[Congressional Bills 113th Congress]
[From the U.S. Government Publishing Office]
[S. 2297 Introduced in Senate (IS)]

113th CONGRESS
  2d Session
                                S. 2297

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 schools.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                              May 7, 2014

  Mr. Tester introduced the following bill; which was read twice and 
  referred to the Committee on Health, Education, Labor, 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 schools.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Nurses for Under-Resourced Schools 
Everywhere Act'' or the ``NURSE Act''.

SEC. 2. FINDINGS.

    Congress finds the following:
            (1) The American Academy of Pediatrics emphasizes the 
        crucial role of school nurses in the seamless provision of 
        comprehensive health services to children and youth, as well as 
        in the development of a coordinated school health program.
            (2) The school nurse functions as a leader and the 
        coordinator of the school health services team, facilitating 
        access to a medical home for each child and supporting academic 
        achievement.
            (3) School nurses promote wellness and disease prevention 
        to improve health outcomes for our Nation's children. In 
        addition, school nurses perform early intervention services 
        such as periodic assessments for vision, hearing, and dental 
        problems, in an effort to remove barriers to learning.
            (4) Recent national data indicates 45 percent of public 
        schools have a school nurse all day, every day, while another 
        30 percent of schools have a school nurse who works part time 
        in one or more schools.
            (5) The American Nurses Association has reported that when 
        there is no registered nurse on the school premises, the 
        responsibility to administer the necessary medications and 
        treatments, and appropriate monitoring of the children, falls 
        on the shoulders of administrators, educators, and staff who 
        are ill-prepared to perform these tasks.
            (6) Statistics from the National Center for Education 
        Statistics indicate that 15 to 18 percent of the 52,000,000 
        students who currently spend their day in school have a chronic 
        health condition.
            (7) A recent study indicated that from 2002 to 2008, the 
        percentage of children in special education with health 
        impairments, due to chronic or acute health problems, increased 
        by 60 percent. School nurses use their specialized knowledge, 
        assessment skills, and judgment to manage children's 
        increasingly complex medical conditions and chronic health 
        illnesses.
            (8) Among adolescents aged 12 to 19 years old, the 
        prevalence of prediabetes and diabetes increased from 9 percent 
        to 23 percent between 1999 and 2008. More than 30 percent of 
        children aged 2 to 19 years old are obese or overweight 
        (defined as having a body mass index of greater than the 85th 
        percentile). In 2008, more than 10,000,000 children in the 
        United States had asthma. The prevalence of food allergies 
        among children under the age of 18 increased 19 percent from 
        1997 to 2007.
            (9) According to the American Academy of Pediatrics, 
        students today face increased social and emotional issues, 
        which enhance the need for preventive services and 
        interventions for acute and chronic health issues. School 
        nurses are actively engaged members of school-based mental 
        health teams and spend nearly 32 percent of their time 
        providing mental health services, including universal and 
        targeted interventions, screenings to identify early warning 
        signs and provide referrals to medical providers, and crisis 
        planning.
            (10) In 2011, the Bureau of the Census reported 9.7 percent 
        of children under the age of 19, which equals 7,600,000 
        children under the age of 19, were without health insurance. 
        Data shows that uninsured children achieve lower educational 
        outcomes than those with health coverage. Children who cannot 
        afford to see a medical provider miss more days of school, 
        experience increased severity of illness, and suffer from 
        disparities in health.
            (11) More than 1,600,000 children experience homelessness 
        each year in the United States. Homeless children develop 
        increased rates of acute and chronic health conditions, and the 
        stress of their living situation can negatively affect their 
        development and ability to learn. As a result, schools have 
        become the primary access to health care for many children and 
        adolescents. School nurses serve on the front lines as a safety 
        net for the Nation's most vulnerable children.
            (12) Communicable and infectious diseases account for 
        millions of school days lost each year. Data illustrate that 
        when students have access to a registered nurse in school, 
        immunization rates increase.
            (13) A 2011 study showed that a school nurse in the 
        building saves principals, teachers, and clerical staff a 
        considerable amount of time that they would have spent 
        addressing health concerns of students, including saving 
        principals almost an hour a day, saving teachers almost 20 
        minutes a day, and saving clerical staff more than 45 minutes a 
        day. This would amount to a savings of about 13 hours per day 
        in the aggregate for such school personnel.
            (14) Determining a balanced student-to-school nurse ratio 
        by using a formula-based approach, taking into consideration 
        the overall health acuity of the student body and the workload 
        of school nurses, offers a reasonable means for achieving 
        better student outcomes.

SEC. 3. REDUCING STUDENT-TO-SCHOOL NURSE RATIOS.

    (a) Definitions.--In this section:
            (1) ESEA terms.--The terms ``elementary school'', ``local 
        educational agency'', ``poverty line'', and ``secondary 
        school'' have the meanings given to the terms in section 9101 
        of the Elementary and Secondary Education Act of 1965 (20 
        U.S.C. 7801).
            (2) Acuity.--The term ``acuity'', when used with respect to 
        a level, means the level of a patient's sickness, such as a 
        chronic condition, which influences the need for nursing care.
            (3) Eligible entity.--The term ``eligible entity'' means--
                    (A) a local educational agency in which the 
                student-to-school nurse ratio in each public elementary 
                and secondary school served by the agency is 750 or 
                more students to 1 school nurse; or
                    (B) a consortium of local educational agencies 
                described in subparagraph (A).
            (4) High-need local educational agency.--The term ``high-
        need local educational agency'' means a local educational 
        agency described in paragraph (3)(A)--
                    (A) that serves not fewer than 10,000 children from 
                families with incomes below the poverty line; or
                    (B) for which not less than 20 percent of the 
                children served by the agency are from families with 
                incomes below the poverty line.
            (5) Nurse.--The term ``nurse'' means a licensed nurse, as 
        defined under State law.
            (6) Secretary.--The term ``Secretary'' means the Secretary 
        of Education.
            (7) Workload.--The term ``workload'', when used with 
        respect to a nurse, means the amount of time the nurse takes to 
        provide care and complete the other tasks for which the nurse 
        is responsible.
    (b) Demonstration Grant Program Authorized.--From amounts 
appropriated to carry out this section, the Secretary of Education, in 
consultation with the Secretary of Health and Human Services and the 
Director of the Centers for Disease Control and Prevention, shall award 
demonstration grants, on a competitive basis, 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 entity, which may include hiring a school nurse 
to serve schools in multiple school districts.
    (c) Applications.--
            (1) In general.--An eligible entity desiring a grant under 
        this section shall submit to the Secretary an application at 
        such time, in such manner, and containing such information as 
        the Secretary may require.
            (2) Contents.--Each application submitted under paragraph 
        (1) shall include information with respect to the current (as 
        of the date of application) student-to-school nurse ratio, 
        student health acuity levels, and workload of school nurses in 
        each of the public elementary schools and secondary schools 
        served by the eligible entity.
    (d) Priority.--In awarding grants under this section, the Secretary 
shall give priority to each application submitted by an eligible entity 
that--
            (1) is a high-need local educational agency or a consortium 
        composed of high-need local educational agencies; and
            (2) demonstrates--
                    (A) the greatest need for new or additional nursing 
                services among students in the public elementary 
                schools and secondary schools served by the agency or 
                consortium; or
                    (B) that the eligible entity does not have a school 
                nurse in any of the public elementary schools and 
                secondary schools served by the eligible entity.
    (e) Federal Share; Non-Federal Share.--
            (1) Federal share.--The Federal share of a grant under this 
        section--
                    (A) shall not exceed 75 percent for each year of 
                the grant; and
                    (B) in the case of a multi-year grant, shall 
                decrease for each succeeding year of the grant, 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 grant.
            (2) Non-federal share.--The non-Federal share of a grant 
        under this section may be in cash or in-kind, and may be 
        provided from State resources, local resources, contributions 
        from private organizations, or a combination thereof.
            (3) 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 
        hardship.
    (f) Report.--Not later than 2 years after the date on which a grant 
is first made to a local educational agency under this section, the 
Secretary shall submit to Congress a report on the results of the 
demonstration grant program carried out under this section, including 
an evaluation of--
            (1) the effectiveness of the program in reducing the 
        student-to-school nurse ratios described in subsection (b)(1); 
        and
            (2) the impact of any resulting enhanced health of students 
        on learning, such as academic achievement, attendance, and 
        classroom time.
    (g) 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 2015 through 2019.
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