When one trained person is the whole emergency system, the system is one absence away from failing.
Every August, school health directors across the country run the same math. Buildings. Nurses. Students with severe or life-threatening medical conditions, such as anaphylaxis or asthma. Staff who can actually respond when something happens between the bus loop and the cafeteria. It never adds up.
The data back that up. According to the most recent National Teacher and Principal Survey from the U.S. Department of Education, only 60% of public schools nationwide have a full-time nurse on site. Nearly 1 in 5 schools has no nurse at all — not full-time, not part-time, not anyone.
In states like North Dakota, Utah, and Michigan, the numbers are even starker. North Dakota sits at 11.6% of schools with a full-time nurse. Utah is at 16.7%. Michigan is at 17.6%. Oregon comes in at 21.4%. These are not outlier districts. One nurse, rotating across buildings. Or no nurse at all.
I’ve spent over fifteen years working on food allergy policy at the state and federal level. And I’ve watched the same failure play out in every kind of institution. The written plan wasn’t the problem. The problem was that the plan relied on one person. A nurse who had every student’s situation memorized. A health aide who had handled every prior reaction. A veteran teacher everyone turned to when things went sideways. Then that person retired, transferred, called in sick, or was just in a different building at 10:40 on a Tuesday — and the plan vanished with them.
If your emergency plan only works when a specific person is in the building, it’s not a plan. It’s a single point of failure.
And school staffing trends are making this worse. Districts are hiring later in the season, budgets for new staff are pared down, and nurse’s duties are stretched across more square footage than the coverage model was designed for. Every person who walks out the door takes their training with them. There is no question that we need more school nurses, no exceptions. And the decision to eliminate full time nursing positions in schools is foolhardy and short sighted. But it is a current reality for which students should not pay the price. If you’re rebuilding your emergency preparedness every fall just to get back to baseline, that’s not a safety system — that’s a recurring expense that buys you a temporary window of readiness.
More training isn’t the answer. The answer is a system that works regardless of who shows up that day.
That means getting the protocol out of people’s heads and into the building itself. Emergency medication needs to be where students actually are — the cafeteria, the gym, the athletic fields — not locked in a nurse’s office that might be in another building entirely. It means clear signage and posted steps right at the point of need, so any trained adult can respond, not just the one person who made it to the August in-service. And it means stock epinephrine, albuterol, and other medications with sourcing, expiration tracking, and refills handled automatically — not sitting on one administrator’s overwhelmed to-do list.
We already know how to do this. Schools don’t run AED programs where the only defibrillator sits in a locked office and only the nurse knows the protocol. AEDs are wall-mounted, visible, and usable by whoever is closest to the emergency. Anaphylaxis and severe asthma deserve the same.
