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

On the Job

Once stereotyped as a slow-paced, low-skill position, school nurses today care for students with complex conditions that require higher-level acute care nursing proficiency. In addition to direct care, school nurses must have exceptional advocacy, public health, and leadership skills. These efforts to positively impact health and improve student attendance rates are critical to extending children's educational opportunities.

Direct Care

School nurses make treatment decisions that may be as simple as applying an ice pack but as complex as an emergency intervention with epinephrine, albuterol, or glucagon. Similarly, the care they provide can range from taking a temperature to tracheostomy care, catheterization, and gastrostomy tube feedings. School nurses also work with families and interprofessional teams to coordinate care for children with chronic conditions such as asthma and diabetes. As primary health educators, school nurses teach students about disease management and help them provide their own developmentally appropriate self-care.

Kessler notes that about half of mental health conditions develop before age 14, which means that school nurses frequently are the first to notice early warning signs and can provide initial assessment and support. School nurses foster an inclusive environment by creating a safe space in the health room for those struggling with bullying or other issues such as anxiety, depression or gender identity development.

If a student has been hospitalized for a physical or mental health condition, the school nurse works with hospital teams, in collaboration with the student and family, to develop successful school re-entry plans.

The school nurses' work isn't limited to students. Teacher and staff health and wellness and disaster preparedness also fit within the scope of school nursing practice.


School nurses advocate for healthier environments by identifying and developing health and wellness policies. Examples include self-carry rules for rescue inhalers, breast-feeding guidelines for students and staff, bus idling policies to mitigate air pollution, and standards on food in the classroom.

School nurses are trained to identify risk factors and detect illness at the population level, making them crucial to public health and surveillance efforts. Surveillance activities include reporting disease outbreaks (for example, measles or mumps) to public health departments. School nurses are playing an important role in the current COVID-19 crisis by coordinating health and nutrition needs while students are out of school and ensuring that schools are ready when students return. The role of the school nurse is vast, highly specialized, and immensely rewarding. (See Student and school benefits.)