,,ii  #aacth ,,congress  #b;d ,session  
,s4 #bbig  ,,in ,,the ,,senate ,,of     
,,the ,,united ,,states  ,may #g1 #bjad 
,mr4 ,tester introduced the following   
bill2 which was read twice and referred 
to the ,committee on ,health1           
,education1 ,labor1 and ,pensions  ,a   
,,bill  ,to make demonstration grants to
 eligible local educational agencies or 
consortia of eligible local educational 
agencies for the purpose of reducing the
 student-to-school nurse ratio in public
 elementary schools and secondary       
schools4  #a4  ,short title  ,this ,act 
may be cited as the ,nurses for         
,under-,resourced ,schools ,everywhere  
,act or the ,,nurse ,act4  #b4          
,findings  ,congress finds the          
following3  7#a7 ,the ,american ,academy
 of ,pediatrics emphasizes the crucial  
role of school nurses in the seamless   
provision of comprehensive health       
services to children and youth1 as well 
as in the development of a coordinated  
school health program4  7#b7 ,the school

 nurse functions as a leader and the    
coordinator of the school health        
services team1 facilitating access to a 
medical home for each child and         
supporting academic achievement4  7#c7  
,school nurses promote wellness and     
disease prevention to improve health    
outcomes for our ,nation's children4 ,in
 addition1 school nurses perform early  
intervention services such as periodic  
assessments for vision1 hearing1 and    
dental problems1 in an effort to remove 
barriers to learning4  7#d7 ,recent     
national data indicates #de percent of  
public schools have a school nurse all  
day1 every day1 while another #cj       
percent of schools have a school nurse  
who works part time in one or more      
schools4  7#e7 ,the ,american ,nurses   
,association has reported that when     
there is no registered nurse on the     
school premises1 the responsibility to  
administer the necessary medications and
 treatments1 and appropriate monitoring 
of the children1 falls on the shoulders 

of administrators1 educators1 and staff 
who are ill-prepared to perform these   
tasks4  7#f7 ,statistics from the       
,national ,center for ,education        
,statistics indicate that #ae to #ah    
percent of the #eb1jjj1jjj students who 
currently spend their day in school have
 a chronic health condition4  7#g7 ,a   
recent study indicated that from #bjjb  
to #bjjh1 the percentage of children in 
special education with health           
impairments1 due to chronic or acute    
health problems1 increased by #fj       
percent4 ,school nurses use their       
specialized knowledge1 assessment       
skills1 and judgment to manage          
children's increasingly complex medical 
conditions and chronic health illnesses4
  7#h7 ,among adolescents aged #ab to   
#ai years old1 the prevalence of        
prediabetes and diabetes increased from 
#i percent to #bc percent between #aiii 
and #bjjh4 ,more than #cj percent of    
children aged #b to #ai years old are   
obese or overweight 7defined as having a

 body mass index of greater than the    
#heth percentile74 ,in #bjjh1 more than 
#aj1jjj1jjj children in the ,united     
,states had asthma4 ,the prevalence of  
food allergies among children under the 
age of #ah increased #ai percent from   
#aiig to #bjjg4  7#i7 ,according to the 
,american ,academy of ,pediatrics1      
students today face increased social and
 emotional issues1 which enhance the    
need for preventive services and        
interventions for acute and chronic     
health issues4 ,school nurses are       
actively engaged members of school-based
 mental health teams and spend nearly   
#cb percent of their time providing     
mental health services1 including       
universal and targeted interventions1   
screenings to identify early warning    
signs and provide referrals to medical  
providers1 and crisis planning4  7#aj7  
,in #bjaa1 the ,bureau of the ,census   
reported #i4g percent of children under 
the age of #ai1 which equals #g1fjj1jjj 
children under the age of #ai1 were     

without health insurance4 ,data shows   
that uninsured children achieve lower   
educational outcomes than those with    
health coverage4 ,children who cannot   
afford to see a medical provider miss   
more days of school1 experience         
increased severity of illness1 and      
suffer from disparities in health4      
7#aa7 ,more than #a1fjj1jjj children    
experience homelessness each year in the
 ,united ,states4 ,homeless children    
develop increased rates of acute and    
chronic health conditions1 and the      
stress of their living situation can    
negatively affect their development and 
ability to learn4 ,as a result1 schools 
have become the primary access to health
 care for many children and adolescents4
 ,school nurses serve on the front lines
 as a safety net for the ,nation's most 
vulnerable children4  7#ab7             
,communicable and infectious diseases   
account for millions of school days lost
 each year4 ,data illustrate that when  
students have access to a registered    

nurse in school1 immunization rates     
increase4  7#ac7 ,a #bjaa study showed  
that a school nurse in the building     
saves principals1 teachers1 and clerical
 staff a considerable amount of time    
that they would have spent addressing   
health concerns of students1 including  
saving principals almost an hour a day1 
saving teachers almost #bj minutes a    
day1 and saving clerical staff more than
 #de minutes a day4 ,this would amount  
to a savings of about #ac hours per day 
in the aggregate for such school        
personnel4  7#ad7 ,determining a        
balanced student-to-school nurse ratio  
by using a formula-based approach1      
taking into consideration the overall   
health acuity of the student body and   
the workload of school nurses1 offers a 
reasonable means for achieving better   
student outcomes4  #c4  ,reducing       
student-to-school nurse ratios  7a7     
,definitions  ,in this section3  7#a7   
,,esea terms  ,the terms elementary     
school1 local educational agency1       

poverty line1 and secondary school have 
the meanings given to the terms in      
section #iaja of the ,elementary and    
,secondary ,education ,act of #aife 7#bj
 ,u4,s4,c4 #ghja74  7#b7  ,acuity  ,the 
term acuity1 when used with respect to a
 level1 means the level of a patient's  
sickness1 such as a chronic condition1  
which influences the need for nursing   
care4  7#c7 ,eligible entity ,the term  
eligible entity means-- 7,a7 a local    
educational agency in which the         
student-to-school nurse ratio in each   
public elementary and secondary school  
served by the agency is #gej or more    
students to #a school nurse2 or  7,b7 a 
consortium of local educational agencies
 described in subparagraph 7,a74  7#d7  
,high-need local educational agency     
,the term high-need local educational   
agency means a local educational agency 
described in paragraph 7#c77;,a7--  7,a7
 that serves not fewer than #aj1jjj     
children from families with incomes     
below the poverty line2 or  7,b7 for    

which not less than #bj percent of the  
children served by the agency are from  
families with incomes below the poverty 
line4  7#e7 ,nurse ,the term nurse means
 a licensed nurse1 as defined under     
,state law4  7#f7 ,secretary ,the term  
,secretary means the ,secretary of      
,education4  7#g7  ,workload  ,the term 
workload1 when used with respect to a   
nurse1 means the amount of time the     
nurse takes to provide care and complete
 the other tasks for which the nurse is 
responsible4  7b7  ,demonstration grant 
program authorized ,from amounts        
appropriated to carry out this section1 
the ,secretary of ,education1 in        
consultation with the ,secretary of     
,health and ,human ,services and the    
,director of the ,centers for ,disease  
,control and ,prevention1 shall award   
demonstration grants1 on a competitive  
basis1 to eligible entities to pay the  
,federal share of the costs of reducing 
the student-to-school nurse ratios in   
the public elementary schools and       

secondary schools served by the eligible
 entity1 which may include hiring a     
school nurse to serve schools in        
multiple school districts4  7c7         
,applications  7#a7 ,in general ,an     
eligible entity desiring a grant under  
this section shall submit to the        
,secretary an application at such time1 
in such manner1 and containing such     
information as the ,secretary may       
require4  7#b7 ,contents ,each          
application submitted under paragraph   
7#a7 shall include information with     
respect to the current 7as of the date  
of application7 student-to-school nurse 
ratio1 student health acuity levels1 and
 workload of school nurses in each of   
the public elementary schools and       
secondary schools served by the eligible
 entity4  7d7  ,priority  ,in awarding  
grants under this section1 the          
,secretary shall give priority to each  
application submitted by an eligible    
entity that-- 7#a7 is a high-need local 
educational agency or a consortium      

composed of high-need local educational 
agencies2 and  7#b7 demonstrates-- 7,a7 
the greatest need for new or additional 
nursing services among students in the  
public elementary schools and secondary 
schools served by the agency or         
consortium2 or  7,b7 that the eligible  
entity does not have a school nurse in  
any of the public elementary schools and
 secondary schools served by the        
eligible entity4  7e7 ,federal ,share2  
non-,federal ,share  7#a7 ,federal      
,share ,the ,federal share of a grant   
under this section-- 7,a7 shall not     
exceed #ge percent for each year of the 
grant2 and  7,b7 in the case of a       
multi-year grant1 shall decrease for    
each succeeding year of the grant1 in   
order to ensure the continuity of the   
increased hiring level of school nurses 
using ,state or local sources of funding
 following the conclusion of the grant4 
7#b7 ,non-,federal ,share ,the          
non-,federal share of a grant under this
 section may be in cash or in-kind1 and 

may be provided from ,state resources1  
local resources1 contributions from     
private organizations1 or a combination 
thereof4  7#c7 ,waiver ,the ,secretary  
may waive or reduce the non-,federal    
share of an eligible entity receiving a 
grant under this section if the eligible
 entity demonstrates an economic        
hardship4  7f7  ,report  ,not later than
 #b years after the date on which a     
grant is first made to a local          
educational agency under this section1  
the ,secretary shall submit to ,congress
 a report on the results of the         
demonstration grant program carried out 
under this section1 including an        
evaluation of--  7#a7 the effectiveness 
of the program in reducing the          
student-to-school nurse ratios described
 in subsection 7b77#a72 and  7#b7 the   
impact of any resulting enhanced health 
of students on learning1 such as        
academic achievement1 attendance1 and   
classroom time4  7g7  ,authorization of 
appropriations  ,there are authorized to

 be appropriated to carry out this      
section such sums as may be necessary   
for each of fiscal years #bjae through  
#bjai4