Becoming a School Nurse: Roles, Responsibilities, and Career Insights

In the U.S., students spend six to seven hours a day in school daily, making it a key environment for their well-being and development, second only to home. School nurses play a crucial role in this, as student health directly impacts academic success and social outcomes.

When physical and behavioral health are properly managed, students can focus on learning without unnecessary distractions. If you are passionate about using your nursing skills to empower student success, explore the diverse roles and responsibilities of school nurses and learn how to embark on this fulfilling career path.

The Evolving Role of School Nurses

Nursing in public schools began with one simple goal: reducing student absenteeism. While early school nursing focused on diagnosing illnesses and sending sick students home, this approach did little to curb the spread of communicable diseases.

In 1902, Lina Rogers was the first registered nurse to treat students in a school environment. The hygiene education she provided led to a 90% drop in absenteeism.

Since then, the role of the school nurse has evolved from focusing on absenteeism prevention to offering more comprehensive health management. Today’s school nurses provide emergency care, assess physical and behavioral health, and help students manage chronic illnesses.

They also ensure equitable access to culturally competent care, benefiting not only individual students and their families but also entire communities. On top of that, there are many benefits to switching from bedside nursing to school nursing. 

School Nurse Roles and Responsibilities

According to the National Association of School Nurses (NASN), the school nurse job description typically includes the following:

• Direct care for students
• Leadership in developing a system of care for the school
• Health screenings and referrals for medical conditions
• Monitoring and reporting immunizations and illnesses to support a healthy school environment
• Health education for students and their families
• Leadership in developing system-wide health policies
• Facilitating communication between school personnel, healthcare providers, families, and the community

These responsibilities highlight the wide-ranging impact school nurses have on students’ health and success. These responsibilities can also change depending on whether you are an elementary school nurse or a secondary school nurse. 

Direct Care 

Direct care remains one of the most essential responsibilities of a school nurse.

Managing Acute and Chronic Health Conditions

School nurses perform an initial evaluation by observing the student’s behavior and appearance, asking questions, taking vital signs, and checking medical records. The nurse may provide basic first aid and, with parental permission, administer over-the-counter medication.

Your school nurse roles and responsibilities will also include developing individualized healthcare plans for students with chronic conditions. This means having a plan for administering medications on a schedule or setting up classroom accommodations.

Emergency Preparedness and Response

A school nurse must prepare emergency plans for various situations, including mass casualty events, diabetic emergencies, and allergic reactions. These plans may include identifying at-risk students, training teachers and staff on first aid and CPR, maintaining emergency supplies, and establishing clear channels of communication with families, EMS personnel, and healthcare providers.

Health Screenings and Preventive Services

Health screenings are part of creating a healthy school environment. Here is how nurses contribute to student wellness throughout the school year and beyond.

Conducting Routine Health Screenings

One of the most critical responsibilities is performing or coordinating vision and hearing screenings. These screenings are key in the early detection of health issues, which can facilitate prompt intervention and, as a result, better health outcomes.

Immunization Monitoring and Compliance

Ensuring students receive required immunizations reduces the spread of infectious diseases. As a school nurse, you will review and maintain student immunization records. You might also carry out an education program, communicating with students’ families to help them access vaccination and immunization services.

Health Education and Promotion

As part of creating a healthy school environment, school nurses engage in the following health promotion and education activities.

Educating Students and Staff

Schools are an integral part of every community, which means school nurses play a proactive role in school and community health. Part of that role is developing initiatives that show students and their families how to stay safe and healthy. Your initiative might focus on good nutrition practices, the importance of physical activity, and the prevention of chronic diseases.

Promoting a Healthy School Environment

School nurses can educate students on hand hygiene and respiratory etiquette to help prevent and curb the spread of infectious diseases. However, creating a healthy school environment goes beyond avoiding illnesses.

Many school nurses create school health programs that educate students about the dangers of bullying and substance abuse. They may also offer activities and resources to support students’ mental health.

Care Coordination and Advocacy

School clinics often serve as a coordination hub for student, family, and community care.

Developing Individualized Healthcare Plans

School nurses operate within a collaborative care network that includes parents, guardians, healthcare providers, and school staff. This ensures a tailored healthcare plan that considers and addresses all of a student’s special health needs.

Serving as a Liaison Between School, Home, and Community

As a school nurse, you can serve as a central point of contact for a student’s care. This means facilitating communication among families, healthcare providers, and school administrators to ensure alignment across care teams.

Leadership and Policy Development

Along with providing health care, school nurses advocate for students, families, and communities in an administrative and public health capacity.

Developing Health Policies and Procedures

Your policies and procedures guide others in the school on how to keep students safe and healthy. School health plans may include policies on:

• When to send students home or allow them to come back to school after they contract a contagious illness
• How often to clean student bathrooms, classrooms, and common areas to prevent the spread of illness
• How teachers and other staff should respond to student physical and mental health emergencies
• How to handle medication administration, storage, disposal, authorization, and review

Advocating for Student Health Needs

School nurses advocate for student well-being by requesting essential resources, such as mental health professionals or security staff, and promoting policies that support a safe, healthy school environment.

Legal and Ethical Responsibilities

Nurses have a legal and ethical duty to provide care according to established standards, whether in a school setting or any other environment.

Ensuring Confidentiality and Privacy

School nurses are bound by a number of federal regulations, including the Family Educational Rights and Privacy Act (FERPA). This means that you must maintain student health information confidentiality and obtain proper consent before sharing health records.

Navigating Ethical Dilemmas

School nurses may face a broad variety of ethical dilemmas, including:

• Deciding when to disclose sensitive information to parents, administrators, healthcare providers, and other stakeholders
• Navigating religious and cultural objections to certain medications and procedures
• Recognizing and reporting possible child abuse and neglect
• Navigating disagreements between parents and guardians regarding student health care needs
• Balancing the need to inform parents about student health concerns while maintaining trust and rapport with students
• Striving to help students and families access quality care even when there is a lack of resources
• Delegating tasks to other personnel while still ensuring that students receive high-quality health services
• Advocating for students with disabilities to help them thrive at school

It’s important for school nurses to know how to handle these issues and who to contact for help when questions arise.

How to Become a School Nurse

The road to becoming a school nurse starts with gaining the right qualifications.

Educational Requirements

To become a school nurse, you will first need to become a registered nurse. The steps to achieve this goal include:

• Completing a two-year associate’s or four-year bachelor’s degree in nursing
• Passing the National Council Licensure Examination for Registered Nurses (NCLEX-RN)
• Applying for licensure according to the processes and rules in your state

Once you have become a licensed registered nurse in your state, you may need to obtain an additional certification from the National Board for Certification of School Nurses (NBCSN).

Gaining Relevant Experience

School district job opportunities may require clinical experience with children, families, and communities. This could include working in a hospital pediatric unit, a private pediatric practice, or as a community health educator or advocate before transitioning to school nursing.

These roles can prepare you to meet your students’ day-to-day needs, communicate more effectively with their families, and advocate for those in your local community.

Career Outlook and Salary Expectations

According to the Bureau of Labor Statistics, registered nurses across all settings earned between $63,720 and $132,680 in 2023, and the field is expected to grow 6% between 2023 and 2033.

As school nurses are increasingly called upon to address the ongoing student mental health crisis, the demand for their expertise has grown—and is expected to keep rising.

School Nurses at the Heart of Student Success

School nurses have multifaceted responsibilities that span direct care, preventive services, health education, policy development, and legal and ethical duties. As awareness grows about the connection between student health and academic success, the role of the school nurse will continue to evolve and expand.

If you want to work with and advocate for children, families, and communities, connect with GHR Education and take the next step in securing your dream school nursing role.