Making School Nurse Staffing Observable: An Adaptive Staffing Architecture for Ratios, RN Coverage, and Workload

School nurse staffing is often reported as a student-to-nurse ratio. A ratio describes how thinly nursing capacity is distributed but cannot show whether a registered nurse (RN) was present in a particular school when a student needed care. Studies also measure different staffing exposures, including caseload, employment, building presence, and program participation, which limits synthesis. This policy report distinguishes three complementary constructs: caseload ratios, building-level RN coverage, and workload. It compares four policy options and recommends an adaptive framework combining a state-set caseload ceiling subject to recalibration, an RN access floor, and workload-responsive staffing increments. Dedicated financing, school-level reporting, absence contingencies, phased implementation, and scheduled recalibration are required safeguards. The recommendation rests on evidence and a normative judgment that access to RN assessment should not depend on school assignment. The framework is designed to make staffing observable and revisable; it does not establish a validated staffing threshold.