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Appropriate School Nurse and Counselor Ratios

Most people remember school nurses as the people who gave out band-aids and sent you home when you were sick and school counselors as the people who helped them organize college applications.

That was then. This is now.

School nurses promote student physical and mental health by providing care coordination, assisting in on-going care for children during the school day, and intervening in acute emergencies.

School counselors help students manage academic planning and success, post-secondary pathways, mental health, emotional regulation, interpersonal skills, conflict management, and short-term counseling.

Together these individuals are often the first line of defense with students who are sick, being bullied, have suicidal thoughts, or are in abusive home situations.


The COVID-19 pandemic has brought on an increased need for both physical and mental health supports for students. These heightened needs highlighted and stressed services that were already understaffed.

School Nurses

The National Association of School Nurses (NASN) and the American Academy of Pediatrics (AAP) recommend a full-time nurse in each school and the NSAN recommends a nurse-to-student ratio of 1-to-750. Georgia’s current ratio of nurses to students is 1-to-1,734, over double the recommended number. Many schools in Georgia lack their own designated nurse altogether. It is not uncommon for rural and low-income communities to share a single traveling nurse between locations.

In school districts with shared nurse-systems, staff members like front office advisors and administrators are often left to dole out medications and essential treatments to students – a role far outside of the scope of their training. Ongoing treatment is a part of every school day, as over 40% of school-age children have a chronic-health condition.

Studies have shown that improved nurse-to-student ratios improve both the health and education outcomes for students, including reducing chronic absenteeism, reducing teen pregnancy rates, and increasing family engagement.

School Counselors

The American School Counselor Association (ASCA) recommends a 250-to-1 ratio of students to counselors. As of 2020, Georgia schools have an average student-to-counselor ratio of 432-to-1, nearly double the recommended level. In rural and low-income communities, these ratios worsen.

With such vast numbers of students to support, school counselors get bogged down by paperwork and administrative activities outside of their roles, only leaving them enough time to support students with the highest needs. Students facing impending mental health crises or who need guidance during a tumultuous period may go untreated altogether.

It is difficult in the best of times to learn in poor mental health. The turbulence and isolation brought on by the COVID-19 pandemic has caused steep increases in mental health concerns for students, and is disproportionally effecting students from low socioeconomic status households.

Research ties appropriate ratios between students and counselors to better health and academic outcomes. Students who are able to get 1-on-1 support from counselors perform better on college entrance and placement exams and are able to learn more about the job and education opportunities available to them, strengthening Georgia’s workforce pipeline.

Proposed Actions to Take

Through leveraging unspent federal COVID relief dollars, as well as partnering with local health clinics and medical associations, Georgia can uplift physical and mental health in our educational communities and achieve appropriate ratios of students to nurses and counselors.

At a roundtable involving educational experts and legislators, the following priorities were identified.

  • Establish clear definitions and outlines on the role of nurses and counselors in the K-12 system that align with the suggested NASN and ASCA standards.
  • Expand mental and academic wellness staff by establishing a maximum ratio of 1-to-300 counselors to students.
  • Expand health wellness supports by legislating that every school must have a minimum of 1 active nurse on campus at all times.
  • Create a clear budgetary priority to fund the above supports annually.
  • Increase partnership incentives between local health clinics and school systems to support student needs that fall outside of nursing and counseling staff roles.

These key legislative levers can greatly expand the support available for our K-12 students and re-prioritize their wellbeing during this global health crisis.

Sources and Additional Readings

American School Counselor Association’s Guidelines for The Role of Counselors in Schools

Unique Challenges Facing K-12 Schools Reopening During the COVID-19 Pandemic

National Association of School Nurses’ Fact Sheet

CDC Study on Parent, Student, and Teacher Mental Health Outcomes During COVID-19

Current COVID-19 Response Guidelines For Georgia’s K-12 Schools

Federal Economic Relief from COVID-19

ASCA Summary of Studies on How School Counseling Affects Student Outcomes

CDC Outline of Long Term COVID-19 Conditions and Related Disability

The Role School Nurses Play in Preventing Teen Pregnancy

GaSPC Requirements to Become a School Counselor

How School Nursing Has Evolved

Updated on June 14, 2023

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