Program Evaluation Oversight Committee – School Nurse Update

The Joint Legislative Program Evaluation Oversight Committee met on Monday, April 9, 2018.

School Nurses:

Sara Nienow, Principal Evaluator, presented on meeting current standards for statewide nurses. She proposed that this may cost up to $79 million annually.



Her findings overview included the following information:

  1. School nurse duties have increased in scope and complexity.
  2. NC did not meet the nurse to student ratio, nor does it have 1 nurse per school.
  3. State funded programs are only accessible to those schools that meet the criteria.
  4. Medicaid pays for school nursing services. However, most LEAs do not seek reimbursement.
  5. The education budget subsidized health care when non-nurses provide care.

She stated that 22% of nurses serve 3 or more schools. The National Association of School nurses recommends students have access to an RN at all times. Providing 1 school nurse per 750 students would cost $45 million. However, providing 1 school nurse in every school would cost $79 million.

She also noted that 76% of medication administration is preformed by unlicensed assistive personnel compared to 24% completed by school nurses.She added that a school nurse is often the only health care professional in a school.

There were 4 recommendations given:

  1. The NCGA should direct the State Board of Education to update the school nursing standard, and develop a implementation plan to achieve the standard.
  2. The NCGA should direct DHHS and DPI to prepare a consolidation plan for 2 state funded school nurse programs and to implement acuity models. The reallocation of the funding should begin in 2020-21.
  3. The NCGA should direct DHHS to examine Medicaid rates for school nursing services.
  4. The NCGA should direct DHHS to request a Medicaid state plan amendment to authorize Medicaid reimbursement documented in a health plan.

Danny Stanley, Director of Public Health, DHHS, added that they support the report, and will work closely with DPI on moving forward.

Matt Paggett from Bill Drafting presented the bill draft that will be voted on in the next meeting.



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