School Nursing

Today's school nurses not only deal with the typical bruises and tummy aches that have always been part of school life, but must now contend with a student population that is increasingly more medically fragile.

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School Nursing

Nurses began working in schools in the 1800s to identify and quarantine people with communicable diseases. Now, their main responsibility is to provide nursing care and health counseling to students with increasingly complex medical conditions and chronic illnesses, disabilities, challenges and special needs such as ADHD and autism, to name a few. Some school nurses are devoted to one-on-one care with medically needy students who otherwise would not be able to attend school.

According to the National Association of School Nurses (NASN) (2019) report, "only 39 percent of schools employ a full-time school nurse, while 35 percent of schools employ a part-time school nurse. Twenty five percent of schools do not a have a school nurse at all".

The National Association of School Nurse’s (NASN) definition of School Nursing: “a specialized practice of nursing, protects and promotes student health, facilitates optimal development, and advances academic success. School nurses, grounded in ethical and evidence-based practice, are the leaders who bridge health care and education, provide care coordination, advocate for quality student-centered care, and collaborate to design systems that allow individuals and communities to develop their full potential.” (NASN Board of Directors February 2017).

Skills/Qualities

  • Must possess a broad knowledge base that covers pediatric, public health and mental health nursing as well as school law and policy.
  • Must have Leadership qualities and the ability to work both independently and collaboratively to manage health programs effectively and advocate for needed change.
  • Should have strong interpersonal skills and enjoy working with children, teens, family members, educators and administrators of diverse backgrounds.

Work Environment

School nurses spend most of their workday in the school health office in public, private, vocational, alternative and early childhood schools across the United States. They also move around the school assisting students, attending meetings, giving presentations, and observing learning.

Some positions require the school nurse to travel between schools. Most school nurses work regular daytime school hours, many of whom enjoy the same Summer and holiday vacations as students.

Experienced school nurses may advance to positions of greater responsibility in which they coordinate school health programs at the district or state level. Others go on to work for public health agencies. Nurses who hold a doctorate may conduct research in the field of school nursing or teach classes at the university level.

Duties/Responsibilities

School nursing has multiple components and the role of the school nurse is a broad one, dependent on many factors, including the school setting (rural, urban, suburban), health needs of the student population and the availability of specialized instructional student support services and programs. Some of the duties include:

  • Develop and implement health plans in accordance with federal laws which require schools to develop individualized education plans for students with disabilities.
  • Dispense medications and show teachers how to administer care.
  • Work with educators to set developmentally appropriate learning standards for physical education programs.
  • Serve as a resource for faculty teaching health-related content.
  • Assess the physical as well as emotional status of students.
  • Provide health assessments of students to determine eye problems, hearing impairment, growth and other health problems that may negatively affect the student's studies.
  • Implement plans for intervention and remedies as well as follow ups for students who are ill.
  • Provide crisis intervention in cases of injuries and acute illnesses or emotional problems.
  • Develop plans for the control of contagious diseases by way of immunizations, timely discovery, and close monitoring.
  • Facilitate normal development and positive student response to interventions.
  • Provide leadership in promoting health and safety, including a healthy environment.
  • Provide quality health care and intervene with actual and potential health problems.
  • Use clinical judgment in providing case management services.
  • Actively collaborate with others to build student and family capacity for adaptation, self-management, self advocacy and learning.

Education

  • Some schools employ LPNs. However, the NASN recommends an RN with a BSN.
  • Additional training and background checks may be required in some states.
  • School nurses may pursue voluntary national certification, which is administered jointly by the NASN and the National Board for Certification of School Nurses.
  • Most schools prefer nurses with at least two years experience in an acute care setting.

Certification

National Board for Certification of School Nurses (NBCSN)

The NBCSN offers the Nationally Certified School Nurse (NCSN) certification examination.

Eligibility  (not all-inclusive)

  • Graduate from accredited RN Nursing program with BSN or higher degree
  • Successfully pass NCLEX-RN
  • Current, unencumbered RN license in U.S. state of practice
  • Minimum 1,000 hours worked within the 3 years prior to taking the test
  • RNs enrolled in MSN programs that do not confer BSN may not apply to take the examination until completion of the graduate program

Publications

The Journal of School Nursing

NASN School Nurse

NASN Weekly Digest

Job Outlook

The enactment of the Affordable Care Act could provide an opportunity to strengthen a nurse program that serves the nation's 52 million school-age children. For many of these students, the school nurse is the sole provider of access to health care.

Health care reform's emphasis on wellness is consistent with the goals of school nurses, who provide continuity of care and promote healthy lifestyles for students during their most critical developmental years. They perform early intervention services such as periodic assessments for vision, hearing and dental problems with the goal of removing barriers to learning.

Salary (2020)

School nurses enjoy competitive salaries.

According to ZipRecruiter, the yearly salary for a School Nurse in the U.S. is $60,739.

According to salary.com, the average School Nurse salary in the U.S. is $51,074 and ranges between $40,807 and $64,478.

A Day In The Life Of A School Nurse

Resource/Reference

National Association of School Nurses (NASN): Definition of School Nursing

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tnbutterfly - Mary

About tnbutterfly - Mary, BSN

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tnbutterfly has been in nursing for more than 35 years, with experience in med-surg, pediatrics, psychiatrics, parish nursing, and disaster nursing. As the allnurses.com Content & Community Director, don't hesitate to contact her if you have suggestions or need assistance.

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Specializes in Peds, Med-Surg, Disaster Nsg, Parish Nsg.

This would be a great place for school nurses to share advice, comments, experiences about school nursing to those who are considering this avenue of nursing.

What do you love about your job?

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Specializes in OB/GYN.

Good Morning to all nurses!

I am a public health nurse seeking to pursue public school nurse. I have 5 kids of my own and find it diff with the schedule, job is endless with its paperwork. I need some peace of mind and more stability despite tje lower salary of school nurse. Any advice of pros and cons of public school nurse? Please advise. Thank you and have a great day!

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As a school nurse what are you legally required to report?

Are you required to share everything with the parents?

For example, a student has an eating disorder. Is that something you have to tell the parents or can you keep that between you and the student?

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Every nurse is a mandated reporter. I would have a conversation with the school counselor, as they may have protocols for family meetings. You should not take this on yourself.

We can not give legal advice per TOS, however, as a thought process--I would never, ever get into conversations with kids without stating that confidentiality is important, however, dangerous behaviors can not be. If a child is eating disordered, this does take more than just the school nurse to discuss with parents.

It may be worth it going forward to develop policies regarding this, a crisis intervention/management team with protocols.

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Specializes in School Nursing.

I have been a lurker on the school nursing thread for a while now and I'm happy to say I have been offered a position as a school nurse at the district I actually grew up in and went through all my K-12 education at!

I have two years acute nursing experience on a very busy neuroscience floor. Any tips for a newbie transitioning from the hospital??

For example when I say busy I mean: 6:1 patient to nurse ratios, one CNA for 24 patients. My usual patient load is 2 neurosurgical cases (I.e. crani's, lumbar drains, new VP shunts...) 2-3 acute CVAs and usually one generic medical patient. So I am very used to running my booty off and not getting lunches or breaks. I'm super excited to work with children (which is a big passion of mine) but I'm also looking forward to having a healthier work environment for myself!!

P.S. I'll have to get my pink for wednesdays :D

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Congrats!

I am only a student nurse but I know during our rotation for school nursing it was a circus. On the day we went, there were 5 kids trying to get out of class, 2 asthmas, 1 diabetes and 1 marijuana joint in a trashcan fire (both resulted in the asthmas visits). Did I mention this was a really good school too?

But you sound like you're ready for it. Good luck and enjoy!

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Specializes in School Nursing.

Thank you guys! My first day is tomorrow! The good thing is I do get a lot of training so I'm more excited than nervous!

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Hope your first day went well! Congrats and welcome!

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Specializes in CVICU, SchoolRN, MICU, PCU/IMU, ED.

Best advice I can give as someone that's recently transitioned from critical care to the school setting - question everything the kids tell you (I'm in an elementary), call the parents often to verify/make them feel in the loop, and expect the unexpected - even more so in the school setting.

I like working with the kids - they make me laugh, I feel like I'm making a difference with some, and I can't make up the stories I've heard, I really need to write some of these down so I can make a book.

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Specializes in Peds, Neuro, Orthopedics.

Congrats! I'm a former neuro nurse too, so I can sympathize. Same patient load, too. So happy I made the switch, you will be too! My busiest days in school nursing are nothing compared to trying to take care of 6 neuro patients!

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Specializes in School Nursing.

My question is regarding the above titles-

What difference if any are there between the two?

I am located in California if that makes a difference.

RN started out as Credentialed School Nurse, but has since signed a contract and says she is only allowed to do 504's, IEP's and screenings.

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