Should Athletic Trainers Be School Nurses? One Legislator Thinks So.

• Athletic trainers in Iowa could work as school nurses as early as July if recently introduced legislation is passed. 
• Rep. Shannon Lundgren introduced the bill in mid-January, and a week later a subcommittee recommended passage. 
• The Iowa Athletic Trainers Society supports the move, but education and healthcare organizations are opposed. 

Athletic trainers in one state could soon step on the field as school nurses — if recently introduced legislation gains enough momentum. 

Iowa Rep. Shannon Lundgren, who authored House Study Bill 10, told the Des Moines Register her goal was to help school districts within her congressional district that have had issues with hiring school nurses and “need more options.” 

“What I would like to do is work towards that middle ground,” she said. “Not replacing our school nurses. That was never my intent. But giving the flexibility to our schools to have somebody with some degree of medical training that can do a little bit more than a teacher with maybe medication training or something of that sort.” 

She introduced the bill on Jan. 15, and on Jan. 22 a subcommittee recommended passage. 

If approved, the bill would allow Iowa school districts to begin employing athletic trainers “to provide health services to its students” beginning July 1. Each school district would be required to employ one school nurse or athletic trainer for every 750 students in the district. 

Who Supports Athletic Trainers as School Nurses?

Several organizations from the educational and healthcare industries came out against the measure, while the Iowa Athletic Trainers Society (IATS) is in favor. 

An Iowa State Education Association lobbyist, who spoke at a recent subcommittee meeting, doubted that athletic trainers have the skillset to handle special healthcare needs, such as writing health plans. 

“We have school nurses that serve folks that are as young as 3 and as old as 18,” Melissa Peterson said. “That again is not something that traditionally has been under the purview of an athletic trainer. We appreciate we have shortages, but we shouldn’t be putting students at risk.” 

However, IATS President Nate Newman, who also spoke at the meeting, argued that athletic trainers are trained to administer medication, treat seizures, and respond to behavioral health issues, among other medical events. 

“All of these things are required to be taught within our programs and for our students to know and be tested on and be ready to practice when they start,” he said, according to the Des Moines Register report. 

School Nurse vs. Athletic Trainer

Much like nurses, athletic trainers must hold professional licensure through a state regulatory board and renew that license on a regular basis. A master’s degree from an accredited athletic training program is also required, along with passing a Board of Certification (BOC) exam, according to the National Athletic Trainers’ Association.  

A BOC-certified trainer is “educated, trained and evaluated” on the five following areas, referred to as practice domains: 

• Risk reduction, wellness, and health literacy. 
• Assessment, evaluation, and diagnosis. 
• Critical incident management. 
• Therapeutic intervention. 
• Healthcare administration and professional responsibility. 

Rural Nursing Shortages and the School Nurse

Qualification differences aside, the bill’s introduction, according to Lundgren, stemmed from the larger issue of struggling to hire nurses in rural areas. In Iowa alone, more than 60 counties have Health Professional Shortage Area designations, according to the Health Resources and Services Administration. 

A 2021 study from the National Association of School Nurses found that only 65.7% of schools have a full-time nurse and 6.3% have no nurse at all. The Midwest has the second-highest percentage of schools with no nurse on staff at 7.5%. 

The Bottom Line

A bill introduced earlier this month in the Iowa Legislature would allow athletic trainers to be hired as school nurses. On Jan. 22, a subcommittee recommended the measure be passed, despite opposition from education and healthcare organizations. The Iowa Athletic Trainers Society supports the bill. 

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