BILL ANALYSIS �
AJR 24
Page 1
Date of Hearing: March 28, 2012
ASSEMBLY COMMITTEE ON EDUCATION
Julia Brownley, Chair
AJR 24 (Bonilla) - As Amended: March 19, 2012
SUBJECT : Proposed federal Student-to-School Nurse Ratio
Improvement Acts of 2011 and 2012.
SUMMARY : Calls upon the members of California's congressional
delegation to sign on as cosponsors of, and requests the
Congress and the President of the United States enact, the
proposed federal Student-to-School Nurse Ratio Improvement Acts
of 2011 and 2012. Specifically, this bill :
1)Makes findings and declarations relative to the crucial role
school nurses have as the leader and coordinator of the school
health services team in the provision of health services to
children and youth.
2)Makes findings and declarations relative to the lack of school
nurses in 15 California counties and the 4,000:1
student-to-school nurse ratio statewide.
3)Makes findings and declarations relative to the increasingly
severe and chronic health conditions, such as autism, asthma
and diabetes that children across the nation and in California
are experiencing.
4)Makes findings and declarations relative to the fact that
schools are the only source of health care for many children
and adolescents in the United States and that the presence of
a school nurse leads to an increase in student attendance at
school.
5)Resolves that the Legislature urges the members of
California's congressional delegation to sign on as cosponsors
of the proposed federal Student-to-School Nurse Ratio
Improvement Acts of 2011 and 2012.
6)Resolves that the Legislature requests that the Congress and
the President of the United States enact the federal
Student-to-School Nurse Ratio Improvement Acts of 2011 and
2012.
AJR 24
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7)Resolves that the Chief Clerk of the Assembly transmit copies
of this resolution to the President and Vice President of the
United States, to the Speaker of the House of Representatives,
to the Majority Leader of the Senate, to each Senator and
Representative from California in the Congress of the United
States, and to the author for appropriate distribution.
EXISTING LAW :
1)Expresses legislative intent that the governing board of each
school district and each county superintendent of schools
maintain fundamental school health services at a level that
allows them to preserve a pupil's ability to learn, fulfill
existing state requirements and policies regarding pupils'
health, and contain health care costs through preventive
programs and education. (Education Code (EDC) 49267)
2)Defines a school nurse as a registered nurse (RN) currently
licensed under the Nursing Practices Act, who has completed
the additional educational requirements for, and possesses a
current credential in, school nursing. (EDC 49426)
3)Specifies the qualifications for a school nurse to be a valid
certificate of registration by the Board of Nurse Examiners of
the State of California or the California Board of Nursing
Education and Nurse Registration and a health and development
credential, a standard designated services credential with a
specialization in health, or a services credential with a
specialization in health. Specifies the services credential
with a specialization in health authorizing service as a
school nurse shall not authorize teaching services unless the
holder also completes the requirements for a special class
authorization in health in a program that is approved by the
commission. Specifies on and after January 1, 1981, the
qualifications for a nurse shall also include proof
satisfactory to the school district that the nurse has
acquired training in child abuse and neglect detection. (EDC
44877)
FISCAL EFFECT : This bill is keyed non-fiscal.
COMMENTS : This resolution resolves that California's State
Legislature urges the congressional delegation from California
to sign on as cosponsors of the federal Student-to-School Nurse
Ratio Improvement Acts of 2011 and 2012. Further, this
AJR 24
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resolution resolves that California's State Legislature requests
the Congress and President of the United States to enact the
Student-to-School Nurse Ratio Improvement Acts of 2011 and 2012.
The federal Student-to-School Nurse Ratio Improvement Acts of
2011 and 2012: Introduced on June 16, 2011 in the United States
Congress as H.R. 2229 and on January 31, 2012 as S. 2407, this
federal legislation would authorize the Secretary of Education
to provide demonstration grants to local educational agencies
(LEAs) in order to reduce the ratio of students to school nurses
in public elementary and secondary schools. It would provide
priority for grants to LEAs that serve a high number or
percentage of impoverished students and demonstrate the greatest
need for new or additional nursing services for their students.
Currently, H.R. 2229 has been referred to the Committee on
Education and the Workforce as well as the Committee on Energy
and Commerce within the United States House of Representatives;
and, S. 2407 has been officially introduced. Among the
co-sponsors of H.R. 2229, four representatives are from
California's congressional delegation. S. 2407 was not
introduced by and has not been co-sponsored by any California
senators.
School nurses in California: According to Children Now, only
17% of California's schools have a school nurse or school health
center. Statistics from 2010 indicate that California's
student-to-school nurse ratio is 2,172:1. This ratio is far
higher than the recommended ratio by the National Association of
School Nurses (NASN). The NASN recommends guidelines of 750:1
for students in general population; 225:1 in the student
population that may require daily professional school nursing
services or intervention; and 125:1 in the student population
with complex health care needs. In addition, the NASN recommends
there be a school nurse in each school all day, every day.
Current state law expresses legislative intent for school
districts to maintain fundamental health services at levels so
that a student's ability to learn is preserved and state health
requirements and policies are fulfilled, but does not require
school districts to maintain any specific student-to-school
nurse ratio. As a result, school districts are free to choose
how best to implement health services. In 2009, according to the
author, 15 entire counties within California did not have a
single public school with a school nurse. In comparison to other
AJR 24
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states across the nation, California ranks 45th in
student-to-school nurse ratio. California, therefore, stands to
benefit tremendously from the proposed federal Student-to-School
Nurse Ratio Improvement Acts of 2011 and 2012.
Districts with high numbers of impoverished students and low
numbers of school nurses: The federal legislation provides
districts with high school nurse-to-student ratios and high
numbers of or a high percentage of impoverished students to
receive preference for demonstration grants. California is home
to many districts that would fit these priority characteristics.
Lack of trained and certified individuals: The implementation
of such a policy would likely require an increased number of
trained school nurses to take on positions within California
schools. It is unclear if enough credentialed school nurses
would be available to take on these new positions or if the
augmentation of recruiting efforts for school nurse
credentialing would be required. According to the Commission on
Teacher Credentialing, in 2009, 231 preliminary or clear
credentials were issued for school nurses. Between 2002 and
2009, the average number of credentials issued was 247
credentials per year. It appears possible that in order to take
full advantage of the federal Student-to-School Nurse Ratio
Improvement Acts of 2011 and 2012, California may need to
increase recruitment efforts and program offerings for such
credentials.
Value of school nurses: According to an extensive study
published by the Children's Advocacy Institute within the
University of San Diego School of Law in 2009, school nurses
"serve as the focal point for the well-being of the student
body." Using school nurses to provide basic healthcare for
students is considered to be the most practical solution
available at the current time for California to address major
student healthcare concerns. The report states that the
"presence of a school nurse makes it much more likely that
communicable diseases, chronic illness and problems such as teen
pregnancy, depression and learning disabilities will be
identified and treated." Not only do school nurses support
student health, but it is well documented that when school
nurses are present, student attendance and performance increase.
California would clearly benefit from the passage of this
federal legislation.
AJR 24
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Committee amendment: The resolution specifies that currently
there is just one school nurse for every 4,000 pupils in
California. According to Children Now's 2010 report, the most
current student-to-school nurse ratio in California was 2,172:1.
Staff recommends changing the language of the resolution to
reflect 2,172 instead of 4,000.
Arguments in support: The sponsor of the resolution, the
California School Nurses Organization (CSNO) writes, "all
students deserve to have their health needs met while in the
school setting. If AJR 24 is enacted, it will send a clear
message to the federal government that passage of both H.R. 2229
and S. 2047 is imperative to the well being of California's
students and to the benefit of California schools in order to
ensure that students are in the classroom every day, healthy and
ready to learn."
Previous legislation: AJR 10 (Brownley), Resolution Chapter 68,
Statues of 2011, supports the school-based health center program
authorized by the federal Patient Protection and Affordable Care
Act, as enacted by the United States Congress in 2010 and
supports an appropriation to fund such centers.
AB 2456 (Torlakson) from 2010, which was held on the suspense
file in Assembly Appropriations, would have required California
school districts to employ one nurse for every 750 pupils
enrolled in the district and would have authorized school
districts to bill a pupil's health insurer for the cost of
health care services provided to pupils.
SB 1200 (Leno) from 2010, which was held on the suspense file in
Assembly Appropriations, would have added availability of
school-based health care to the timely access to care provisions
for which the department may adopt standards.
ACR 99 (Swanson), Resolution Chapter 93, Statues of 2009, urged
school districts to take the necessary steps to increase school
nurse salaries.
AB 426 (Hall) from 2009, which was referred to the Assembly
Education Committee, would have required the Department of
Education, in consultation with specified entities, to recommend
to the Legislature ways to address specific health-related needs
of pupils on school campuses, including but not limited to,
AJR 24
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diabetes, asthma and obesity-related diseases.
REGISTERED SUPPORT / OPPOSITION :
Support
California School Nurses Organization (sponsor)
United Nurses Associations of California / Union of Health Care
Professionals
California State Parent Teacher Association
Many Individuals
Opposition
None on file.
Analysis Prepared by : Mark Murphy and Chelsea Kelley / ED. /
(916) 319-2087