School Nurses: Keeping School Children, Families, and Communities Healthy

Mayumi A. Willgerodt, PhD, MPH, RN, FAAN, FNASN; Catherine Yonkaitis, DNP, RN, NCSN, PHNA-BC


Am Nurs Journal. 2021;16(2) 

In This Article

School Nursing Defined

The National Association of School Nurses (NASN) defines school nursing as a specialized practice that "protects and promotes student health, facilitates optimal development, and advances academic success." The NASN goes on to explain that school nurses are grounded in ethical and evidence-based practice and work as leaders to bridge healthcare and education. They coordinate care, advocate for quality student-centered care, and work with others to design systems that allow individuals and communities to develop to their fullest potential. Functioning within local educational systems, school nurses help to ensure children have access to education by providing and managing complex care across multiple healthcare sectors, including public health, community agencies, hospitals, and insurance systems.

School nursing practice is guided by the NASN's Framework for 21st Century School Nursing Practice, which articulates the key principles of evidence-based school nursing practice: care coordination, leadership, quality improvement, and community/public health. (See Practice framework.) Upholding these principles requires collaboration across disciplines and settings that includes teachers, school staff and administrators, community providers, insurance providers, and parents and guardians. For example, a student may visit the school nurse on a Monday describing a weekend visit to the emergency department for asthma exacerbation. Immediately, the nurse begins coordinating the care this student might need—health teaching for the student and family, communicating with the student's classroom and physical education teachers to determine any necessary accommodations, reviewing the student's health record to ensure flu shots are up-to-date, and, as needed, helping with health insurance applications and follow-up appointments with a healthcare provider. The nurse also may work with the building and grounds keepers to help eliminate triggers. These collaborations are critical in school nurses' work.

School nursing practice is regulated by state nurse practice acts and standards of practice and ethics. What makes school nursing unique from other specialties, however, is that school nurses work within local or state educational systems. Therefore, school nursing practice must adhere to the legal mandates of the nursing profession and conform with education-specific state statutes (for example, those related to sexual health education and automated external defibrillator training) and federal law (for example, Title IX). In this way, school nurses have specialized knowledge that straddles both the health and education systems.

An NASN Workforce Study reports that approximately 132,000 practicing school nurses (95,000 full-time equivalents) care for the nation's 56 million children. About half (53%) of public school nurses are baccalaureate-prepared RNs.