School nurses, psychologists, and other health workers are experiencing a daunting dilemma: They have a rapidly growing workload, but many don’t feel like they have enough support or resources to effectively meet the demands.
Results from a new nationally representative survey from the EdWeek Research Center paint a picture of a helping profession overwhelmed with student needs, both physical and mental. The volume of work—coupled with salaries lower than they could get outside of the school system—has prompted some school health workers to consider quitting, even though many feel a responsibility to the children in their care.
“People who go into education want to do everything they can to support students, so they’ll work themselves to death to provide that support,” said Jason Pedersen, a school psychologist in the Derry Township district in Hershey, Pa.
But, he added, “the expectation for additional job functions has increased. We’re typically asked to do more with less. We are trying to do the best we can in all the helping professions. … There are people who are drowning—they burn out.”
The EdWeek Research Center surveyed 3,480 school health workers in March. The sample included about 2,300 school nurses, 350 social workers, and 245 school psychologists, among other health-related job titles.
Most of the school health workers surveyed said that since 2019, the number of students struggling with anxiety, depression, vaping or smoking or chewing tobacco, marijuana use, and obesity has increased—and are challenges for their school or district. Anxiety was the largest health challenge, with 59 percent of school health workers saying it was a “major” challenge.
And the survey results indicate that they’re having trouble keeping up: Relatively few school health workers said their school or district did an excellent job meeting students’ health needs.
Twelve percent of school health workers said their school was “very” or “somewhat” insufficiently able to meet students’ physical health needs, and nearly a quarter said the same about meeting students’ mental health needs. (About 30 percent said their school or district wasn’t sufficiently meeting students’ sex education needs, and 7 percent said their school or district did not try to meet those needs at all.)
Staff shortages create ‘overwhelming’ conditions
One major obstacle to meeting students’ health needs: staff shortages. Many school districts don’t have enough psychologists, counselors, or nurses on campus to appropriately respond to the mounting needs, leaving these health workers with oversized caseloads.
Adrienne Floriano, a school nurse at a large, urban school district in southern California, said her district has two vacant nursing positions right now. As a result, she is responsible for three sites—a preK-8 school, a high school, and the health clinic at the district office, where she administers vaccines and gives physical exams.
She is constantly running between locations. At one school, two students have diabetes and need her to give them insulin injections a couple times a day. She’s also responsible for special education assessments, attending individualized education plan meetings, devising care plans for students with conditions like asthma, and conducting screenings for height, weight, and vision, along with making referrals to counselors as needed.
“It’s so overwhelming,” she said.
And when school health workers are stretched thin, they’re not always able to provide the full complement of supports for students—especially since the priority is typically special education services, which schools are federally mandated to provide.
“Usually, if you’re stretched really thin, your administrators are going to say, ‘Focus on making sure we’re in compliance with special education laws,’ and help address different mental health needs or systems-level interventions or preventative services second or third or fourth,” said Eric Rossen, the director of professional standards for the National Association of School Psychologists.
The catch is that providing those things help to prevent the need for special ed. compliance in the first place, he said: “It is a bit of a nasty cycle.”
Pedersen, who was named the 2023 School Psychologist of the Year by NASP, said he’s heard from school psychologists who are tasked with conducting as many as 150 special ed. evaluations in a 180-day school year—putting them in a “reactionary role,” he said, and leaving them little time to focus on anything else.
“That’s not why people go into school psychology,” he said. “It’s something we’re committed to, and want to do, … but oftentimes that ends up being the only mechanism they have to provide support for students.”
Pedersen added: “They’re asked to do the same function over and over and over again with no end in sight. They don’t feel like they’re making a difference.”
Some school health workers will quit
About 20 percent of school health workers said they were likely to leave their current job in the next two years to pursue the same type of work for a different employer, and about 30 percent said they were likely to leave their current profession entirely in the next two years to retire or pursue a different line of work.
Not all employees who say they intend to quit will actually end up doing so, for financial and logistical reasons. And the percentage of school health workers eyeing the exit door is lower than the percentage of teachers who say they intend to quit within the next two years—that figure is 35 percent, according to another EdWeek Research Center survey earlier this year.
Still, the numbers are cause for some concern, given the pipeline challenges in recruiting new school health workers to the field, experts said.
When asked why they were planning on leaving their current position, 35 percent of school health workers said they could get a higher salary elsewhere. Since the pandemic, many hospitals have increased their salaries for nurses, given workforce shortages and market pressures.
“I’m content to be where I’m at, I love what I do, but it’s hard knowing that, gosh, I could go somewhere else to work and earn another $30 to $40 an hour,” said Julie Light, a school nurse in a rural area outside of Cedar Rapids, Iowa.
In open-ended responses to the EdWeek Research Center survey, many school health workers indicated plans to retire. Others said they were feeling overwhelmed and drained from the burdens of the job.
“We have been overworked, and I am burning out,” said one school health worker.
“Too emotionally draining,” said another.
“Is education my job, or is it supposed to be my life?” another school health worker said. “The entire profession is unrealistic right now, but for some reason I stick with it because I feel SO bad for the students who are stuck in the middle.”
Psychologists cite too much work and not enough help
Twenty-one percent of school health workers said they are considering leaving because they don’t have enough support from district or school leaders, and 18 percent said their workload is too high.
School psychologists were significantly more likely than other school health workers to say that they were considering leaving because their workload is too high—44 percent, compared to 15 percent of nurses and 27 percent of social workers. They, along with health and sex education directors, were also the most likely to say they don’t have enough support from district and school leaders.
Rossen said school psychologists often feel like they have “a bunch of work dumped on them without sufficient support.” The message from administrators, he said, seems to be: “We are asking more, but giving you the same or less to do that ‘more’ with.”
“It’s a lot of those little things where there isn’t a sense of appreciation, there isn’t really a sense of being seen,” Rossen said. “It creates this sense that it’s a bit of a grind, and it creates this churn in education.”
One form of support could be adequate time and opportunity for professional learning. School health workers overwhelmingly said they could benefit from professional development in a handful of areas. The top of the list: helping students cope with anxiety.
But oftentimes, many districts don’t provide PD that’s specific to school health workers. Instead, district-provided trainings are typically tailored to classroom teachers.
School psychologists are “forced to sit in on 6th grade reading pedagogy, versus learning about something like how to deal with suicide threat or risk,” Rossen said.
School nurses, for instance, need training on how to be health leaders in their school districts and communities, and how to use and collect health-related data, said Kate King, the president-elect of the National Association of School Nurses and a middle school nurse in Columbus, Ohio.
They also need to understand the “gamut of mental health diagnoses, treatments, and evidence-based practices,” she said, since many students often show up to the nurses presenting physical symptoms of mental health challenges. (Frequent stomachaches, for example, could be a sign of anxiety.)
Yet many districts don’t have school nurse administrators overseeing health services programs, she said, leaving school nurses largely on their own.
“If as a school nurse, your boss is the principal or the person in charge of special ed. or—maybe a little better—a counselor, those folks don’t always know how to advocate for professional development specifically for nurses,” she said.
School health workers said in interviews that the bulk of their professional development came from state and national professional associations. But districts don’t always cover the registration fees and travel costs associated with that training, said Pedersen, the school psychologist in Pennsylvania.
A ‘plea’ for more support
School health workers say they hope states and districts will invest more into the helping professions, especially as student mental health needs continue to rise.
“There’s a lot we can do to support teachers,” Pedersen said. “My plea is that people recognize that. These are highly trained people and they’re on your staff, and you can use them to greater effect to support your goals—[which can] keep them engaged and [wanting] to stay.”
After all, many school health workers say they care deeply for their students and feel passionate about the work.
“It’s a great job,” said Floriano, the school nurse in California. “It has been hard, and there are a lot of challenges—obesity, mental health, the drug problems are all issues—but what a great place to be able to combat those and make a difference.”
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