As of 2025, DC public and public charter schools continue to face a critical shortage of school-based nurses, while many health suites in school communities are still inconsistently staffed despite efforts to stabilize the system.

In FY 2023, Mayor Bowser’s budget included a $4.5 million expansion to the DC School Health Services Program (SHSP) to increase nursing services in DC public and public charter schools and introduced a cluster model for school-based nurses in the school year 2023-2024. Facing criticism from advocates, including a unanimously passed resolution by the DC State Board of Education against it, the cluster model was implemented to fill school health suites by maximizing nursing hours and pave the way to expand the DC SHSP to provide comprehensive services inclusive of other health professionals to provide full-time services, such as community care navigators. The Children’s School Services (CSS), a project of Children’s National Hospital, was the primary grantee of the DC SHSP and put in charge of the day-to-day operations,  staffing school health suites with nurses and other allied health professionals. Under this cluster system approach, a team—typically consisting of up to two nurses and three medical technicians—provides health services to as many as four nearby schools.

Unfortunately, a public notice on the DC Department of Employment Services (DOES) website confirms that as of June 28th, Children’s National will lay off 226 school-based nurses and ally healthcare workers and end the CSS initiative. A Washington Post article states that the SHSP will be run directly by the DC Department of Health from now on yet there is no stated plan on the rehiring process for school-based nurses at this point. 

The Mayor’s FY 2026 proposed budget that’s currently being reviewed by the DC City Council does not specifically have a line item that increases investments in the DC SHSP. However, there is a proposed increase of 2.4% to the Uniform Per Pupil Funding Formula (UPPF), which will increase the overall investments in DC students and may indirectly increase available funding for school-based nursing services.  

Based on the past few years of headlines that highlight the critical need to hire more school-based nurses on both locally and nationally, the Mayor’s current budget does not reflect the sense of urgency articulated in DC State Board of Education’s unanimously approved resolution SR24-18: Advocating for Enhanced School Nurse Staffing and Support in DC  (Resolution SR24-18) that passed on September 25, 2024. Resolution SR24-18 articulates the following key points:

• Critiques DC’s current cluster model, where one nurse serves multiple schools, resulting in limited nurse presence and weak student-to-nurse relationships.
• Urges the District to staff one full-time, 40-hour/week registered nurse in every public and charter school during school hours.
• Calls on the DC Department of Health to estimate costs for competitive salaries, enhanced working conditions, and expanded nursing services.
• Requests exploration of a loan repayment program to incentivize school nurses, similar to those in other health professions.
• Recommends partnerships with institutions like UDC to develop school‐based nursing career paths

Cited in a recent Washington Post about the nursing shortage in schools and the sudden changes to the DC SHSP that ended the $25 million contract with Children’s National’s CSS program, LaJoy Johnson-Law, a former AJE staffer, a mother of a teen with medical complex needs, and the Ward 8 representative on the DC State Board of Education, was quoted in saying, “I’m angry [because nursing shortages] affects my daughter’s care and other families’ care. As Abria’s mom, I’m outraged. As a public official, I’m even more outraged. Why would you put schools in the direct line of fire like this?”

The WaPo article also notes there is a nation-wide school nursing crisis and that one-third of all US public schools lack a full-time nurse, forcing a reliance on cluster models like the one we have in DC. This issue is further complicated by the fact that since the pandemic, students across the country are navigating school systems with more healthcare needs. Also, and most disturbingly, there are no federal guidelines for the role of school nurses, and thus no budgetary requirements to support increased investments in school-based health services at a time when the federal government is also contemplating significantly reducing Medicaid spending overall, creating more barriers for students to receive quality healthcare in schools.

Here are some structural long term recommendations that we propose to addressing school nursing staffing crisis both in Washington, D.C. and nationally, in light of Children’s National abruptly ending its $25 million contract with DC Department of Health for unknown reasons:

• Pass legislation guaranteeing nurse staffing ratios: Codify in DC law that every school must have at least one full-time registered nurse present during school hours.

• Develop a school nurse career pipeline: Partner with UDC, Trinity Washington University, and high schools to train future nurses with a focus on school-based health.

• Raise school nurse salaries to parity with hospital RNs: Adjust salary schedules to reflect competitive market rates and address wage inequity.

• Fund mental health and wellness supports for nurses: Provide burnout prevention, trauma training, and wellness stipends to retain staff.

• Strengthen family and community engagement: Educate families on their rights to school health services and include parent leaders in school nurse hiring panels.

Additionally, here are current pieces of federal legislation and potential funding opportunities that can positively impact school-based nursing programs nationwide:

• H.R.305 – One School, One Nurse Act

Congresswoman Frederica Wilson (D-FL) introduced the “One School, One Nurse Act” on January 9, 2025 to authorize the Secretary of Education to carry out a grant program to assist local educational agencies with ensuring that each elementary and secondary school has at least one registered nurse on staff. 

The US Department of Education will create a competitive 5-year grant program for eligible entities (local educational agencies or partnerships with state agencies). Applicants must submit a needs assessment, describe student health needs, a plan for addressing nurse shortages and retention, and efforts to recruit nurses from underrepresented communities. Priority will be given to high-need agencies and those committed to diversifying the nursing workforce  (U.S. Congress, 2025).

• S.547 – Train More Nurses Act

U.S. Senators Jacky Rosen (D-NV) and Susan Collins (R-ME) introduced the “Train More Nurses Act” on February 12, 2025 to require the Secretary of Health, Human Services, and the Secretary of Labor to conduct a study and issue a report on grant programs to support the nursing workforce.

Within one year, the Secretaries are required to submit a report to Congress with recommendations for enhancing these programs. The three key goals are: 

• Increasing nurse faculty, particularly in underserved areas.
• Providing pathways for nurses who have more than 10 years of clinical experience to become faculty at schools of nursing.
• Encouraging and increasing more pathways for licensed practical nurses to become registered nurses (U.S. Congress, 2025).
• H.R.3262 – NURSE Act

Representatives Dina Titus (D-NV) Jennifer Kiggans (R-VA) introduced the NURSE (Nurses for Under-Resourced Schools Everywhere) Action May 7, 2025 to establish a federal demonstration grant program to help eligible local educational agencies and consortia increase the number of registered school nurses in public elementary and secondary schools.

Grants will cover up to 75% of costs initially, decreasing over time to encourage sustained local or state support, with a possible waiver of local contribution requirements for entities facing economic hardship (U.S. Congress, 2025).

• H.R.3333 – MORE Nurses Act

The Magnifying Opportunities to Recruit and Educate Nurses Act (MORE Nurses Act) was introduced by Representatives Jim Costa (D-CA) and Jen Kiggans (R-VA) on May 13, 2025. This bill directs the National Advisory Council on Nurse Education and Practice to examine and report on the growing nursing shortage in the United States and propose policy solutions. Its provisions include the following:

Assess the Nursing Workforce by:

• Evaluating the current state and trends of the U.S. nursing workforce.
• Examining the capacity of educational institutions to train future nurses.
• Identifying causes of the nursing shortage.
• Reviewing existing federal policies that affect nursing education and workforce development.

Build on current or past evaluations and avoid repeating work by reviewing relevant findings, conclusions, and recommendations from other task forces, committees, commissions, and public or private organizations related to the national nursing shortage.

Analyze Federal policy that has impacted the nursing shortage. This includes analyzing federal support of nursing education programs, nursing workforce diversity, and incentives for nurses to work in underserved areas and communities. 

Finally, the National Advisory Council is to submit their findings, conclusions, and recommendations to the President, Congress, and the Secretary of Health and Human Services within one year. The National Advisory Council shall make the report publicly available online (U.S. Congress, 2025).

• S.1874 – Title VIII Nursing Workforce Reauthorization Act of 2025

Senators Jeff Merkley (D-OR), Susan Collins (R-ME), Tammy Baldwin (D-WI), Marsha Blackburn (R-TN), Richard Blumenthal (D-CT), Chris Coons (D-DE), Kirsten Gillibrand (D-NY), Mark Kelly (D-AZ), Adam Schiff (D-CA), Lisa Murkowski (R-AK) introduced Title VIII Nursing Workforce Reauthorization Act of 2025 on May 22, 2025. This bill directs to amend the Public Health Service Act to reauthorize and enhance federal programs supporting nursing education and workforce development.

The bill calls for expanded federal nursing education grants to include students in nurse practitioner, nurse-midwifery, nurse anesthesia, and clinical nurse specialist programs. It clarifies that funds may cover clinical education and preceptor costs.

The Act also calls for strengthening nursing workforce capacity by supporting simulation and telehealth tools, increasing nursing faculty and student numbers, and promoting clinical training through healthcare partnerships. Survivors of sexual assault are added as a priority population for training. Lastly, it increases authorized funding to $184.3 million and $121.1 million annually for fiscal years 2026–2030 to support these efforts  (U.S. Congress, 2025).

Please note: The upcoming Committee of the Whole – Budget Oversight Hearing is scheduled for June 17, 2025, at 11:00 AM. The last day to submit testimonies for DC education issues is June 20, 2025.