The National Association of School Nurses (NASN) defines school nursing as a specialized nursing practice that advances the well being, academic success, lifelong achievement, and overall health of students. The role of the school nurse has evolved, as their responsibilities often go beyond just ensuring that basic health services are available to students during the school day.
The mission of school nurses is multi-faceted and includes:
- Providing preventive services
- Identifying problems in the earliest stages
- Overseeing interventions and referrals as a way to foster health and ensure educational success
Naturally, school nurses work to promote a healthy school environment. Beyond promoting health and safety for students within the school facility during the school day, they also encourage students to maintain healthy habits and behaviors when they are not in school. These nursing professionals are also responsible for identifying both actual and potential health problems, providing case management services, and collaborating with educators, school officials, students, and families to ensure students respond positively to their environment and develop normally.
School Nurse Job Duties, Responsibilities, and Settings
The NASN views school nurses as leaders in the school community who oversee all school health policies and programs. It is up to school nurses to provide expertise and oversight of school health services and to promote health education.
Because healthy children are successful learners, school nurses advocate for the physical, emotional, mental, and social health of students.
Using their clinical knowledge and judgment, school nurses routinely perform the following duties:
- Provide healthcare to students and staff
- Perform health screenings
- Coordinate referrals to private healthcare providers
- Serve as liaisons between school personnel, family, and community healthcare providers to ensure a healthy school environment
In some ways, the school nurse job description is unique from that of other nursing specialists that work within a conventional clinical setting.
The main job responsibilities of school nurses include:
- Developing plans for student care based on assessment, interventions, and identification of outcomes, and the evaluation of care
- Serving as consultants with other school professionals, such as food service personnel, physical education teachers, coaches, and counselors
- Providing health-related education to students and staff in both individual and group settings
- Monitoring immunizations, managing communicable diseases, and assessing the school environment as to prevent injury and ensure safety
- Overseeing infection control measures
- Actively participating in school safety plans that address school violence, bullying, and emergencies that may occur at school
- Overseeing medication administration, health care procedures, and the development of healthcare plans
- Overseeing vision, hearing, body mass index, and mental health screening procedures
- Making decisions related to the delegation of healthcare tasks as directed by state laws and professional practice guidance
- Providing health advice to school educational teams, such as the Committee on Special Education and the Individualized Educational Plan (IEP) team
- Assisting families with locating outside care and obtaining health insurance
School nurses may work in a number of settings, including:
- Public school systems
- Departments of health
- Public health departments/agencies
- Hospitals
- Private, parochial, and charter schools
- Universities
The Important Role School Nurses Play in Today’s School Environment
After a child’s home, the school represents their “most influential environment,” according to the NASN. And with more students entering schools with health and mental health problems, it has become more difficult for pediatricians to manage their care throughout the school day. As a result, school nurses serve as healthcare representatives on site whose services are seen as being essential to coordinated care.
Students today are more likely to face homelessness, immigration, poverty, family crises, and violence, all of which can dramatically influence their physical and mental health needs. Therefore, school nurses perform a critical role by addressing major health problems through services such as preventive and screening services, health education, and immunizations.
Today’s school nurses may also provide interventions for:
- Acute and chronic illnesses
- Adolescent pregnancy
- Communicable diseases
- Dental disease
- Injuries and emergencies
- Mental health
- Nutrition
- Obesity
- Sexually transmitted diseases
- Substance use and abuse
Today’s school nurses also have a unique role in ensuring school health services for children with special needs, including children with chronic illnesses (diabetes, asthma, etc.) and disabilities of various degrees of severity.
Further, because federal and state laws dictate that children with special needs must be included in the regular school setting, school nurses must be able to assess their health status and identify any health problems that may create a barrier to educational progress. They must also develop and oversee an individualized healthcare plan so as to ensure the effective management of any problems in the school setting.
As healthcare educators, school nurses are also often required to provide health education to students in contemporary topics, such as:
- Adolescent pregnancy prevention
- Exercise
- Nutrition
- Oral health
- Parenting
- Prevention of sexually transmitted diseases/infections
- Smoking prevention and cessation
- Substance use and abuse
Degree Requirements to Become a School Nurse
School nurses and the services they provide are governed at the state level. Therefore, their educational requirements are subject to the state in which they work. As such, it is common to find that certification and licensing requirements vary quite a bit from one state to the next. It is also common for school nurses to possess master’s degrees as this field tends to be fairly competitive.
A few examples of school nurse pre-service requirements include:
- Arizona: School nurses must obtain a school nurse certificate issued by the Department of Education, which requires a current RN license in Arizona and a bachelor’s degree.
- California: School nurses must be currently registered as an RN, must possess a bachelor’s degree and must possess a current credential in school nursing, which requires 26 units beyond the bachelor’s degree.
- Maine: School nurses in Maine must possess a current RN license in Maine and a bachelor’s degree. Candidates for nurse jobs must also have at least three years of experience as a nurse, with at least one of those years being within the 5 years immediately prior to their initial application.
- New Mexico: School nurse professionals must possess an RN license and a bachelor’s degree, while school nurse supervisors must possess an RN license and a master’s degree.
Many RNs choose to return to school to achieve their Master of Science in Nursing (MSN) as they work to become a school nurse. RN to MSN programs are often preferred to traditional BSN and MSN programs, as they are designed to offer a more streamlined, accelerated approach to achieving both their BSN and MSN.
Most RN to MSN programs allow students to transfer up to 30 credits of their undergraduate nursing education toward their BSN degree, thereby speeding up the process of achieving their MSN. Many RN to MSN programs are completed entirely online, as they are designed to accommodate the busy schedule of today’s nursing professionals.
Students working in states that require a credential in school nursing (e.g., California, West Virginia, and Pennsylvania) often take their certificate classes as part of an MSN.
An MSN in School Nursing (or MSN with a School Nurse Services Credential) is designed to build upon the foundational courses in community health nursing and provide theoretical and practical experience in nursing and education. Graduates of these programs are prepared to respond to the healthcare needs of their state’s school districts. Many go on to serve as instructional school nurses and supervisors of school health services. Many manage health programs for school districts.
Typical graduate coursework in an MSN in School Nursing program includes:
- School Nursing
- Community Mental Health
- Intro to Education: Theory and Practice
- Adolescent healthcare
- Primary healthcare of the young family
- Theory and practice in school nursing
Certification Requirements to Become a School Nurse
School nurses throughout the U.S often pursue the National Certified School Nurse (NCSN) credential through the National Board for Certification of School Nurses (NBCSN).
To earn the NCSN credential, applicants must take and pass an examination, which is offered as a computer examination that can be taken at testing centers located throughout the U.S.
To qualify to sit for the NCSN examination, candidates must possess the following:
- At least 1,000 clinical hours within the past 3 years
- A current RN license; AND
- A bachelor’s degree or higher in nursing; OR
- A bachelor’s degree in a health-related field relevant to school nursing, which must include at least 6 credits in the following subjects (in any combination):
- Management of primary healthcare problems among children and/or adolescents
- Health assessment of children and/or adolescents
- Public health/community health/epidemiology; AND
The NCSN certification is valid for a period of 5 years. To qualify for recertification, candidates must possess a current RN license and at least 2,000 hours of clinical practice in school nursing in the past 5 years, of which at least 750 hours must be in the past 3 years.