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. Specialties School Article

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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

I could be all wrong on this, but I work for a major pediatric hospital that contracts with school districts to provide nursing services. My pay is hourly, I am able to get benefits, yada-yada. My base pay is less though than I would be if I was a district employee on the a teacher scale. On the upside of this, there are resources backing you from the hospital. We do also participate in the educational retirement system, not social security.

I think there are probably different meanings depending on where you work. I mostly do clinic hands on, but do IHP's and ETR's when necessary.

Specializes in Pediatric.

I am now finishing up my first year as a school nurse. Honestly I am very excited for next year already. I have decided on a lot of changes that I will be implementing. My 2 offices are very dated. The nurses before me both retired out! I have done so much decluttering it is unreal. My question is.....how do you store things?? Like inhalers?? I have a EPI box that l love.

Also how do you decorate? I have PK-6 and 7-12.

Specializes in School Nursing, Home Health.

Glad you like it! Hopefully admin moves this to "School Nurses". Under specialties, "School Nurses" is one for future reference.

When the school year slows down, I start going through old files. The cabinet on my desk is where I keep most used forms and Dr. notes. I also have a cabinet where I keep my inhalers and OTC meds. I put the name on the meds and inhalers are kept in boxes. The cabinet is always unlocked and the students and staff know where to get them.

As far as decorating. I never do lol, I am in HS so it's a bit different

Specializes in School Nurse.

All the student stuff (inhalers, diabetic supplies, etc...) are in plastic ziplock "shoe boxes" in a storage cabinet. Each box has the student name on it.

For each individual student's emergency medication, I have gallon sized Ziploc bags or clear plastic pencil cases that contain the medication, copy of the med order, and emergency plan.

Those individual student bags are separated in a divided hanging shoe organizer that is hung on the wall behind my office door-which cost me $10 at Walmart. This way, everything is organized and easily accessible in an emergency.

Specializes in education, school nursing, med-surg, urgent care.

In my clinic, I inherited a system where meds/inhalers are kept in small Tupperware containers and kept in a locked cabinet (if you have the space for that). I write the student's name on the Tupperware using masking tape so I can reuse it. :)

I'm in a PK-12 independent school. I have a med cart with area for daily routines and 2 drawers for PRNs. As for decorating I bought foam shapes at the dollar store; pumpkins for Halloween /Fall, snowflakes for Winter, shamrocks for St. Patrick's day, and flowers for spring. Nature based things to avoid offending anyone. I have plants in my windows. and I have blocks on one file cabinet and wooden tray, painted to look like stream. I filled it with smooth rocks and "rubby rocks" (my daughter has SPD and named them that because she finds it soothing to hold and rub the clear glass "rock"), I got those at the dollar store too. The kids can touch the stuff and may take one rubby rock. I've even had upper school students request a "rubby rock". I also have hand washing posters and flu prevention info. In my office area of the Health Office I have my mega blocks minion, some stuff friends, and artwork my kids made me, including a bowling pin penguin.

Specializes in School Nurse.

I have a large rolling tool chest for my meds. The large bottom drawer is for inhalers bagged in gallon zip-lock bags, names on top right corner. I made a divider for the drawer and have alphabetized them. For fire drills I roll it out, for evacuation it & I will need to go on SPED bus.

I keep my room fun. I currently have "Pet's Rock" posters, the kids love them.

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My "Med Cart"

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I have an interview for a school nurse position-for a large high school. I've never been a school nurse. What are some interview questions that you think they will ask me? And you got any good responses for those questions? I want to be prepared! Thank you guys!

I'd want to k now:

How long has the current nurse been there and why is she/he leaving?

Who does the Nurse report to? (principal vs. lead nurse, etc.).

What health and wellness policies are in place? (look up on line and see if available to review prior to your interview and you will likely come up wth more questions to ask)

What are the expectations for teaching (health classes for students, emergency prep for staff, etc.).

Do they pay for continuing education for you?

What does nurse do on staff PD days?

Are there subs available? Do you have to find and coordinate coverage if you will be out?

Are you required to go on field trips?

What is the nursing budget for supplies, etc.?

That's just a start ;) Let us know how it goes!

Specializes in School Nurse.

A question I got was "If a parent/student is delinquent with immunizations what would you do"

After three notices, I would call the parent. If this is a I don't believe in vaccinations issue then I would guide them to get the affidavit. If they do want vaccinations then I would tell the parent we will have to exclude the student until the immunizations are current - and the principal will sign off on this. In my sweetest most understanding voice.

Specializes in ICU/community health/school nursing.

You will get the general (Describe a time when you had a conflict; describe a time when you have to pull everyone together, etc.) Think about those.

You might get a very simple dosage calculation - the first school nurse job I interviewed for, the director wanted to make sure we could calculate an insulin ratio.

You will get a question about prioritization: Teacher with chest pains, student having an asthma attack and a kid with a possible fracture all show up at once in your clinic. Give some thought to that one.

"A teacher keeps sending you a student who's falling asleep in class. What would you do?" My answer: is this medical or behavioral? Multidisciplinary team approach once you find out it's not medical.

"What school do you want to go to?" Counter that one by asking what's available. If you really want high school nursing, just know that there are about 4 elementary nurse gigs to every high school spot. Answer the question by identifying your strengths and add "but I'm open to going where the need is greatest" (unless that's not true).

Find a way to give answers that highlight your assessment skills, your ability to take a good history, and your ability to work well with a multidisciplinary team.

I remember saying "well, it depends" a lot at my interview for this job.

Good luck!!