NEW YORK (ASRN.ORG)- If swine flu reappears in schools this fall, it'll probably be a school nurse who first discovers it. But nationwide, the ratio of nurses to students falls short of the federally recommended standard, raising concerns that the shortage could undermine efforts to catch and control what could be a deadly flu season. 

U.S. Census data from 2005 to 2007 suggests that each school nurse cares, on average, for 971 students. In 13 states, the ratio is more than 2,000 to 1. 

In its own 2007 survey, the National Association of School Nurses found the ratio was 1,151 students per nurse. 

In either analysis, the nurse workload exceeds the recommendation from the Centers for Disease Control and Prevention: one nurse per 750 students. 

"Either way, it's not good for kids out there who have no safety net," says Amy Garcia, executive director of the National Association of School Nurses.

Further, the association recommends a 1-to-225 ratio for schools that require "daily professional school nursing services" and 1-to-125 in schools with "complex health care needs."

Data show that workloads for elementary school nurses have remained essentially unchanged since 1999 at about 455 students per nurse. But in secondary schools, workloads have grown 14%, from 733 students per nurse to 835. 

Nationwide, an estimated 45% of public schools have a full-time nurse on staff, the nurses association says. Add part-time nurses and the figure jumps to 75%. But that leaves 25% of schools with no nurse at all. 

New CDC guidelines released last week discourage schools from closing even if the H1N1 virus, or swine flu, strikes. Homeland Security Secretary Janet Napolitano said only schools with "high numbers of high-risk students" showing symptoms should consider closing, but she warned that shutting down a school, even temporarily, "causes a very significant ripple effect" in the community. 

Instead, the new CDC guidelines say ill students should be kept out of school until 24 hours after their fever subsides. 

Schools' first line of defense: frequent hand washing, coughing etiquette, routine cleaning and close monitoring of symptoms. In schools where students show symptoms, Education Secretary Arne Duncan says educators should set aside a room for students, "a safe place for them to stay" until they can go home. 

By the numbers:

 

Nationally, the ratio of nurses to students falls short of the recommended federal standard: 1 nurse per 750 students, which could affect how well schools can control an outbreak of the H1N1 virus, or swine flu. The National Association of School Nurses in 2008 calculated how many students there were per registered school nurse in all 50 states, Washington D.C. and the Overseas School Health Nurses Association representing Department of Defense schools.

 

Number of students per nurse:

Vermont                      275

New Hampshire             347

Massachusetts               419

OSHNA                        445

Connecticut                   460

Delaware                      519

Alaska                         530

Kansas                         552

Wyoming                      595

Maine                           602

Rhode Island                   632

Washington, D.C.             652

New Jersey                     674

Missouri                         748

New Mexico                     780

Pennsylvania                    832

Texas                             841

Virginia                           873

Iowa                               889

South Carolina                  901

Maryland                         913

Alabama                         936

New York                        1,007

Indiana                           1,022

Washington                      1,060

Arkansas                         1,084

West Virginia                    1,159

South Dakota                    1,195

Arizona                            1,217

North Carolina                    1,320

Mississippi                        1,394

Nebraska                         1,407

Tennessee                        1,415

Georgia                           1,734

Minnesota                         1,803

Nevada                            1,814

Louisiana                         1,868

Kentucky                         1,877

Colorado                          2,101

California                         2,240

Wisconsin                         2,359

Idaho                              2,368

Ohio                               2,377

Florida                            2,605

North Dakota                    2,828

Illinois                            2,893

Oklahoma                        3,110

Montana                          3,137

Oregon                           3,142

Michigan                         4,204

Utah                              4,893

Hawaii has no school RNs

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