Can a LPN be a school nurse?

HazelLPN, LPN · Dec 8, 2010

I'm not in AZ, but I'm a retired LPN now working as a substitute assistant school nurse. The real school nurses here are all RNs with at least a BSN education and a license from the state department of education. Many also hold MSN or MEd degrees. They have the same contract and salery scale as the teachers with the same benefits and union protection. The assistants are RNs without the BSN or license from the state or LPNs and generally work only with special needs students who require more attention than the regular school nurse can give them. I consider myself a volunteer, because the pay is peanuts and nowhere near what a nurse with my years of experience is worth (54 years in nursing, 44 years critical care, 17 years pediatric/neonatal critical care). I don't do it for the money....I have a good retirement and I married well...I want to stay active as long as I can before they carry me off to a LTC facility.

I do enjoy the job. I work about once a week, and do very little nursing. I'll do some trach care and give some tube feeds...change diapers here and there.....occasionally give a med....but there is a lot of time where I'm helping the students. Yesterday I helped an MRDD student do an art project and the week before I played checkers with a high school sophmore who I had taken care of as a baby 15 years earlier when she was in the in the NICU on ECMO!

If you really want to do school nursing, I would encourage you to get your BSN and take a job in critical care. Why? Many of the school nurses working seem to be former ICU nurses. You need to have excellent assessment skills and have a lot of automy. I may be biased, but I think that critical care is one of the best places to learn these things. After several years in the ICU, get your license to be a school nurse.

Best to you,

Mrs. H.

mmm333, LVN · Mar 7, 2011

No offense to LPNs, but by law they care for stable patients with predictable outcomes and cannot perform assessments, teaching, or management functions.

This might be useful in making educated guesses about a cold, but they aren't accountable for spotting things like anaphylaxis, paralytic ileus, aneurysm, or other emergencies. If the RN was onsite, then the LPN would be fine. If not, they might be jeopardizing their own license.

EMTs/medics would almost be more suited to deal with assessment and referrals in this prehospital-type setting. They would definitely serve as a good interface with EMS if needed. They'd have to be working under an RN within the district in either case.

It seems like the reality vs. the laws/statutes are totally out of sync in these unfunded school nurse environments. There are many unenforced laws out there demanding all sorts of credentialing which many schools can't currently afford to pay someone for having. In California there was a 1978 proposition called prop 13 which allowed schools to funnel money where they saw fit, and essentially stop paying for full-time school nurses. So most schools are totally out of compliance with various statutes about what kind of school nurses they are supposed to have. This is one reason why we are seeing whooping cough, mumps, flus, etc. making comebacks.

It seems like the schools are trying to work out a vision where they have RNs who also become the health teacher and help disabled children as well, filling several tasks and running clinic hours each day when they aren't teaching or assisting. In reality this may be alot to juggle given the size of the school/campus/nature of student body & community, etc.

Now, some staffing agencies will place an RN or LVN in a school setting to assist on particular student with special needs often involving mobility & ADLs. This role is not a full "school nurse" who runs a clinic/teaches/assesses, so they aren't really "the" school nurse and don't need all the specialized education unless they want to get involved on that level/scope of practice. Some states have a specific Scope of Practice written out for school nurses.

kythe, LPN · Mar 7, 2011

I'm in AZ also, but I've found that job descriptions and opportunities vary by school district. When I was in nursing school, each individual school in that particular district had an RN school nurse. We did some of our clinicals in that environment.

Where my kids go to school now, there is one RN working for the entire district and each individual school has a "health aide" who calls herself "school nurse". We had been in the district for over a year before I even realized they are not real nurses. I have gotten my kids to call her "health aide" rather than "nurse", because I feel she is lying.

I have considered applying as a health aide, but I've been told I'm overqualified since all they do is paperwork under the "management" of an RN. I disagree, I actually had a parent approach me once asking if they could hire me privately to go to the school during the day to give their child insulin, since the school had no licensed personnel to do this. I refused because it is legally the school's responsibility to provide medical care for children, whether they like it or not.

I think the school district is trying to cut corners by denying real medical personnel. It doesn't make sense though, because school nurses don't honestly get paid much more than health aides.

There is another district I am aware of that has 1 RN overseeing 3 schools, also a result of budget cuts in the last few years. But they also have no place for LPN's except as a health aide.

HazelLPN, LPN · Jul 9, 2011

No offense to LPNs, but by law they care for stable patients with predictable outcomes and cannot perform assessments, teaching, or management functions.
This might be useful in making educated guesses about a cold, but they aren't accountable for spotting things like anaphylaxis, paralytic ileus, aneurysm, or other emergencies. If the RN was onsite, then the LPN would be fine. If not, they might be jeopardizing their own license.
EMTs/medics would almost be more suited to deal with assessment and referrals in this prehospital-type setting. They would definitely serve as a good interface with EMS if needed. They'd have to be working under an RN within the district in either case.
It seems like the reality vs. the laws/statutes are totally out of sync in these unfunded school nurse environments. There are many unenforced laws out there demanding all sorts of credentialing which many schools can't currently afford to pay someone for having. In California there was a 1978 proposition called prop 13 which allowed schools to funnel money where they saw fit, and essentially stop paying for full-time school nurses. So most schools are totally out of compliance with various statutes about what kind of school nurses they are supposed to have. This is one reason why we are seeing whooping cough, mumps, flus, etc. making comebacks.
It seems like the schools are trying to work out a vision where they have RNs who also become the health teacher and help disabled children as well, filling several tasks and running clinic hours each day when they aren't teaching or assisting. In reality this may be alot to juggle given the size of the school/campus/nature of student body & community, etc.
Now, some staffing agencies will place an RN or LVN in a school setting to assist on particular student with special needs often involving mobility & ADLs. This role is not a full "school nurse" who runs a clinic/teaches/assesses, so they aren't really "the" school nurse and don't need all the specialized education unless they want to get involved on that level/scope of practice. Some states have a specific Scope of Practice written out for school nurses.

It depends on the state where the LPN works as LPN scope in one state is not the same as it is in the next state. I worked most of my career in critical care, nowhere in my scope of practice did it state that I was restricted by law to "stable patients with predictable outcomes". We didn't have stable patients in the ICU, even the more stable ones have the potential to become unstable. I was responsible for the shift assessment but was limited in that I could not write the initial assessment on admission. Again, this varies from state to state.

Lots of misinformation about LPNs out there. If the question is "can an LPN do (fill in blank) the answer is almost always "it depends on the state and facility where the LPN practices". There are LPN school nurses out there, but only in certain states.

Best to you,

Mrs H.

MusicNurseCarrlee, LPN, LVN · Jul 9, 2011

I worked as an LPN/LVN school nurse in special education classrooms with "medically fragile" children in both California and Nevada through agency placement(very rewarding experience).There are also home health agencies that place LPNs one on one with students in schools. I think it depends on the state, the school system and the medical staffing needs at any given time. I wish you the best on your journey: )

LVN_it1995, BSN, RN · Jul 9, 2011

I am in California and most LVN's have to take the position of Health Assistant to the RN who usually has a masters degree.

JustBeachyNurse, LPN · Jul 9, 2011

In my state, the title of school nurse requires a BSN & special education certification from the state dept of education. Many school nurses just take the extra couple of classes and earn their MSN while getting their school nurse certification.

Larger districts sometimes have health care assistant positions that theoretically could be filled by an LPN, CNA, or EMT. However these jobs pay less than $10/hr usually as they are considered paraprofessional positions.

There are LPN's that are hired (publicly, privately or via agency) as a 1:1 care assistant for a child with additional medical needs (like trach, g-tube, CP, seizure precautions) or medically fragile. In many situations the nurse starts at the child's home and is his personal nurse on the bus ride to school, stays with child 1:1 throughout the school day, lunch, gym, etc and rides the bus with the child to the child's home. There is often also a 1:1 educational paraprofessional aide to help the child with academics as needed. The LPN on these cases are not permitted to provide nursing care to the other students. These nurses cannot legally use the title of "school nurse" because of the education, license, and certification required for the title.

AZMOMO2 · Jul 9, 2011

In AZ there are school nurses currently working and there are job posting for such.

platinum_garb · Jul 16, 2011

The school nurses in chicago that are LPN's with experience are making $18-19/per hour, with good benefits. this is th route that i know two "burned" out nurses have took, leaving LT and hospital.

I know this post is a bit old, but I just wanted to say that in my situation this pay info is incorrect. The pay rate varies based on the agency you go with. (I made more). It's best to shop around. Also, I was eventually hired by the Board of Ed and made even more plus great benefits. LPNs should never settle for under mid-20's an hour or better. Better rates are out there!

mmm333, LVN · Jul 16, 2011

It's sometimes hard to respond to posts globally instead of doing so with a bias toward my own home state... yes, it does always depend on the state.