School Nurses Are the Lowest-Paid LPNs in the Country. Here’s Why.

School Nurse Rules is a three-part Nurse.org analysis of the laws governing school nursing in all 50 states and the District of Columbia. It grew out of Jana Price’s investigation into the firing of a Pennsylvania school nurse who refused an assignment she believed fell outside her license.

Moriah Benjamin’s job as a school nurse in Millville, Pennsylvania paid about $28,000 a year. Ten months, no benefits, no paid sick days. She took it because she wanted to do the work.

“The money was horrible, if I’m being honest,” she later told the school board. “No benefits is not realistic for 2026. I took pride in what I did.”

Most nurses reading that salary already know it is low. What is less obvious is how a licensed practical nurse ends up there in the first place, and the answer has almost nothing to do with the job itself. Nurse.org compared her pay to federal wage data and then looked at how all 50 states and the District of Columbia decide what kind of employee a school nurse is. In 21 states, a school nurse only receives professional pay if she holds an RN license, which means a licensed practical nurse doing the same job falls outside that pay structure.

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Her $28,000 covered ten months of work. Most wage figures cover twelve, so setting the two side by side makes the gap look larger than it is. Hourly is the fairer comparison.

A standard school year runs about 180 days. At seven and a half hours a day, that is 1,350 hours, and $28,000 across 1,350 hours works out to $20.74 an hour.

Federal data puts the median wage for licensed practical nurses in Pennsylvania at $30.74 an hour. The bottom tenth of LPNs in the state earn $24.76 or less.

Her rate sits below that bottom tenth. And it stays there no matter how you count the hours. For $28,000 to reach even the 10th percentile, she would have had to work fewer than about 1,131 hours, which is roughly 151 days. A normal school year is 180.

In plain terms: she was paid less per hour than about nine out of ten licensed practical nurses in Pennsylvania. That is before benefits, which she did not receive.

Benjamin is a single mother. Her son was diagnosed with strep throat during her first months on the job, and she missed work caring for him. She was later diagnosed with influenza herself. As a probationary employee with no paid leave, every one of those days counted as an absence against her record. The school board later approved them as unpaid leave, which district officials testified was a payroll step rather than a judgment that the absences were acceptable. The district cited persistent absenteeism when it moved to terminate her.

Whatever else is disputed about that case, and much of it is, this part is structural rather than personal. Paid sick leave is one of the things that usually travels with professional employee status in a school district. So is health coverage, so is a salary schedule, and so is being paid across twelve months instead of ten. Which classification a school nurse lands in decides all of it at once.

Benjamin’s pay was unusually low. Her situation was not.

Across the country, school nursing pays licensed practical nurses less than any other setting we examined. Here is the national picture, by setting:

Two things stand out. Hospitals are not the high payer for LPNs the way they often are for RNs. Skilled nursing facilities employ nearly twice as many LPNs as hospitals do and pay them almost $4.50 an hour more, and that is what pulls the national median up.

Schools sit at the bottom of the list. An LPN who moves from a nursing home to a school health office takes about an $8 an hour cut. Compared to the national median across all settings, working in a school costs a licensed practical nurse roughly $5 an hour, or about $10,500 a year.

There are only 10,920 LPNs in the entire country working in elementary and secondary schools. It is a small workforce, and of the settings we examined it is the lowest paid.

Nurses themselves have found the same pattern. The National Association of School Nurses, drawing on its school nurse workforce study, reports that 34.2% of registered nurses working in schools earn more than $60,000 a year, against 69.5% of the registered nurse workforce overall. For licensed practical nurses the gap is wider: 1.5% of those working in schools clear $60,000, compared with 24.6% of LPNs generally. That comparison measures school nurses against other nurses rather than against other work settings, and it lands in the same place the federal wage data does.

One more figure for scale. The median registered nurse in Pennsylvania earns $96,430. A registered nurse’s scope is broader and the preparation is longer, so the two roles are not interchangeable, and in most states the certified school nurse position is limited to RNs. What that means in practice is that the pay ladder in a school health office starts at a rung an LPN is not eligible to stand on.

Here is the part that explains the number, and it is not really about nursing at all.

In most school districts, one decision drives nearly everything about pay. Are you professional staff, the category teachers are in, or support staff, the category that usually covers aides, clerical workers and custodians? Education codes generally call the first group certificated and the second classified. That single label typically determines your salary schedule, your retirement system, your health insurance, your paid leave, and whether you are paid for ten months or twelve.

We reviewed how every state classifies school nurses. In 21 of them, we found that a school nurse counts as professional staff only if she holds a state school nurse certificate or license, and each of those credentials requires an RN license.

Plenty of LPNs go on to become RNs, and bridge programs are widely available. But that takes more schooling, more money and more time, and it does not change the work in front of her today. An LPN who has not made that jump is outside the professional category in those 21 states, and outside whatever pay structure comes with it, no matter how well she does the job.

What makes this hard to see is that none of the rules we read mention LPNs at all. There is no provision anywhere saying LPNs get paid less. The whole thing happens through the credential.

Pennsylvania is one of the 21. State regulation at 22 Pa. Code § 49.1 defines an Educational Specialist as “professional certified personnel whose primary responsibility is to render professional service other than classroom teachers, such as… a school nurse,” and separately provides that professional personnel may not perform duties in any area for which they are not certified. The school nurse certificate requires an RN license. Benjamin held an LPN license, so she was not eligible for the certificate, which meant she was never in the category where school nurse pay actually gets set. What was left was decided locally, with nothing to compare it against.

It is the same split described in the first article in this series. Nursing rules define what a school nurse has to do. Employment rules define what she is worth. Nobody connected them.

Mississippi Pays RNs a Salary and LPNs an Hourly Wage

In the states we reviewed, twenty reach that outcome without saying so. One puts it in writing.

Mississippi publishes a Recommended Non-Binding School Nurse Salary Schedule, built from the state teacher pay scale and adjusted for nursing degrees. It begins with this:

“This salary schedule is applicable to Registered Nurses (RN) only, classified as exempt employees under the Fair Labor Standards Act (FLSA). Licensed Practical Nurses (LPN) are non-exempt employees under FLSA and should be paid on an hourly basis.”

In everyday terms: RNs get a salary, LPNs get an hourly wage. In school employment that distinction usually carries benefits, paid leave and summer pay along with it. The line between salaried professional and hourly worker is drawn precisely at the license.

Mississippi is not the worst state here. Out of all 51 jurisdictions we reviewed, it is the only one that states the split in plain language. Twenty others reach the same result through the credential requirement without writing it down. Mississippi is just the place you can read it.

The biggest group is the one that made no decision.

In 25 states, we found nothing in the law saying whether a school nurse is professional staff or support staff. Not in the education code, not in the retirement rules.

Some states appear twice where different provisions point different ways. Source: Nurse.org, School Nurse Rules, a review of education codes and state retirement provisions in all 50 states and the District of Columbia.

When nobody at the state level decides, the district decides, and in practice that often means whoever writes the job posting. A salary still gets set. What does not get set is any standard to measure it against.

Four states did decide, and went the other way. The New York State Teachers’ Retirement System states that “business managers, school nurses, teacher aides and other non-instructional positions are considered classified,” which leaves them in the general state retirement system rather than the teachers’ one. Arkansas treats school nurses as classified employees, Florida’s definition of instructional personnel leaves them out, and Oregon says it plainly: “‘Teacher’ does not include a school nurse.”

A handful of states answered the question directly, and what they wrote is short.

Iowa Code § 279.13 defines “teachers,” for the purpose of the school contract requirement, to mean “all licensed employees of a school district and nurses employed by the board,” and requires a written contract stating the number of contract days and the annual pay. Nurses are named, and there is no RN-only requirement anywhere in that provision.

Delaware went further. Its pay statute, 14 Del. C. § 1305, is called “Basic salary schedule for teachers, nurses, principals, superintendents,” and § 1310 puts nurses holding the state certificate on that schedule. In Delaware, school nurses are in the title of the law.

Three others did it in narrower ways: Massachusetts grants professional teacher status to a “school nurse” by name after three years (M.G.L. ch. 71, § 41), Minnesota’s teacher retirement definition includes “nurse” outright (Minn. Stat. § 354.05), and Rhode Island’s retirement chapter has a section headed “Membership of school nurses” (R.I. Gen. Laws § 16-16-4).

None of these states solved anything complicated. They answered a plain question that most of the states we reviewed left unasked: when a nurse works in a school, what kind of employee is she?

Where nobody answers, the answer shows up anyway. It shows up one job posting at a time. The one Benjamin answered said $28,000, ten months, no benefits.

Next in this series: Pennsylvania and Louisiana both cap school nurses at one per 1,500 students. In one state that limits how many children a nurse is responsible for; in the other it limits how many nurses the state will pay for. Part three sorts the 14 kinds of school nurse staffing ratio, and what almost none of them say.

Related Reading

The investigation this analysis grew out of

School Nurse Rules

More on school nursing

🤔Is your school nursing position classified as professional staff or support staff, and did anyone tell you before you took the job? Tell us in the comments below.

About This Analysis

School Nurse Rules is a Nurse.org review of the rules governing school nursing in all 50 states and the District of Columbia, covering who is permitted to serve as a school nurse, whether districts are required to provide nursing services at all, staffing ratios, credentials and pay.

Wage figures come from the Bureau of Labor Statistics Occupational Employment and Wage Statistics program, May 2025. Those figures are annualized and do not account for a ten-month school contract, which is why we use the hourly comparison. BLS does not publish a Pennsylvania-only figure for LPNs working in schools, so the comparison across settings is national.

In a small number of states, a current statute and the agency guidance describing it point in different directions. Where that happened we have said so rather than choosing between the two.

The Educational Specialist definition appears at 22 Pa. Code § 49.1, and the certification requirement at 22 Pa. Code § 49.11(b) and 28 Pa. Code § 23.54.

Benjamin’s salary and hearing testimony come from Jana Price’s investigation of the Millville hearing.

Nurse.org Analysis