NC Budget Magnifying Glass: Senate budget makes huge cuts to school nurses despite historical underfunding and clear research

This is the first post of a Budget and Tax Center blog series on public services and programs that face cuts in the budget process or have been underfunded in past years. 

There would be 70 fewer school nurses in North Carolina’s public education program under the Senate budget, even though the statewide average nurse-to-student ratio has been far below national standards for at least a decade. In addition to this 30 percent cut to the School Nurse Funding Initiative, the Senate budget would shift the remaining 166 nurses to the state’s most economically lagging counties, known as Tier 1 counties.

Apparently, the Division of Public Health “asked” for this cut in response to the Governor’s directive to cut spending by 2 percent, per the comments made today by the Fiscal Research Division staff. Senate budget writers factored agencies’ responses to the Governor into their budget proposal.  Again, this is just another decision by leadership that makes clear the harmful choices that must be made when policymakers reduce the availability of revenue—which is what occurred when lawmakers passed last year’s tax plan that drains available revenue for public investments.

There is a mountain of research that shows that health and education go hand in hand. That’s why the state instituted comprehensive school health services in public schools, per the state Division of Public Health:

“North Carolina’s leaders in both education and health agree that health and education are interdependent.  Many students are in school with health-related issues that may impose barriers to learning, requiring timely response that fosters the academic success of every student.”

The national standard for the nurse-to-student ratio is 1 nurse for every 750 students. North Carolina has not met that standard in any year in the last 10 years. In fact, the North Carolina average ratio was more than twice above the national standard for the fiscal years between 2004 and 2006. There was considerable progress made in lowering the ratio in the mid-2000s but further progress was stalled due to the Great Recession, as illustrated in the chart below.

Unlike many areas of the state budget, the school nurse program largely escaped the wrath of budget austerity following the deep economic downturn. Given, how far off-the-mark North Carolina has been compared to the national standard, any further reduction to the program would have been detrimental to student health and learning. Such will be the harmful outcome of Senate budget proposal if it were to be implemented.

The Senate budget would also shift the remaining 166 nurses to the state’s most economically lagging counties, known as Tier 1 counties, based on the goal of having additional counties meet the ratio. Yet, a cursory look shows that many of the state’s Tier 1 counties already meet the target ratio of 1:750, likely due to smaller population sizes, per the map below. Tier 2 and 3 counties, which also serve children who are low-income and lack affordable health care, would just be out of luck.

Source: North Carolina Annual School Health Services Report: 2012-13, page 44

Let’s hope that the House budget writers make no further cuts to School Nurse Funding Initiative. There are revenue options available. Policymakers should stop the additional tax cuts that are slated to begin January 2015. Instead, they should pursue much-needed investments that will build a stronger economy going forward.