NURSE Act

II 117TH CONGRESS 1ST SESSION S. 1602 To make demonstration grants to eligible local educational agencies or con- sortia of eligible local educational agencies for the purpose of increasing the numbers of school nurses in public elementary schools and secondary schools. IN THE SENATE OF THE UNITED STATES MAY 12, 2021 Mr. TESTER (for himself, Mr. MERKLEY, Mr. PETERS, and Mr. BENNET) in- troduced the following bill; which was read twice and referred to the Com- mittee 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 increasing the numbers of school nurses in public elementary schools and secondary schools. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Nurses for Under- 4 Resourced Schools Everywhere Act’’ or the ‘‘NURSE 5 Act’’. 6 VerDate Sep 11 2014 00:42 May 27, 2021 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S1602.IS S1602 kjohnson on DSK79L0C42PROD with BILLS 2 •S 1602 IS SEC. 2. FINDINGS. 1 Congress finds the following: 2 (1) The National Association of School Nurses 3 identifies schools as primary locations to address 4 student health issues, since a school nurse is the 5 health care provider that many students see on the 6 most regular basis. 7 (2) The American Academy of Pediatrics has 8 recognized the crucial role that school nurses play in 9 children’s health and has called for having a full- 10 time school nurse every day and in every school 11 building. 12 (3) The school nurse functions as the leader 13 and coordinator of the school health services team, 14 including by carrying out chronic disease manage- 15 ment and health promotion as well as facilitating ac- 16 cess to a medical home for each child and supporting 17 academic achievement. 18 (4) School nurses promote wellness and disease 19 prevention to improve health outcomes for our Na- 20 tion’s children. In addition, school nurses perform 21 early intervention services such as periodic assess- 22 ments for vision, hearing, and dental problems, in an 23 effort to remove barriers to learning. 24 (5) The American Federation of Teachers has 25 called for a nurse in every school, as nurses are 26 VerDate Sep 11 2014 00:42 May 27, 2021 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S1602.IS S1602 kjohnson on DSK79L0C42PROD with BILLS 3 •S 1602 IS front-line workers that address an array of health 1 needs and their presence in a school can help to im- 2 prove student learning. 3 (6) According to 2017 data from the National 4 Association of School Nurses, only 39.3 percent of 5 schools employ a full-time school nurse, while 35.5 6 percent of schools employ a school nurse only part- 7 time, and 25.2 percent do not have a school nurse 8 at all. 9 (7) The National Association of School Nurses 10 has reported that medication administration to stu- 11 dents is one of the most common health-related ac- 12 tivities performed in school. As more chronically ill 13 and medically unstable children enter the school sys- 14 tem each year, the medical factors that promote and 15 support their academic success increase, including 16 the need for medications that enhance overall health 17 or stabilize chronic conditions. 18 (8) National data indicate that between 15 and 19 20 percent of children who spend their day in school 20 have a chronic health condition. 21 (9) According to the American Academy of Pe- 22 diatrics, students today face increased social and 23 emotional issues, which enhance the need for preven- 24 tive services and interventions for acute and chronic 25 VerDate Sep 11 2014 00:42 May 27, 2021 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S1602.IS S1602 kjohnson on DSK79L0C42PROD with BILLS 4 •S 1602 IS health issues. School nurses are actively engaged 1 members of school-based mental health teams and 2 spend nearly 32 percent of their time providing men- 3 tal health services, including universal and targeted 4 interventions, screenings to identify early warning 5 signs and provide referrals to medical providers, and 6 crisis planning. 7 (10) According to the Department of Edu- 8 cation, during the 2013–2014 school year, 1,360,747 9 children enrolled in public schools experienced home- 10 lessness. Homeless children develop increased rates 11 of acute and chronic health conditions, and the 12 stress of their living situation can negatively affect 13 their development and ability to learn. As a result, 14 schools have become the primary access to health 15 care for many children and adolescents. School 16 nurses serve on the front lines as a safety net for 17 the Nation’s most vulnerable children. 18 (11) Communicable and infectious diseases ac- 19 count for millions of school days lost each year. 20 Data illustrate that when students have access to a 21 registered nurse in school, immunization rates in- 22 crease. 23 (12) Throughout the COVID–19 pandemic, 24 school nurses have played an important role helping 25 VerDate Sep 11 2014 22:11 Jun 04, 2021 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S1602.IS S1602 kjohnson on DSK79L0C42PROD with BILLS 5 •S 1602 IS students and coordinating activities such as contact 1 tracing and symptom screening. 2 SEC. 3. INCREASING THE NUMBER OF SCHOOL NURSES. 3 (a) DEFINITIONS.—In this section: 4 (1) ESEA TERMS.—The terms ‘‘elementary 5 school’’, ‘‘local educational agency’’, ‘‘secondary 6 school’’, and ‘‘State educational agency’’ have the 7 meanings given to the terms in section 8101 of the 8 Elementary and Secondary Education Act of 1965 9 (20 U.S.C. 7801). 10 (2) ACUITY.—The term ‘‘acuity’’, when used 11 with respect to a level, means the level of a patient’s 12 sickness, such as a chronic condition, which influ- 13 ences the need for nursing care. 14 (3) ELIGIBLE ENTITY.—The term ‘‘eligible enti- 15 ty’’ means— 16 (A) a local educational agency in which not 17 less than 20 percent of the children are eligible 18 to participate in the school lunch program es- 19 tablished under the Richard B. Russell National 20 School Lunch Act (42 U.S.C. 1751 et seq.); 21 (B) a consortium of local educational agen- 22 cies described in subparagraph (A); or 23 VerDate Sep 11 2014 00:42 May 27, 2021 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S1602.IS S1602 kjohnson on DSK79L0C42PROD with BILLS 6 •S 1602 IS (C) a State educational agency in consor- 1 tium with local educational agencies described 2 in subparagraph (A). 3 (4) HIGH-NEED LOCAL EDUCATIONAL AGEN- 4 CY.—The term ‘‘high-need local educational agency’’ 5 means a local educational agency described in para- 6 graph (3)(A)— 7 (A) that serves not fewer than 15,000 chil- 8 dren who are eligible to participate in the pro- 9 gram described in such paragraph; or 10 (B) for which not less than 40 percent of 11 the children served by the agency are eligible to 12 participate in the program described in such 13 paragraph. 14 (5) NURSE.—The term ‘‘nurse’’ means a reg- 15 istered nurse, as defined under State law. 16 (6) SECRETARY.—The term ‘‘Secretary’’ means 17 the Secretary of Education. 18 (7) WORKLOAD.—The term ‘‘workload’’, when 19 used with respect to a nurse, means the amount of 20 time the nurse takes to provide care and complete 21 the other tasks for which the nurse is responsible. 22 (b) DEMONSTRATION GRANT PROGRAM AUTHOR- 23 IZED.— 24 VerDate Sep 11 2014 00:42 May 27, 2021 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S1602.IS S1602 kjohnson on DSK79L0C42PROD with BILLS 7 •S 1602 IS (1) IN GENERAL.—From amounts appropriated 1 to carry out this section, the Secretary of Education 2 shall award demonstration grants, on a competitive 3 basis, to eligible entities to pay the Federal share of 4 the costs of increasing the number of school nurses 5 in the public elementary schools and secondary 6 schools served by the eligible entity, which may in- 7 clude hiring a school nurse to serve schools in mul- 8 tiple school districts. 9 (2) SEAS.—In the case of an eligible entity de- 10 scribed in subsection (a)(3)(C) that receives a grant 11 under paragraph (1), such entity shall use amounts 12 received under the grant to award subgrants to the 13 local educational agencies that are members of the 14 entity, and reserve not more than 10 percent of such 15 grant funds to support statewide activities to meet 16 a variety of health needs, which may include hiring 17 a nurse to provide training and technical assistance 18 to schools statewide that meet the criteria estab- 19 lished in subsection (d)(2)(A). 20 (c) APPLICATIONS.— 21 (1) IN GENERAL.—An eligible entity desiring a 22 grant under this section shall submit to the Sec- 23 retary an application at such time, in such manner, 24 VerDate Sep 11 2014 00:42 May 27, 2021 Jkt 019200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S1602.IS S1602 kjohnson on DSK79L0C42PROD with BILLS 8 •S 1602 IS and containing such information as the Secretary 1 may require. 2 (2) CONTENTS.—Each application submitted 3 under paragraph (1) shall include information with 4 respect to the current (as of the date of application) 5 number of school nurses, student health acuity lev- 6 els, and workload of school nurses in each of the 7 public elementary schools and secondary schools 8 served by the eligible entity. 9 (d) PRIORITY.—In awarding grants under this sec- 10 tion, the Secretary shall give priority to each application 11 submitted by an eligible entity that— 12 (1) is a high-need local educational agency, a 13 consortium composed of high-need local educational 14 agencies, or a State educational agency in consor- 15 tium with high-need local educational agencies; and 16 (2) demonstrates— 17 (A) the greatest need for new or additional 18 nursing services among students in the public 19 elementary schools and secondary schools 20 served by the agency or consortium; or 21 (B) that the eligible entity does not have 22 a school nurse in any of the public elementary 23 schools and secondary schools served by the 24 VerDate Sep 11 2014 00:42 May 27, 2021 Jkt 019200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S1602.IS S1602 kjohnson on DSK79L0C42PROD with BILLS 9 •S 1602 IS local educational agency or the consortium- 1 member local educational agencies. 2 (e) FEDERAL SHARE; NON-FEDERAL SHARE.— 3 (1) FEDERAL SHARE.—The Federal share of a 4 grant under this section— 5 (A) shall not exceed 75 percent for each 6 year of the grant; and 7 (B) in the case of a multiyear grant, shall 8 decrease for each succeeding year of the grant, 9 in order to ensure the continuity of the in- 10 creased hiring level of school nurses using State 11 or local sources of funding following the conclu- 12 sion of the grant. 13 (2) NON-FEDERAL SHARE.—The non-Federal 14 share of a grant under this section may be in cash 15 or in kind, and may be provided from State re- 16 sources, local resources, contributions from private 17 organizations, or a combination thereof. 18 (3) WAIVER.—The Secretary may waive or re- 19 duce the non-Federal share of an eligible entity re- 20 ceiving a grant under this section if the eligible enti- 21 ty demonstrates an economic hardship. 22 (f) REPORT.—Not later than 2 years after the date 23 on which a grant is first made to a local educational agen- 24 cy under this section, the Secretary shall submit to Con- 25 VerDate Sep 11 2014 00:42 May 27, 2021 Jkt 019200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S1602.IS S1602 kjohnson on DSK79L0C42PROD with BILLS 10 •S 1602 IS gress a report on the results of the demonstration grant 1 program carried out under this section, including an eval- 2 uation of— 3 (1) the effectiveness of the program in increas- 4 ing the number of school nurses; and 5 (2) the impact of any resulting enhanced health 6 of students on learning, such as academic achieve- 7 ment, attendance, and classroom time. 8 (g) AUTHORIZATION OF APPROPRIATIONS.—There 9 are authorized to be appropriated to carry out this section 10 such sums as may be necessary for each of fiscal years 11 2022 through 2026. 12 Æ VerDate Sep 11 2014 00:42 May 27, 2021 Jkt 019200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6301 E:\BILLS\S1602.IS S1602 kjohnson on DSK79L0C42PROD with BILLS