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The Role of the School Nurse: A Vital Part of Today’s Healthcare System

July 7, 2020  |  Category: Nursing

A boy and a school nurse holding a clipboard smile at each other.

A student’s ability to learn is tied directly to their health. Some lucky students may never have to visit a school nurse during the span of their education. Others may visit the school nurse once or twice for an injury or illness. However, some students rely on school nurses for ongoing health needs such as juvenile diabetes, epilepsy, or emotional and physical disabilities. As a result, the role of school nurses now goes far beyond school-centered support—today’s school nurses play a vital role on the front lines of public health.

History of School Nurses: Origins

In an effort to combat contagious disease and decrease student absenteeism, New York City hired 150 physicians in 1897 to inspect students for signs of illness. Students found to be sick were sent home with a note directing them not to return to school until they were symptom-free.

Unfortunately, this intervention proved ineffective. Notes often didn’t make it home to parents, and when they did, parents often couldn’t afford the treatments required. Children who stayed home from school still gathered with their schoolmates to play in the streets surrounding their tenements, spreading the infectious diseases doctors were trying to prevent.

A Groundbreaking School Nurse

It wasn’t until 1902 that a registered nurse (RN), Lina Rogers, was assigned a monthlong trial position in schools to see if nursing care in a school setting could make a difference. Covering four different schools with a combined enrollment of nearly 9,000 students, Rogers faced challenging conditions.

Rogers made do with limited supplies in makeshift clinics set up in tiny broom closets, but her efforts were instantly apparent. The positive results seen during the experiment bolstered her cause and convinced schools to keep her on beyond her trial period.

Rogers treated plenty of scrapes and falls, but she also identified students with disabilities who required an alternative learning environment. In addition, she made house calls to treat children who fell ill from contagious diseases. On these visits, she gave families information on hygiene practices and explained how to prevent disease and infections.

Within six months, student absenteeism dropped by a staggering 90%. This convinced the school board to fund the hiring of additional nurses. By 1917, New York City schools employed nearly 400 nurses. Many cities followed.

The Changing Role of School Nurses During the 20th Century

The primary goal for school nurses throughout the 20th century followed the foundation laid by Lina Rogers in 1902: Maintain student health and promote school attendance. However, the last century saw critical changes in the role of school nurses.

Focus on Comprehensive Care

Responsibilities expanded and diversified to include complex tasks such as managing chronic diseases, emergency preparedness, case management, and behavioral health evaluations.

In addition to treating acute medical issues that come up in the course of a school day, school nurses enacted preventive treatments for specific health problems. They also began working closely with health professionals and organizations to make sure students were equipped with the right resources.

Reporting any suspected parental neglect, abuse, or failure to follow home medical treatments became another function of school nurses.

For students who have ongoing medical needs, collaboration with their primary healthcare provider became a crucial component of school nurses’ jobs. Nurses from the early 1900s through today help maintain necessary treatments and medications to set each student up for success in and out of the classroom.

Public health, which aims to prevent disease, has been a key mission of school nurses throughout history and continues to be a main objective for nurses today. Immunizations, obesity prevention, and substance abuse assessments are all functions of this role.

Developments and Achievements

Throughout the 20th century, nursing in schools achieved a number of victories:

  • During the 1920s and the 1930s, the criterion for school health programs was developed through a partnership between the National Health Organization (NEA) and the American Medical Association (AMA).
  • When immunizations for a number of harmful diseases were being developed in the 1930s, schools became the hub of large-scale immunization programs run by public health and school nurses, resulting in a plummeting child mortality rate.
  • Following a nursing shortage after World War II, traditional universities incorporated nursing programs into their curricula.
  • School nurses provided crucial support, creating AIDS programs and drug prevention programs in schools during the 1980s.

Starting in 1993, Medicaid reimbursements made it possible for school districts to hire more school nurses to provide health services to their beneficiaries.

Functions of Modern School Nurses

Using advancements from the previous century, contemporary school nurses fill the gap between healthcare and education in today’s classrooms. School nurses provide acute and emergency care, treat and assess behavioral health concerns, connect student families with community resources, and create care plans for students with chronic conditions.

Within these tasks, the three main goals of the modern school nurse are disease prevention, providing culturally competent care in diverse school settings, and ensuring equitable access to healthcare. By taking a closer look at these, it becomes clear that the function of the school nurse is both nuanced and integral to the health of our communities.

Disease Prevention

Schools provide optimal conditions for the spread of disease, so it’s critical to prevent diseases from taking hold in a student population. School nurses employ a number of practices to keep schools healthy and disease-free.

  • Vaccination ensures that students gain immunity to diseases such as polio and measles. School nurses help enforce the vaccines mandated for school enrollment and send out reminders to families, staff, and students. Vaccines may be administered through health care providers or in School Located Vaccine (SLV) clinics when available.
  • School nurses can limit the spread of contagion by teaching student hygiene best practices, such as proper handwashing techniques. They may also consult with janitorial services to ensure that schools are following state or federal cleaning mandates during pandemics such as COVID-19.
  • Vision and hearing screenings. In-school vision and hearing checks administered by school nurses determine whether a student needs support in these areas. Unchecked, vision and hearing issues can greatly impact a student’s ability to learn.
  • School nurses educate students, families, and staff on topics affecting health and demonstrate techniques to aid well-being. Topics covered range from dental hygiene practices to asthma education.
  • Nutrition and physical activity. Nutritious meals and active students result in healthier school environments. School nurses play a pivotal role in determining nutrition for meals and promoting physical activity in classrooms and during recess breaks.

Culturally Competent Care

To provide the best care to individual students, school nurses must be aware of student cultural diversity. No two students are alike, and a number of factors can influence cultural norms and related healthcare preferences and expectations, including the following:

  • Socio-economic status
  • Religion
  • Sexual orientation
  • Language or dialect
  • Dietary practices

Culturally competent school nurses take these elements into consideration when determining how to best communicate with students and their families. By showing care and respect, nurses can interact with students and their families effectively and help build healthier communities. School nurses must be aware of their own cultural competency and assess their level of understanding to improve cultural proficiency if needed.

Equitable Access to Healthcare

Many families don’t have access to medical services for one or more of the following reasons:.

  • Geographic limitations. Certain areas, in particular rural regions, have limited healthcare options. The nearest doctor may be 40 miles away, with a calendar booked months in advance.
  • Economic constraints. The high price of insurance limits many families from being able to afford medical insurance. A parent may also be unable to afford taking time off of work in order to take their child to an appointment.
  • Legal residency. Students without legal citizenship may be deterred from seeking healthcare due to the difficulty of receiving coverage. Undocumented immigrants only qualify for emergency Medicaid, and permanent residents must be U.S. residents for five years before qualifying for Medicaid. These policies create gaps in coverage, making it impossible for some immigrant students to qualify and preventing many families from seeking healthcare.

School Nurse Job Description: Care and Leadership

From kindergarten through college, school nurses play an important role in the delivery of medical treatment. School nurses are often the only healthcare providers in an academic setting and may serve as primary care providers in some geographic region where other healthcare options are limited.

As such, school nurses are responsible for providing care to a wide range of students, including those with physical and mental disabilities or chronic medical conditions. In fact, the Individuals with Disabilities Education Act dictates that qualifying students be identified and evaluated to ensure that they receive appropriate services. As qualified health professionals, school nurses are responsible for conducting these comprehensive health evaluations and creating detailed plans of care to ensure that students’ needs are met.

The job of a school nurse doesn’t stop at medical treatment, however. School nurses also fill important leadership roles in schools and districts, using their expertise to promote community and public health. They not only work to improve standards of care at a district level, but they also act as advocates for student safety, helping create policies to address issues such as bullying and school violence.

School nurses may work in a variety of settings, including public schools, private schools, alternative schools, summer camps, and U.S. military bases. Traditionally, nurses were employed at one school site where they worked in an on-campus clinic, but it’s now more common for nurses to travel between different schools within a district. Most school nurses work daytime hours when school is in session and have summers and other holidays off. Nurses who work in boarding schools, however, will have varied shifts and may not have the same holiday schedule.

School Nurse Skills: Engage, Lead, Provide Care

Successful school nurses share certain characteristics that set them apart from other types of RNs. School nurse requirements include the following:

  • Excellent communication skills
  • Cultural competence
  • Knowledge of school policies and laws
  • Experience working with mental health disorders
  • Enjoy working with children
  • Organizational skills

Above all, school nurses must be driven and self-motivated. They must undergo extensive schooling and training to become a nurse, as well as engage in continued learning throughout their careers.

Medicine is an evolving field that requires a commitment to continuing education to stay current on new developments. School nurses must be dedicated to medical science and participate in continuing education programs to stay up to date with advancements in the field.

School Nurse Requirements: How to Become a School Nurse

People who are interested in this profession may wonder how to become a school nurse.

Obtain a Bachelor of Science in Nursing (BSN)

Courses covered in the curricula of BSN programs consist of anatomy, nutrition, public health, microbiology, pharmacology, and more. Students learn fundamental nursing theories and principals and gain practical knowledge on how to apply these learnings to treat patients from different cultures and communities. BSNs also provide clinical training for hands-on experience in the profession of nursing.

Pass the National Licensure Council Examination (NCLEX)

Nurses must pass the NCLEX before they can seek employment. To sign up for the NCLEX, students must first apply for a license in the state in which they wish to work. The test is scored by the National Council of State Boards of Nursing (NCSBN) and looks at critical thinking skills around topics like patient management, disease prevention and early detection, and safety.

Gain NCSN Credentials

The National Certified School Nurse (NCSN) credential is a voluntary certification RNs can pursue to demonstrate advanced education, clinical experience, and knowledge. The following requirements must be met before taking the test to gain this credential:

  • Submit a copy of a current RN license, valid in the United States.
  • Send in an academic transcript proving successful completion of a bachelor’s degree in nursing program (or higher).
  • Meet the minimum of 1,000 hours of clinical experience within a school setting during the past three years.

Maintain Credentials

NCSB certification is valid for five years, which means school nurses must stay current in their studies as retesting is required to maintain NCSB credentials. In addition to this, school nurses must maintain their RN license and work a minimum of 2,000 hours in a school setting over the course of five years to be eligible for renewal.

School Nurse Salary and Job Outlook

According to the U.S. Bureau of Labor Statistics (BLS), the median annual school nurse salary was $63,690 in 2019.

As with all professions, the school nurse salary varies depending on geographic region. States and regions with higher costs of living tend to have higher pay. The highest wages are in California, where salaries reach upwards of $100,000. Massachusetts, Hawaii, Oregon, and Alaska also offer high salaries to school nurses.=

Between now and 2026, the BLS projects 15% job growth for RNs, which is a much higher rate than other industries. It’s important to note that this growth rate is for all types of RNs, and the prospects for school nurses may differ depending on factors such as budget and student enrollment.

Promote Student Health by Becoming a Registered Nurse

There has always been a need for nurses to promote wellness and provide care for our communities. Being a school nurse can be an incredibly rewarding, dynamic career. With a curriculum designed to advance the careers of RNs, AdventHealth University Online’s Bachelor of Science in Nursing program prepares graduates for leadership roles in one of the fastest-growing job markets.

Recommended Readings

Career Spotlight: How to Become a Public Health Nurse Practitioner

Acute Care Nurse Practitioner vs. Family Nurse Practitioner: Choosing a Career for Care

Guide to Cultural Sensitivity in Nursing


Centers for Disease Control and Prevention, School Health Services

National Association of School Nurses, Cultural Competency
National Association of School Nurses, IDEIA and Section 504 Teams – The School Nurse as an Essential Team Member

National Association of School Nurses, Immunizations

National Association of School Nurses, The Role of the 21st Century School Nurse

National Center for Biotechnology Information, “Evolution of School Health Programs”
NEAToday, “School Nurses Vital to Health, In and Out of School”
Newsday, “The Nurse Is In: School Health Professionals Evolve to Meet Students’ Needs”The Online Journal of Issues in Nursing, “School Nursing and Population Health: Past, Present, and Future”
Pediatrics, “Role of the School Nurse in Providing School Health Services”

U.S. Bureau of Labor Statistics, Registered Nurses
Washington State Nursing Association, “Coronavirus Highlights School Nurse Role in Public Health Prevention and Response”

Working Nurse, “Lina Rogers, The First School Nurse”