The reality of school nurse-to-student ratios in independent schools

Annual Report for Independent Schools Health ServicesIn a previous blog, we covered new research for independent school nurses and health services, and we gave an overview of the 2013-14 Annual Report of Independent School Health Services. Now, it’s time to dig a little deeper and look at the staff and facilities that make school health services possible.

To segment and analyze data, we asked respondents a series of questions focused on each school’s health center staff and facilities. Each school knows that type of information on their own services, but how do they compare to other schools? The resulting data allows schools to see how they measure up in these areas, and allows for easier comparison with characteristically similar schools among other data points. So, let’s get to the good stuff.

Nearly all schools (89%) reported having some type of nurse on staff, but just 18% have a full-time RN on staff, and another 18% have a part-time RN on staff. Fifty-four schools (36%) have more than one nurse on staff, and 36 schools (23.8%) have a full- or part-time doctor on staff. Of the respondents that have a full-time or part-time doctor on staff, 85% take boarding students.



Report for Nurse and Doctors on staff in schools


The National Association of School Nurses (NASN) recommends “a formula-based approach with minimum ratios of nurses-to-students depending on the needs of the student populations as follows: 1:750 for students in the general population, 1:225 in the student populations requiring daily professional school nursing services or interventions, 1:125 in student populations with complex health care needs, and 1:1 may be necessary for individual students who require daily and continuous professional nursing services.”

  • Over 89% of schools in this survey reported a nurse to student ratio equal to or below the goal of 1:750. Schools that reported more than 10% of their student population suffered from seizures reported a nurse to student ratio of 1:100 or less.


  • Nearly half of the respondents (75 schools) reported that their current nurse to student ratio was in line with what they felt an ideal ratio would be; however, 43% could use improvement in this area, stating that their current ratio was higher than ideal.

Nurse-to-student survey for actual vs. idea ratio

  • We also asked schools to identify their health center’s annual budget, excluding salaries. The majority of schools fell into the $10,000 or below category. However, 5.3% of schools noted a budget between $100,001-$275,000.


  • Moving on to facilities, schools were asked to identify the number of health centers on their campus. Those numbers ranged from as few as zero to as many as five, with the majority having just one. Most schools also reported having a relatively small amount of space for the health center in terms of square footage, most having 500 square feet of space or less.

  • Respondents were also asked to identify the other school departments with which they communicate most frequently. Not surprisingly, Administration, Admissions, Athletics, and Safety took the top spots. However, a number of other departments also made the list, with Counseling and Food Services rounding out the bottom.


  • Many health professionals have been incorporating technology into their daily routines to help document visits and complete various other tasks. Just 11.3% of respondents said they do not use any type of device and still do all of their work by hand.

Chart of Types of Technology used in Schools


For more on the staffing and facilities, and six other sections full of valuable data,
download the full Annual Report.