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School nurses can be an important source of mental health support for students, but most schools don鈥檛 have access to a full-time nurse.

That is the case even though students鈥� mental health needs have been rising for more than a decade and the pandemic has鈥攊f anything鈥攁ccelerated that trend.

In 2019, 37 percent of high school students reported feeling so sad and hopeless that they couldn鈥檛 take part in their day-to-day activities鈥攗p from 26 percent in 2009, according to the .

Add to that the increased stress, isolation, and grief many K-12 students have experienced through the pandemic, and children and teens are now in a 鈥渕ental health state of emergency,鈥� warned the American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry, and the Children鈥檚 Hospital Association last fall.

While school counselors, psychologists, and social workers are important sources of mental health support, so, too, are school nurses, said Kate King, the president-elect of the National Association of School Nurses. But, unfortunately, she said school and district leaders don鈥檛 always leverage their nurses as mental health resources.

King specializes in adolescent psychiatric nursing and is a school nurse at World Language Middle School in Columbus, Ohio. She recently talked to Education Week about the evolving role of nurses in helping students with mental health needs. The conversation has been edited for length and clarity.

What role do school nurses play in supporting students鈥� mental health?

King: School nurses are the sentinels for mental health for students. Students [frequently] come to the school nurse first when they鈥檙e having difficulties. Quite often, their mental health concerns manifest in what we call psychosomatic complaints, or physical complaints. So, headaches, stomach aches, symptoms of panic attacks that students don鈥檛 recognize as panic attacks, even muscle pain, sleepiness. So, school nurses are often the first people to recognize some of those things as mental health concerns.

School nurses are often not included, or recognized, as being able to provide mental health services and certainly school nurses are able to provide mental health services. Now, we鈥檙e not therapists. We don鈥檛 do long-term therapy, and yet mental health encompasses a large percentage of school nurse time in addressing student needs.

In a high school, sometimes that鈥檚 a huge amount. When I was [working] in a high school, I would say, at least two-thirds to three-quarters of my time was spent on the mental health concerns of students.

What happens if you don鈥檛 have enough school nurses? What gets lost in terms of providing mental health supports?

The first thing is that students just get sent back to class. If they are asking for help over and over, and if they are turned away often enough, they stop asking. They internalize their issues and their problems and we can see a spiral into decreased evidence of learning and increased mental health concerns.

The second thing which I think could be even more damaging, is the student鈥攁nd it鈥檚 not that people don鈥檛 care, it鈥檚 just that everybody is so busy right?鈥擳he student gets judged for those things. 鈥淥h, she鈥檚 a whiner or a complainer. Oh, she鈥檚 trying to fake it to get out of class. She鈥檚 lazy or he鈥檚 lazy.鈥�

What are you seeing in your own school? Are you seeing an increase with students struggling to cope with the effects of the pandemic?

I think the pandemic adds another layer to the mental health problems we were seeing before COVID.

So many students have lost a significant other to COVID鈥攁 parent, grandparent, caregivers. Schools provide so much more than they used to and so much more than education. That identification, that safe place to go, that safe person to talk to about all of those things, was missing for quite some time.

And then there鈥檚 the mental health of the school staff themselves. This has taken a great toll. This is something we say often: You need to be a well-regulated adult to assist children to self-regulate. Our own mental health, and where it is, and coping mechanisms, plays a big part in the ability of school staff to provide that support to students. I don鈥檛 mean to say that they鈥檙e not, but it鈥檚 a different ballgame.

See also

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The front of the Bellefonte Area School District certified school nurses office on Aug. 15, 2016 in Centre County, Penn.

Abby Drey/Centre Daily Times via AP

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Erin Bamer, The York Dispatch, November 17, 2021

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The National Association of School Psychologists and the American School Counselors Association both recommend a certain number of students to psychologists and counselors. Does the National Association of School nurses recommend a ratio of students to nurses for schools?

We no longer recommend ratios鈥攁nd neither does the American Academy of Pediatrics. What we have found is that student acuity [or need for more care and monitoring] and then other indicators and factors should be assessed when we are determining does your school need a full-time nurse?

You might look at the number of students in the school who have chronic diseases, such as diabetes, asthma, seizure disorders, sickle cell disease, allergies鈥攖hose are kind of your top five鈥攁nd how well they can manage their own care at school and how much assistance they need. Those are those acuity factors. And then mental health needs are, again, another huge factor in that.

Kids with mental health needs tend to have more physical health complaints and need more support.

What then is your general sense on whether schools have enough nurses or not?

In general, they don鈥檛. We know about 25 percent of schools have a full-time nurse and about 25 percent have no nurse whatsoever. And about 50 percent share a part-time nurse with one, two, or three other buildings. So, no, we don鈥檛 have enough school nurses. And every child deserves access to a school nurse all day, every day.