to adopt a school-based mental health policy, and K-12 schools to adopt and implement a school-based mental health plan with training and a suicide risk referral protocol.  This legislation is critical, yet we still have much more to do to help young people in crisis.

Kids need trained, caring adults in their lives who can help them. School nurses are trained to identify both physical health issues, and the behavioral health concerns that often go along with them. As a result, school nurses are often a student’s first point of entry to getting the mental health or behavioral health care they need. School nurses are a routine part of children’s daily lives. As such, they can be easily accessible to students who need help [2].

School nurses, social workers, and other support personnel can look out for children who have exposure to risk factors, and ensure they don’t have access to “lethal means of self-harm” (like ability to access something like a gun or harmful prescription drugs). Their interventions can save lives.

Keeping Teachers Focused on Education

The state’s school nurse shortage forces teachers to provide health care to students during educational time. When teachers can’t focus on education, all students suffer. State legislators can fix that by allocating school nurse funds efficiently across the state.

The Statewide Shortage of School Nurses

The American Academy of Pediatrics and the National Association of School Nurses recommendations of a minimum of one registered school nurse per school site daily [3].

In North Carolina, more than half of school nurses serve at least 2 schools at a time. Some serve as many as five. In Johnston county for example, there are over 2,000 students for every school nurse [4].

School Nurses Save Money

Relying on teachers, administrators and other non-nurses to provide medical care to students means that education dollars are subsidizing health care in schools. A 2018 legislative report used just one example of a nursing service frequently provided to students by teachers or other non-nurses: administering medication. In 2015-16 the state spent approximately $15 million of education funds simply on providing students with their meds [5]. 

Funding Needed to Meet Student Needs

HB 348 “Add School Nurses for Healthier Students,” would appropriate $102 million each year to ensure a school nurse in every building. State leaders have been able to put some temporary coronavirus relief funding towards increasing school nurses, social workers, and other key support personnel in our schools. However, these funds are only temporary. Our legislators should allocate recurring funding to ensure that all students have regular, ongoing access to school nurses and counseling resources.

A shortage of school nurses short-changes both education and health. In rural counties where children often have less access to health care providers, school nurses are even more important. Many are the main source of preventive health care for kids. Legislators can leverage federal pandemic relief funds and state appropriations to end the state’s school nurse shortage – saving real money and keeping kids safer. 


  1. North Carolina Child Fatality Task Force2021 Annual Report to the NC General Assembly.
  2. National Association of School Nurses. The School Nurse’s Role in the Mental/Behavioral Health of Students.
  3. American Academy of Pediatrics, 2016. The Role of the School Nurse in Providing School Health Services.
  4. NC DHHS 2020. NC Annual Survey of School Health Services.
  5. NC Program Evaluation Division, 2017. Meeting Current Standards for School Nurses Statewide May Cost Up to $79 Million Annually