How to Become a School Nurse

Nurses have been a fixture in private and public schools since the early 1900s when the New York City school system hired Lina Rogers as part of an effort to reduce absenteeism. To call the effort a success would be an understatement; absenteeism fell significantly within a month, and not long after in-school nursing care became the standard across the state. 

Since then, the day-to-day duties of nurses working in school health services haven’t changed much. School nurses still look at sore throats, bandage playground wounds, wrap gym class sprains, and screen for lice. Their work is especially essential for underprivileged students; as the National Education Association points out, “For some students, the school nurse is the only health care professional they ever see.”

Health and education are inexorably linked. Children who feel ill can’t concentrate on learning, and children who don’t know about basic self-care practices are ill more frequently. When you become a school nurse, your job is not only to help students who are sick or hurt, but also to help prevent sickness and injury in the student population so they can focus on education.

As American Nurses Association President Rebecca M. Patton MSN, RN, CNOR put it, “School nurses play a fundamental role in teaching students how to improve their overall health and reduce unhealthy behaviors. School nurses serve to optimize a student’s health, safety, and capacity for learning.”

It’s an important job with responsibilities that can include:

• Sports screenings
• Administering necessary medicines
• Monitoring students’ mental health
• Glucose monitoring
• Checking students’ vision and hearing
• Overseeing school infection control procedures
• Performing CPR
• Helping families get adequate medical care
• Responding appropriately to signs of neglect or abuse 

When you become a school nurse, you will be responsible for making sure that all students have up-to-date vaccinations and that your school complies with all district and state requirements. Some school nurses also act as educators, creating health education classes like sex education and hygiene for students and staff.

In this article, we’ll cover:

• The pros and cons of becoming a school nurse
• The education commitment to become a school nurse
• How school nurses are licensed and accredited
• Career prospects for school nurses

The pros and cons of becoming a school nurse

Nursing is a career that asks a lot of people; becoming a school nurse can be just as stressful as working in a hospital setting or private practice. There are many pros and cons to becoming a school nurse. 

Pros

• Your work schedule will align closely with the local school schedule, which means you’ll have weekends, holidays, and summers off
• You’ll get to know your patients over many years, and you’ll spend a lot more time with them than most nurses do. Andrea Tanner, MSN, RN, NCSN told Campaign for Action that she always left her early clinical experiences “saddened that there wasn’t more time to connect with the patient and build trust that would allow for deeper assessment of the patients’ needs beyond the hospital.” The only setting where she saw that happening was in schools, and that drove her decision to become a school nurse. 
• Every day will be different. 
• According to the U.S. Bureau of Labor Statistics (BLS), nursing jobs should increase at a rate of 16 percent from now until 2026, which will include school nurses.

Cons

• Your patient base will be large since there are no federal laws regulating school nurse staffing. Federal guidelines allow for one nurse for every 750 students, but there are schools where just one nurse serves a student population of many thousands. 
• Keeping on top of district and state requirements can be tough.
• A school nurse salary is generally less than others in the nursing field. 
• As of 2018, only 39 percent of schools in the United States had a full-time, on-site nurse. In some areas, there simply are no opportunities for school nurses.
• If you enjoy working with kids, becoming a school nurse is a great option. There will be days when you’ll have the opportunity to save lives: it’s almost certain that you will work with students who have asthma, epilepsy, diabetes, and other conditions that must be carefully managed when students are in a group setting. 

The educational commitment to become a school nurse

Those with an associate’s degree in nursing (ADN) may be eligible to apply for school nurse positions, but the National Association of School Nurses recommends that all school nurses hold at least a bachelor’s degree in nursing from an accredited college or university.

These nursing degree programs typically include courses in:

• Anatomy
• Emergency care
• Medical assessments and treatment
• Microbiology
• Nutrition
• Pharmacology
• PsychologyStatistics
• Public health

Most accredited BSN programs are four-year, on-campus programs. There are also accelerated programs for those who have already earned a bachelor’s degree in another field (the University of Washington has one) and RN to BSN programs for working nurses (like the University of Cincinnati – Main Campus‘s online RN to BSN). These accelerated degree programs typically take just two to three years, depending on the number of relevant credits you have. 

Once you’ve earned your BSN, you’ll need to take and pass the National Council Licensure Examination-Registered Nurse (NCLEX-RN) in the state where you plan to work. You probably won’t find work in the school system at this point in your journey, however.

Most schools prefer candidates who have at least a few years of clinical experience in addition to the clinical hours required to earn a BSN because school nurses need to be comfortable working without an on-site doctor. That means that before you work as a school nurse, you’ll probably spend many years working at a medical practice or in another clinical setting. A pediatric practice would be a good choice.

You don’t need to earn a master’s degree in nursing (MSN) to become a school nurse, though a master’s may make you a more attractive job candidate. If you’re already working as an RN, there are RN to MSN programs that take just a few years to complete (the Upstate Medical University at SUNY  has one).

Some accelerated graduate-level nursing programs for students with a non-nursing bachelor’s degree are structured as a one-year accelerated BSN nursing program followed by two years of graduate-level study. The University of Pittsburgh Medical Center – Shadyside School of Nursing offers such a BSN that can be completed in three full-time semesters.

The licensure and accreditation for becoming a school nurse

There are various types of certifications available for those who want to become a school nurse; licensure requirements vary from state to state.

In general, you’ll need to:

• Submit an application form 
• Show you passed the NCLEX-RN exam and have an RN license 
• Provide your college transcripts
• Pay an application fee to obtain your nursing license

If you’re not sure what else you’ll need to submit or do to be eligible to work in the school system in your state, you can contact your state’s board of education for clarification and more resources for becoming a school nurse. The National Association of School Nurses also has affiliate chapters in each state that can help you determine what requirements you need to meet to work in schools. These may include a state-specific certification process.

The National Board of Certification for School Nurses (NBCSN) offers its own certification program. NBCSN certification holders must renew every five years and meet certain continuing education requirements.

Some colleges—like California State University – Fresno—offer post-baccalaureate school nursing certificate programs. Keep in mind that while you may not be required to become a certified school nurse to apply for positions in schools, pursuing further accreditation or education for a school nurse does show that you’re serious about what you do. 

Your career prospects after you become a school nurse

As the population grows and new schools are built to accommodate a new generation of students, positions open up for school nurses with each new school. Remember, the BLS shows that the nursing profession is set to grow at a rate of 16 percent until 2026.

However, 2018 statistics demonstrate that only 39 percent of schools in the United States had a full-time, on-site nurse. About 35 percent had a part-time nurse, and roughly a quarter of all schools had no nurse or student health professional at all.

Whether you find full-time employment quickly, have to cobble together several part-time gigs to earn a living, or struggle to land a job after putting in your time as a clinical nurse will depend largely on that year’s education budget. 

It’s all about children’s health

If you can handle the uncertainty, however, you’ll have the satisfaction of knowing you’re doing vital work. When schools don’t have nurses on site, the result can be deadly. Literally: children have died when emergency situations arose at schools without a registered nurse. 

When nurses are present, on the other hand, entire communities benefit. It was a school nurse in New York City who first identified the 2009 epidemic of H1N1 flu after noticing that a growing number of her students were falling ill. Her call to the department of health likely kept the flu epidemic from being even worse.

School nurses may also be the only medical caregivers that disadvantaged children see for routine primary care like vaccinations, vision and hearing screenings, and basic dental care. They are also well placed to recognize the first signs of trouble in kids and teens. That could mean catching an illness early, noting behavioral changes that could signal emerging depression, or identifying growing drug use in the school population. 

When you become a school nurse, your office may be the only safe space a student has to share their fears, come clean, or come out. As one anonymous nurse told The Washington Post, “We are seeing more young kids with mental health issues. They come to us in droves because it’s easier to somaticize your stress through headache and stomachache. It is easier to go to a nurse if you are sexually questioning. We are the less stigmatized place to visit.”

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