Seizure Safety, School Nursing, and the Gap Between Policy and Practice

Michigan’s Seizure Safe Schools legislation is an important step forward. The legislation focuses on seizure recognition training, individualized seizure action plans, emergency medication administration, and legal protections for those responding to students with epilepsy. These are meaningful protections, and increasing seizure education in schools will absolutely improve safety for students.

But legislation and implementation are not the same thing.

In smaller districts, one nurse may cover up to eight school buildings, with reported response times estimated at up to ten minutes.

For a child actively seizing, that gap is not just theoretical;

it is clinically significant.

It creates a system where the expectation of care exists, but access to that care does not.

School nurses are expected to coordinate care plans, train staff, educate school personnel, and prepare buildings for neurological emergencies, often while covering multiple schools and not being physically present when those emergencies happen. Delegation becomes part of the structure of care itself.

Training is a foundational step toward more people recognizing seizures and understanding how to respond will save lives and reduce harm. But training alone cannot replace access to licensed clinical care during an active neurological emergency.

What is happening with seizure care in schools reflects a larger issue across neurological care systems: the expectation of safety without the staffing infrastructure to support it.

Research has shown that seizure training programs can improve school nurses’ confidence in managing epilepsy in the school setting. National school nursing guidelines also continue to emphasize that safe seizure management requires not only education, but appropriate staffing and the physical presence of a nurse when care is needed. Current data shows that many school nurses cover six to ten buildings simultaneously, significantly limiting their ability to respond effectively during emergencies.

This is not isolated to one district. It is systemic.

As both a nursing student and the mother of a child with epilepsy, this issue is deeply personal to me. I have written to Michigan state senators regarding seizure safety legislation, outlining both the importance of seizure education and the realities of implementation in under-resourced districts. Training the general population will make schools safer. But it does not mitigate the entirety of the risk when there is no clinician physically present to respond.

The gap between policy and practice remains.

Children with epilepsy deserve more than emergency protocols on paper. Nurses deserve systems that allow them to practice safely and effectively. Families deserve to know that when a neurological emergency happens at school, timely clinical care is actually accessible.

The Seizure Safe Schools Act moves the conversation forward and is foundational across 26 states currently. But meaningful neurological safety in schools requires more than awareness campaigns and delegated response plans. It requires staffing standards, accountability, and recognition that neurological emergencies cannot wait for someone to drive across a district.

Because for families living with epilepsy, response time is never just a number.

It is the space where outcomes change.

References:

• Austin, J. K., Kakacek, J. R. M., & Carr, D. (2010). Impact of training program on school nurses’ confidence levels in managing and supporting students with epilepsy and seizures. The Journal of School Nursing, 26(6), 420–429. https://doi.org/10.1177/1059840510380206
• Epilepsy Foundation of Michigan – Seizure Safe Schools Advocacy Toolkit
• Michigan Senate Bill 434 (2025)
• Michigan House Bill 5329 (2023)
• Neumann, L., Thompson, M., Clark, E., & Stanislo, K. J. (2025). Introducing NASN’s school nursing evidence-based clinical practice guideline: Students with seizures and epilepsy CPG implementation toolkit. NASN School Nurse, 40(2), 64–72. https://doi.org/10.1177/1942602×251317611
• Raman, L. L., McCallum, S., Berg, A. T., & Killian, S. (2019). Investigation into seizure management in schools.