School nursing services in United States: Where are we? Where do we need to go?

School nurse are often the only health professional accessible to school-aged children who are uninsured, underinsured and those who are not U.S. citizens. State and local public health systems depend on school health services to fulfill their health promotion and illness prevention mission. Increasingly complex health care is provided in schools to medically fragile children and those with chronic health conditions. Yet there are gaps between ideal school health service staffing levels and those targeted in Healthy People 2010. This 2007 study broadly investigated the delivery of nursing care in U.S. schools. A primary aim was to identify national and state patterns of school healthcare delivery. A total of 1,151 public schools were randomly selected from a stratified pool of 92,618 schools nationwide. Results identify patterns of service, funding sources, and the roles of administrative and support staff. Forty-five percent of schools reported at least one full-time Registered Nurse. The average number of schools served by Registered Nurses was 2.2 schools. The average ratio of students to Registered Nurse was 1:1151. School nurse services were compared across regions. There were significant differences between high, middle and elementary schools, but no difference in school nurse staffing between Title 1 and Non-Title 1 schools. The disparities of school health services across the United States have significant implications for the health of school-aged children and the ability of schools to fulfill their public health role.