As schools reopen across Virginia, just under 10% will operate without a nurse, leaving critical gaps in student healthcare, advocates say. School nurses are responsible for managing complex student medical conditions and helping to reduce absenteeism.

Most school divisions in the commonwealth employ nurses, but current laws permit, rather than require, their presence. 

Legislators and experts are exploring updating the state’s Standards of Quality, the school funding baseline requirements for the state and local governments, to include mandatory full-time licensed nurse positions. A report is expected to be presented to the state’s School Health Services Committee next month.

“It is time that we establish a standard of quality that really does require a nurse in every school,” said Senate Education and Health Committee Chair Barbara Favola, D-Arlington, who also chairs the state’s school health services committee.

Favola, advocates and education leaders in Virginia are pushing for mandatory full-time licensed nurses in every public school. Advocates argue it’s imperative to have a nurse in all schools, especially as lawmakers require more health protocols in learning environments.

“It sets a dangerous public policy precedent to continue passing legislation that requires schools to maintain medications, emergency medical equipment, and specialized health protocols without also requiring a qualified healthcare professional to oversee their implementation,” Betsy Looney, former president of the Virginia Association of School Nurses, said.

Earlier efforts have been largely unsuccessful because localities must match the costs, especially in jurisdictions with high local composite indexes, which determine how much localities can pay for their schools.

Last year, the Virginia School Health Services Committee discussed the goal of stationing registered nurses in all of Virginia’s schools and there have been multiple efforts to pass legislation. 

In 2020, then- state Sen. Jen Kiggans and former Del. Dawn Adams carried legislation requiring a registered nurse in every Virginia school building. The proposal did not advance because lawmakers sought additional data.

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About 90.1% of Virginia’s public schools had a licensed nurse, according to data available from the Virginia Department of Health from the 2024-2025 school year. Of these, 69.9% are registered nurses, 20.1% are licensed practical nurses and around 10% are neither.

Both types of nurses are medical professionals, but RNs have more training and receive higher pay.

The data equates to roughly one full-time nurse per 619 students statewide.

Dr. Dana Ramirez, a pediatrician representing the Virginia Chapter of the American Academy of Pediatrics, said the organization wants state law to be amended to require a licensed nurse in every public school building in the commonwealth.

The American Academy of Pediatrics first recommended a minimum of one full-time registered nurse in every school in 2016. The National Association of School Nurses subsequently supported and has continued to advocate for this standard.

“A school nurse provides students access to comprehensive health services and timely recognition and treatment of physical and mental health needs,” Ramirez said in a statement. “This optimizes school attendance, classroom time, and student success, allowing students with acute and chronic medical conditions to remain in school.”

How nurses serve students

Nurses provide the clinical expertise to help students manage complex and chronic health conditions, advocates said. Some of them provide individualized healthcare plans and monitor students for medication side effects, including those related to mental health diagnoses.

Looney said teachers, principals, and administrators should not be expected to function as the school’s healthcare professional.

“While school personnel play an essential role in supporting students, they should not bear the responsibility of managing clinical programs for which they have neither the education nor the professional licensure,” she added.

Nurses are also qualified to oversee and implement life-saving protocols required by law, including the use of stock epinephrine and naloxone for opioid overdose response and the use of automated external defibrillators, or AEDs, commonly used in an emergency to help a heart return to a normal rhythm.

Advocates have also said that having nurses in schools will not only provide relief for nurses floating between schools within a single division, but also support families by helping minimize disruptions to parents’ and caregivers’ work schedules and costly emergency room visits.

Keith Perrigan, superintendent of Washington County Public Schools and president of the Coalition of Small and Rural Schools, said such efforts are important in rural communities.

“Investing in a licensed nurse in every school building is an investment in student health, academic achievement, family stability, and the overall well-being of our communities,” Perrigan wrote in an Aug. 7 letter.

He added, “Requiring a licensed school nurse in every Virginia school is not simply a healthcare issue – it is an educational, public health, and student safety imperative.”

What’s next

Advocates say the first step to putting more nurses in schools is updating the state’s SOQ to include mandatory, full-time licensed nurses among the specialized student support positions that each school board is allowed to provide, thereby making the requirement a formal policy.

The minimum number of specialized student support positions per 1,000 students is three, according to state law.

The list includes school social workers, school psychologists, school nurses, licensed behavior analysts, licensed assistant behavior analysts and other licensed health and behavioral positions, which may either be employed by the school board or provided through contracted services.

Such action would require legislative approval by the General Assembly and the governor.

The Virginia School Health Services Committee will receive a report on the initiative Sept. 23 at 2 p.m.