Got What it Takes for the Job?

The bell rang! Children rush in, and the teachers and the nurse (if the school has one) are there and ready. One first grader trips and scrapes his knee and goes straight to the nurse, who, with a friendly and understanding manner, cleans up the scrape, comforts the child, and sends him to class. Then come the regulars, students with chronic conditions like ADHD, asthma, and diabetes who may need daily medication. The nurse has doctor’s orders and signed parental permission for each. 

Why School Nurses are So Important

In a bustling elementary school with around 600 lively students, the nurse will likely have 35 to 50 visits on a typical day. Every visit must be carefully documented in the electronic health record system. The school nurse basically runs an urgent care clinic single-handedly, and it’s not just the little ones who need her help. School staff members also turn to the school nurse for care. 

Isn’t this the story? Yes, but it’s only part of it.

Responsibilities of a School Nurse

According to the National Association of School Nurses (NASN), the scope of practice of a school nurse includes the following:

  • Administering medication (About 40% of school-aged children need daily medication for chronic conditions, such as allergies, asthma, diabetes, or behavior/learning issues.)
  • Formulating and maintaining health care plans for students with chronic illness
  • Running screenings for problems with hearing, vision, mental health, and others
  • Communicating with, contacting, and engaging family members, teachers, and school administrators
  • Writing health referrals
  • Anticipating and organizing safety
  • Reducing contagious disease
  • Providing health education to the school community
  • You are engaging in advocacy and policy-making.
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And to this list, add:

  • Identifying, assessing, and caring for students with mental health issues
  • Keeping accurate and up-to-date student health records
  • Helping families access outside healthcare or health insurance
  • And last but not least, the well-known care for students in case of injury or illness. 

Has the school nurse always had so much to do? No, and with increasing awareness of health issues and their impact on learning, there is also a rise in the workload and the demand for school nurses. 

Milestones in the Growing Complexity of School Nursing 

The very first school nurse in the U.S. was Public Health Nurse Lina Rogers, hired by the New York City Board of Health in 1902 to combat absenteeism in schools due to infectious disease. Rogers worked with families and communities to treat infections, vastly lowering the number of children who had to be kept out of school for health reasons.

In the late 1940s and early 50s, a major polio epidemic broke out in the U.S., and the school nurses worked in the successful application of polio vaccines. With the school nurses on the front lines, the cases fell by over 99% worldwide. 

The Introduction of School Nurses

In the mid-1970s, the Education for All Handicapped Children Act (now known as the Individuals with Disabilities Education Act, or IDEA) began ensuring public education to children with disabilities, adding significant responsibilities to the school nurse’s job. 

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By the 1990s, public awareness of ADHD and its diagnoses had risen considerably. Medication for children with ADHD increased fourfold from 1987 to 1996, and school nurses played an increasingly important role in administering the medication and monitoring its effects. 

In recent years, school-based mental health services are receiving more attention than ever, with the school nurse bearing much responsibility. However, some grant funding is available for hiring mental health professionals. School nurses are pioneering initiatives to deal with the anticipated surge in need for mental health services in the post-pandemic world.

How Many Nurses Should Work at Each School?

With all these complex and urgent responsibilities, the CDC (Centers for Disease Control and Prevention) advises a ratio of one school nurse for every 750 students. That’s a lot of students for one nurse to care for, and that’s the goal, not the actual reality! The ratios range from 1:500 in Alabama and Vermont to 1:3,000 in Tennessee. Furthermore, according to research published by Pew Trust, over 25% of schools have no nurse, and 35% have only a part-time nurse. 

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Hiring more school nurses as soon as possible seems like the obvious solution, but that is challenging. In addition to the well-known shortage of registered nurses, those working in hospitals can make $10,000 to $20,000 more yearly than school nurses. 

How Much Do School Nurses Make?

The starting salary of a school nurse in 2023 is $40,550 a year, and the average salary is $60,730 a year.

School Nurses Enjoy Their Time Off!

Working as a school nurse does have advantages regarding the schedule and time off. This specialty favors a healthy work-life balance with a work schedule that fits around the school day, no working nights, and time off during the summer, winter, and spring breaks.

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What Kind of a Nurse Makes a School Nurse?


All schools require at least the following:

While not always required, becoming a Certified School Nurse is also highly valued, as well as CPR and First Aid certification. The specific requirements vary depending on the state or school district.

Qualities and Skills

Besides the qualifications, the trusted school nurse needs to love children or teenagers, have a good portion of patience and compassion, and have solid communication, organization, teaching, and presentation skills. 

What is On the Horizon for School Nursing?

A nurse in every school? Most likely! However, that must address the growing complexity of working across healthcare domains and providing coordinated care. Inter-professional teamwork with other specialists will position the school nurse as a potential and actual healthcare leader for millions of students.

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