Nancy Austin, a school health nurse employed by the county, testified in favor of more funding for six additional nursing positions. Credit: Photo courtesy of Montgomery County

There was a roomful of applause on Tuesday when the Montgomery County Council approved $164,279 for six school nursing positions.

It was a far cry from the 26 total positions needed to provide a dedicated nurse in every high school, middle school and elementary school with more than 850 students. But advocates say it’s a start to resolving an emergency shortage of school nurses that’s left current employees overworked and overburdened.

“It’s been a lot of work to get them to understand the need and understand what we do in our jobs,” school nurse Nancy Austin said after the vote, referring to council members. “But we have to continue to have that conversation if we want to see real change.”

The school nursing shortage — which Council Member Craig Rice described as a “crisis” in November — has been an ongoing discussion between legislators, the county’s Department of Health and Human Services, and UFCW Local 1994, a union chapter that represents nurses and other department employees.

School nurses work within Montgomery County Public Schools, but they’re Montgomery County employees, funded through HHS. And while school enrollment has climbed by more than 11,000 students since 2010, 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.


Under state law, the county is required to provide per-pupil funding to MCPS that’s no less than the previous year — a requirement known as “maintenance of effort.” But Austin said the same requirement doesn’t extend to school nursing staff, even though they’re managing a growing number of students.

Over the years, it’s taken a toll on employees. During Tuesday’s public hearing on the funding, Austin told council members that 19 school nurses left the county over the last two years — a turnover rate of 20%.

“Every one of them has cited workload or liability,” she told the council. As nurses manage a higher volume of students, they also manage a higher volume of high-acuity students — children with more serious medical needs, including diabetes or physical disabilities.


School nurses, who carry malpractice insurance like many other medical professionals, often feel uncomfortable managing such a high number of serious cases, Austin explained after the meeting. And in Montgomery County, where most nurses cover two or three schools, they’re often solely responsible for managing a student’s daytime care.

“I have a license to maintain, just like any other professional,” she said. “And I also want to make sure that my students are getting the attention they need.”

Before the vote, Council Member Nancy Navarro said it was time for legislators to act on a conversation they’d had “time and time again.” But Rice also urged County Executive Marc Elrich to add additional nursing positions to his recommended budget for fiscal year 2021.


Rice, chair of the Education and Culture committee, and Council Member Gabe Albornoz, chair of the Health and Human Services committee, previously asked Elrich to add more nursing positions last year. Around the same time, the council added roughly $1.2 million for 12 additional school nurses to a 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.

But Austin said adding more nurses would become increasingly urgent as school enrollment continued to grow. She suggested a funding formula similar to one used by MCPS, which would increase the number of nursing positions based on the number of enrolled students.