When your children are at school, you might expect that a school nurse will always be available to treat any health problems that arise. But according to the most recent data from the Centers for Disease Control and Prevention, collected in 2014, only about half of schools have a registered nurse on staff for 30 hours or more during the week.

That runs counter to new recommendations from the American Academy of Pediatrics, which call for every school to employ at least one full-time registered nurse regardless of school size. Previously, the group had called for one nurse for every 750 students in a school population that was generally healthy.

Whether your child needs an occasional bandage for a skinned knee or has a more complicated health condition—such as diabetes or asthma—that requires regular observation and care, here’s what you need to know about school nurses.

Why There Aren't Enough School Nurses

Although there's a shortage of registered nurses in some parts of the country, the scarcity of full-time nurses in schools is more a function of education budget reductions, says Susan B. Hassmiller, Ph.D., R.N., a senior adviser for nursing with the Robert Wood Johnson Foundation. “School nurse jobs are being cut," she notes, or nurses are being given more schools to oversee.

At the same time, school nurses are facing more challenging student health concerns. More youngsters are coming to school with complex medical needs, says Beth Mattey, M.S.N., R.N., president of the National Association of School Nurses. And for the 21 percent of children in the U.S. who live in poverty, a school nurse might help them access healthcare and better nutrition.

Who's Caring for Your Kids?

In schools that have a full-time nurse, youngsters are usually cared for by an R.N., who has, at minimum, a two-year degree, three-year diploma, or bachelor’s degree, or a licensed practical nurse, who has about a year of nursing education.

But in other schools, students might be able to see a nurse only during certain hours, or they might not have access to any nurse at all. That leaves school staff to provide care.

So, for example, a teacher or school secretary might be in charge of getting help in an emergency, dispensing medication, or providing first aid. In some cases, teachers and staff might be required to be certified in first aid or CPR, but policies vary from state to state. 

Safeguard Your Child's Health

 What should you do to make sure your child is getting the right care during the school day? Take smart steps and ask questions such as the following: 

  • Know who is caring for your child. Ask whether it's a nurse or someone else at your child’s school, Mattey says. If it’s a nurse, find out if he or she is on-site full-time. If there’s no full-time nurse, ask who's responsible for healthcare the rest of the time, and which staff members are trained to administer medication and have first-aid or CPR training.
  • Make sure the school has all the information it needs. Your school probably requires you to fill out an emergency contact form and have your pediatrician fill out a form detailing your child’s health and medical needs. You might also have to sign a release form authorizing school staff to do whatever is needed in an emergency.
  • Be medication wise. Under normal circumstances, school nurses and other school personnel aren't allowed to give your child any medicine (prescription or over-the-counter) without your explicit permission. If your child needs prescription medication during the school day, on either a short-term basis (such as an antibiotic, for example) or regularly, you’ll need to provide written permission that authorizes the nurse (or another school employee) to administer medication you provide. You’ll need to do the same if you want your child to be able to take an OTC pain reliever like ibuprofen (Advil and generic) when needed. If there’s no full-time nurse, be sure to ask: Where will the medication be stored? Who will be administering it? Do they know when to give medication? Will someone call me first?
  • Know the emergency exception. In a medical emergency, the school nurse (or another designated employee) acts as a first responder, doing whatever is necessary to save your child’s life—without phoning you first. At some schools, the medical authorization form you sign gives permission to the nurse or school staff to do whatever is necessary in an emergency. For example, some schools keep treatments such as epinephrine on hand in case a child has an unknown allergy that’s triggered at school and needs immediate treatment for a severe allergic reaction.

If Your Child Has a Serious or Chronic Condition

If your child has asthma, diabetes, epilepsy, or another serious medical condition, your pediatrician should fill out an action plan for treatment. It should outline all the necessary elements of care, such as when a youngster with asthma should use a rescue inhaler for asthma, when a student with diabetes should be given insulin, or what steps should be taken in the case of a seizure.

Your school might provide you with an action plan form; otherwise, your child’s doctor’s office might have one. You can also find condition-specific action plan templates from the following organizations:

The school should keep a copy of the plan on file. Mattey also recommends that parents talk with the school nurse or whoever is responsible for in-school care to make sure he or she understands any special care a student needs.

For the most part, if your child needs to take medication during the day, the drugs will be kept in the nurse’s office or with the school official designated to dispense medicine. Keep meds in their original package and make sure they're clearly labeled with your child’s name. If he or she also uses the medication at home, work with your doctor so that you have one container at school and one at home.

Some schools allow students to carry certain medications with them in case of emergency, such as a rescue inhaler for asthma, an EpiPen for food allergies, or insulin for diabetes. Check with your school for its policy, and if your child carries medication during the day, make sure that the nurse has a backup in case it's left at home or lost.

Is There a Doctor in the House?

There’s a bright spot in all of this: The CDC reports that almost 10 percent of schools have a full-time or part-time staff physician available to students. In addition, there are more than 2,300 school-based health centers nationwide. They provide primary care and often dental services, mental-health treatment, substance abuse counseling, and reproductive services for varying fees.

And some people are working to increase healthcare services in schools. Last February, Sen. Jon Tester (D-Mont.) introduced a bill in Congress that would provide more funding for school nurses in low-income schools. Last year, Oregon created a task force to come up with new ways to pay for school nurses. And Philadelphia, which laid off many of its school nurses several years ago, has now placed a nurse in every school district building, according to a spokesperson.