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

Specializes in school nurse.

Who should pay? Well, most people are required to be responsible for meeting the educational requirements for a given profession. It's nice if the employer kicks in, but...

Specializes in IMC, school nursing.

I would suggest pediatric ER experience. Wish I had that most days. I would also recommend a few years experience before making the jump, school nursing can be a very independent environment and the more experience under your belt, the better equiped you are. Good luck.

Specializes in pediatrics, school nursing.

Would definitely recommend spending time in a variety of pediatric environments... First off, even though you've gone through nursing school, take a basic first aid course... You'd be surprised how much you didn't learn about basic first aid (or forgot). For me, I got my feet wet (and caught the school nurse bug) by doing per-diem school nursing in elementary and high schools. You get an idea of the type of situations you may encounter and hopefully the Universe doesn't throw anything too serious your way. Sometimes, you get to be the lucky one who accompanies the T1DM kiddo on the field trip to NYC! I eventually moved on from that and did LTC for adults then a Pediatrician's office. Doing phone triage and seeing actual sick kids coming from the school was invaluable - you see what every kind of sick looks like. I can SMELL strep now, often don't even need to look in the kids throat to know. I know vaccine schedules and day-to-day treatment protocols (asthma, adhd, etc) like the back of my hand. I got bored pretty quick in office nursing, so I took a job at an acute care children's hospital. Floated to NICU and PICU, saw everything under the sun. EXCELLENT experience, especially for any chronic care kids you may encounter. When nights and the floor got the best of me, I went to an outpatient specialty in Developmental Pediatrics. I wouldn't necessarily recommend this in particular. It was the right move for me and made me VERY desireable in the school districts - I think some school nurses don't really see developmental delay as something they can have a hand in treating, but I can handle the ASD, non-verbal, and behaviorally challenging kids really well as a result of my time spent there. I've just started my first year at an elementary school and I am SO. HAPPY.

Feel free to DM me if you have other specific questions!

Thank you so much for your response- I really appreciate that! Glad you love school nursing and found your niche! Sounds like you have a ton of great experience!!! I'm sure I'll have more Qs in the future about this topic as I research more but I think substitute school nursing is a great idea to get your feet wet first and see if its the right fit.. Thanks again :)

Thanks for the reply! Yes, I was thinking that peds ER would be a really good background first, as you never know what you'll encounter when you are the nurse in charge of possibly hundred of school children! I appreciate the response:)

Specializes in kids.

I teach them about the immunization schedule, the difference between 504s and IEPs, how anxity can show as physical symptoms...

Specializes in School Nurse.

I was a regular ER before I switched, but that was ages ago. School nursing is more like Urgent Care in my opinion but with extra paperwork.

Thank you so much!! I really appreciate the support. ?

Specializes in kids.

tnbutterfly you are right on target!

I am thankful to be in a district that is well supported by the community. We have a fulltime nurse in each school; we are 1 MSN, 1 BSN with an MS in a health-related field and 1 BSN. I'm paid at teacher scale, athough not in the union. Same health benefits and retirement plan etc.

The paperwork is endless, the kids are increasingly medically complex.

Skyrocketing numbers of kids dx with allergies (mostly food).

A lot of time spent working through mental health issues that are playing out somatically (typically with headaches, respiratory stress, and GI issues).

Lots of education for parenting grandparents due to the ever-changing family structure.

Families impacted by the opioid crisis.

Increased suicidality in the US population.

More food insecurity

Hardest job I have ever loved!

Specializes in Cardiology, School Nursing, General.

Hello! I'm a CMA working as a Medical Aide at a school. Basically, I do a job of a SN in a way. Before you ask, in Texas we are allowed to have MA, LVNs, and such to do this type of work. Depending on district.

As NutmeggeRN said, the hardest job I ever loved.

I been working at my location for the last 3 years and it's the best job I ever had. Sure the paperwork and the students are demanding, but it's worth it. I have 560 students from K-8.

The thing I love about my job is the children, I love interacting with them. Sometimes they see me as not an authority figure, especially because of my personality, but I use it as my advantage. It makes it easier for them to talk to me about issues that they feel they can't rely to their parents or the admin team. I listen and if it's something concerning, I do let my counselor and admin team know. I also work hard to advocate students with special needs.

These kids look up to you and that's why I work hard for them. Lots of my kids are in the poverty level, so I see a lot issues stemming from home life, school life and outside the home as well.

Sometimes work can be a bit frustrating, especially parents. You can see our side of the forum, a lot of the time, parents give us a hard time. The main thing is how to deal with them and work together for a solution. Sometimes they will not give you that chance, but all you can do is let it go and move on.

I do recommend this type of job is you like children, but also remember you will be isolated most of the time. We have no nurse station or any way to contact our co-workers since they as are busy and unable to talk at times. We do have our head nurse, but they can help as much as they can. As such, most of the job is on hands learning.

This is why most of us head here to talk and ask questions. Lots of the real RNs in the forum have helped me so much in the past 3 years and for that I thank them at the bottom of my heart.

The real ones work harder and know more than me, but love their job even more. If you are thinking of becoming a School Nurse, go for it!