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School Nurse (School Nursing) Career Guide

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By Frieda Paton, M.Cur, RN

A student’s health status is directly related to his or her ability to learn. Students’ unmet health needs, physically or psychologically, will affect their ability to make the most out of their educational experience and may have difficulty in achieving and engaging in the educational process. A school nurse supports students’ success in the learning process by providing health care through assessment, intervention, and follow-up for all the children within the school setting.

After the home, the school environment has the most considerable influence on any child’s development. In this environment, the school nurse’s role is to bridge the gap between the child’s health and his or her education.

If you enjoy working with children or teens, are prepared to work alone, and take the initiative, then working as a school nurse may be the perfect career choice for you.

Table of Contents

What is School Nursing and a School Nurse?

School nursing is a specialized practice of nursing that advances the well-being, academic success, and lifelong achievement and health of students. Keeping children healthy, safe, in school, and ready to learn should be a top priority for both healthcare and educational systems,” states the US National Association of School Nurses (NASN) in its position statement on the ‘Role of the 21st Century School Nurse’. “With approximately 50.1 million students in public elementary and secondary schools, educational institutions are excellent locations to promote health in children, and the school nurse is uniquely positioned to meet student health needs.”

The practice of school nursing began in the United States on October 1, 1902. Lina Rogers, the first school nurse, was hired to reduce absenteeism by providing nursing care to students and families regarding their healthcare needs related to communicable diseases. She led the implementation of evidence-based nursing care across New York City schools. Since that time, the role of school nurses has expanded and become increasingly diverse.

What Does a School Nurse Do?

Dealing with injuries and illnesses

The first thing that comes to mind when thinking about the school nurse’s work is taking care of the children’s daily scrapes and bumps. School nurses are also called to deal with acute illnesses such as bouts of flu, vomiting, and diarrhea, and even more serious emergencies like concussions and broken bones.

In these situations, the nurse will assess whether to call the parents to fetch the child or advise that an ambulance is called. The nurse looks after the student until he or she is handed over to the next level of care.

The school nurse, however, does much more than attend to injuries and illnesses that crop up on a day-to-day basis.

Coordination of care

School nurses supervise the long-term care of students with chronic conditions. This could involve specific individualized nursing care plans or emergency care plans. Students may require daily medication or treatments as ordered by their family medical practitioner.

The school nurse assists students to become partners in their care, promoting self-management. Their duties could include teaching children with, for example, diabetes, asthma, or severe allergic reactions, how to manage their condition, and how to administer their own medication. The school nurse does this in collaboration with the child’s parents, primary health care provider, and teachers. 

Where children have special health needs, the school nurse should be involved in their Individualized Educational Plans and might also need to educate teachers about the child’s needs and treatment objectives.

On behalf of the child, the school nurse serves as the advocate and link between school personnel, parents, teachers, and health providers.

Health screening

The school nurse is responsible for the students’ health screening at regular intervals. Health screening for vision, hearing, height, and weight (BMI), and dental problems are usually included. Laws depending on the state may determine these screenings and their frequency.  Further assessments can be included in the program of the specific school.  Where problems are identified, the school nurse does the required referral and follow-up.

School nurses also monitor immunizations to make sure that all the students are protected against infectious diseases within the school environment.


School nurses provide leadership in school health policies, programs, and procedures where their expertise in health is needed. They also provide guidance in other matters related to the health, well-being, and safety of the students in the school environment. They also serve on policy and planning committees dealing with issues such as environmental safety, emergency response, and disaster plans, bullying and violence, and school food services.

School nurses need to be fully up-to-date with all the particular state’s laws and regulations relating to school health and take an active part in communicating the information to teachers and others. You can get an idea of how extensive these laws can be in this 219 page Tennessee School Health Laws document.

School nurses are responsible for safekeeping the confidential health records of all the students. This could include their own records, health questionnaires, and permissions completed by parents, immunization certificates, and referral letters and instructions from primary health care providers.

Health promotion

Another role of school nurses is the promotion of optimal physical and mental health through various health programs in the school setting. Improving the health of the students would mean improving the student’s performance both in school as well as in later life.

The clients of school nurses are not limited to students, most of the time, they are involved in the health education activities for groups, teachers, and even parents and community organizations.

Training of school staff and others in CPR, first aid, and how to manage other possible health emergencies like seizures or food allergies are also part of their role.

Furthermore, school nurses often assist students and their families with addressing the social determinants of health by referring them to health and social service agencies that they may not be aware of.

Where do School Nurses Work?

School nurses often work in educational institutions in public or private schools of different levels, in vocational schools, or in international schools. They usually work when the school or the academic year is in session. A school nurse may also work in juvenile correctional facilities or orphanages.

How to Become a School Nurse?

The qualifications a school nurse needs include significant knowledge and skills in pediatric, mental, and public health as well as school policies and laws related to education. They must be skilled in assessment and planning, critical thinking, communication at all levels, and referral.

The National Association of School Nurses (NASN) recommends that a professional school nurse should at least be a registered nurse with a baccalaureate degree. The requirements in different countries and states vary and could require additional certification or licensure. You should check what the specific requirements are in your location. Many school nurses also hold Master’s and Doctoral degrees.

If you are still a student nurse and interested in a career in school nursing, it would be a good idea to include some courses in pediatric and family health. An advanced nursing qualification in pediatric nursing would of course also be a strong recommendation.

Throughout the US, various certificate courses in school nursing are available, some of which provide for online study combined with some internship and on-campus coursework.

The NASN also supports the certification of school nurses by the National Board for Certification of School Nurses (NBCSN). This board is accredited by the Accreditation Board of Specialty Nursing Certification – a national body that sets strict and comprehensive standards for the certification of nursing specialties.

You have to be employed as a school nurse, with three years of experience, to take the certification exam. Certified school nurses must provide proof of continuing education and be re-certified every five years.

How Much Does a School Nurse Earn?

A school nurse can earn an average salary of $48,920 in the United States. School nurse salary range is typically within $39,098 to $61,776 and is dependent on factors such as education, certifications, location, additional skills, and experience or years in the profession.

What are the Pros and Cons of School Nursing?

Most schools have only one school nurse, and she runs the health office, and the complete school health program, on their own. This has the advantage of being able to plan your own work and set your schedules. It is seldom as pressurized as the hospital environment.

Working on your own can, however, can become quite lonely and lead to professional stagnation. This is why it is a good idea for school nurses to join their state school nursing association where they can network, learn, and get inspiration from others in the same situation.

One of the downsides of being the only health professional on the staff is that other staff members sometimes don’t appreciate all you do. They believe you are just waiting for the next sick or injured child to walk through the door.

Brent Thompson, a nurse educator who accompanies his students as part of clinical education, had the following to say about school nursing: “My students usually come out amazed at the complexity of a job where you work mostly alone in your decisions. Of course, you have to like working with children and or teens, plus deal with parents of all stripes. School nursing is probably one of the most misunderstood specialties in nursing because everyone has had contact with one, but you only saw a tiny sliver of what they do all day. It is a complex but rewarding specialty. Best of all, I haven’t met a school nurse yet who didn’t love what they do.”

Another frustration may also be when other staff members question your knowledge and experience. As in other working environments, every situation differs.  It depends largely on the support provided by management and on the strength of your own personality.

“You will have many teachers that try to tell you how to do your job. Many will not respect your opinion. Many think you should just do as they say,” wrote Nurse ABC.  “You have to learn to stand your ground.  You are the only medical person, and sometimes they just don’t get why you freak out over stuff like low blood sugars or a dizzy child that just got hit in the head, but they freak out over vomit and lice and don’t understand why you don’t.”

Salaries for school nurses are generally fairly average and, as the only nurse on the staff, there isn’t really any opportunity for advancement. What does makes up for this, especially if you have a young family, is having weekends and school holidays free.

The following testimonial by Norma Lawson Totherow about her career as a school nurse sums it up well:

“I was a school nurse for 10+ years. It was interesting, nerve-wracking, heartbreaking. At the end of the day, if I could look back and say I made a positive impact on one child’s life, it was worth every effort. It warms my heart nowadays when I get a wedding invitation or birth announcement from one of my ‘babies,’ or they remember who I am when I see them.”

School Nurse Organizations

If you’re interested in becoming a school nurse or would want to learn more, check out these organizations, websites, and societies for school nurses:

  • National Association of School Nurses (NASN) [https://www.nasn.org/home] – Largest and widely recognized association of school nurses. Its position is “To optimize student health, safety and learning, it is the position of the National Association of School Nurses that a professional registered school nurse be present in every school all day, every day.”
  • National Board for Certification of School Nurses (NBCSN) – Advances the quality of school health services & school nurse practice. Their rigorous credentialing sets the professional standard for school nursing.
  • American School Health Association – The mission of the American School Health Association is to transform all schools into places where every student learns and thrives. They envision healthy students who learn and achieve in safe and healthy environments nurtured by caring adults functioning within a coordinated school and community support systems.
  • The Journal of School Nursing – The Journal of School Nursing (JOSN) is a bi-monthly peer-reviewed forum for improving the health of school children and the school community.
Frieda Paton is a registered nurse with a Master’s degree in nursing education. Her passion for nursing education, nursing issues and advocacy for the profession were ignited while she worked as an education officer, and later editor, at a national nurses’ association. This passion, together with interest in health and wellness education since her student days, stayed with her throughout her further career as a nurse educator and occupational health nurse. Having reached retirement age, she continues to contribute to the profession as a full-time freelance writer. In the news and feature articles she writes for Nurseslabs, she hopes to inspire nursing students and nurses on the job to reflect on the trends and issues that affect their profession and communities - and play their part in advocacy wherever they find themselves.

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