Credit: Photo by Kate Masters

Two Montgomery County Council committees unanimously recommended extra money to fund six additional school nursing positions — a move Council Member Craig Rice called a small step to address an ongoing staffing crisis.

The Education and Culture committee met with the Health and Human Services committee on Monday for a joint session on school nursing shortages, a problem that’s continued for several years. 

School nurses work within Montgomery County Public Schools, but are Montgomery County employees, funded through the Department of Health and Human Services. 

As school enrollment has climbed, funding for nursing staff hasn’t kept pace. Montgomery County has 98 nurses for 206 schools and a nurse-to-student ratio of 1 to 1,660. That’s far higher than in surrounding areas, including Prince George’s County, a jurisdiction with similar school enrollment but a nurse-to-student ratio of 1 to 693.

“For MCPS, they see increased enrollment and they get a teacher,” said Nancy Austin, a school nurse in Montgomery County who attended Monday’s committee meeting. “We see increased enrollment and we get nothing. That’s why it’s such a struggle.”

The nursing shortage has become a recurring issue for both committees, which previously requested extra funding to hire for new positions.


Rice, chair of the Education and Culture committee, and Council Member Gabe Albornoz, chair of the Health and Human Services committee, sent County Executive Marc Elrich a letter in April, asking him to add 12 more school nurse positions to his proposed budget for fiscal year 2020.

Around the same time, the joint committee added roughly $1.2 million for those 12 additional school nurses to a council wish list for the fiscal 2020 budget cycle. Both the executive and legislative branches ultimately put aside the request to focus on competing budget priorities, according to a report by council analysts.

It’s become a point of frustration for school nurses, whose expanding workload often includes more complicated medical cases. Kate Hagner, another school nurse at the committee meeting, said she just created a treatment plan for a student who returned from the hospital last week with a diagnosis of sickle cell anemia.


School health providers are often on the front lines of everything from diabetes to teen vaping to growing rates of depression and anxiety among young adults, Dr. Travis Gayles, the county’s health officer, said on Monday.

“It’s important that these kids get a healthy start,” he said. “We want to make sure we have the resources to treat children across the continuum.”

It’s difficult when most school nurses are assigned to cover two or three schools, Austin said. While she specializes in diabetes care for one of the county’s elementary schools, it’s not uncommon for her to visit other campuses at least four or five times a week, she said.


In 2018, school nurses handled roughly 850,000 health cases — including three opiate overdoses during a single week in October, according to a report from the department.

Nurses work closely with school health room technicians, who also provide basic medical care. But it’s often not enough to relieve the burden of the job.

Montgomery County has a health room technician assigned to every school, but their level of expertise often varies, Gayles said. The position only requires a high school diploma. School nurses are still responsible for overseeing the technicians on staff.


“In many cases, they’re notifying the nurses to ask about the provisions of treatment,” he said. “It’s not quite the same level of knowledge and understanding.”

The joint recommendation for supplemental funding is an acknowledgment that the school nursing shortage has reached “emergency status,” Rice said. At least 18 school nurses have left the county over the last year, according to UFCW Local 1994, a union chapter that represents nurses and other employees with the Department of Health and Human Services.

Officials would need to add 26 nursing positions to provide a dedicated nurse in every high school, middle school and elementary school with more than 850 students. The county’s Commission on Health recommended the increase in a letter earlier this month, citing current guidelines from the American Academy of Pediatrics for a dedicated nurse in every school.


Finalizing the funding will be another challenge. The committees’ recommendation still has to go before the full council and Elrich, who struggled to close a $44 million budget shortfall in his first year on the job.

At their meeting on Monday, committee members requested funding for six additional nurses — half the additional staffing they requested earlier this year, Rice pointed out. He also acknowledged that the new positions, estimated to cost more than $600,000, would be a difficult request for the executive’s team.

“In the time I’ve been here, we haven’t had many special appropriations,” he said. “They’re very rare. We understand it presents a challenge to the executive staff from a budgeting perspective. But if we didn’t feel that this was of the emergency nature it is, then we wouldn’t do this.”