How to Become a School Nurse

    January 5, 2021
    Happy child holding bear with healthcare professional in background

    By Kathleen Colduvell RN, BSN, BA, CBC

    A school nurse works with school-aged children in a school setting. School nurses have a variety of responsibilities and are a vital part of the educational system. This career guide will take a closer look at all aspects of school nurses and help guide individuals interested in following this path of nursing. 

    Part One What is a School Nurse?

    Students experiencing illness or injury during the school day or at after-school activities will report to the school nurse for further care. School nurses are responsible for assessing these students and determining if a higher level of care is needed.

    School nurses are governed at a state level so requirements within a state should be identical for all school nurses. Other responsibilities of a school nurse may include the following:

    • Medication administration
    • Glucose monitoring
    • Oversee vision, hearing, health, and mental health yearly screenings
    • Administer wound care to injured students
    • Assess and treat students with mental health issues
    • Annual sports screenings
    • Overseeing school infection control standards
    • Respond to health emergencies and perform CPR or lifesaving measures if warranted
    • Assess students and contact parents or emergency services if needed
    • Communicate with students’ families regarding continuous illnesses (e. lice, chicken pox) 
    • Maintain student health records
    • Scoliosis screenings
    • Assist families with obtaining outside healthcare and obtaining health insurance
    • Ensure vaccinations are up to date and complaint with school district and state requirements
    • Submit all required documentation to the state regarding students’ vaccination records
    • Assist with free and reduced lunch programs
    • Health education classes (ex. sex education) to students and staff in a private and group setting

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    Part Two Where Can a School Nurse Work?

    While a school nurse is a Registered Nurse and can be employed in a variety of settings – School Nurses work primarily in the educational setting, they generally are found in public or private elementary school, middle school, or high school. Some colleges and universities employ school nurses for their campus health programs. School nurses can also be found at vocational schools or juvenile correction facilities. A complete list of locations school nurses should consider is as follows: 

    • Public School Systems (elementary schools, middle/jr. high school, high school)
    • Private and parochial schools
    • Alternative schools
    • Hospitals
    • College/University
    • Pre-schools
    • Department of Health
    • Vocational schools
    • Overseas military bases
    • Summer camps

    Part Three School Nurse Salary

    The salary range for a school nurse can be deceiving and vary greatly state to state and even within the same county in a state. Depending on the work location this will impact pay. Some school districts pay according to the same scale as a teacher’s salary – these nurses are generally Certified School Nurses (see below). Others (with only a RN) pay an hourly rate. Even though school nurses report at a state level, the pay scale is not the same across a state.

    According to the average hourly rate for a school nurse is $26.90 while the yearly income is $46,635. Current information regarding the exact pay of a school nurse is much lower than the BLS report. It is important to remember when looking at places of employment to determine the exact pay scale and increase scale. 

    The U.S. Bureau of Labor Statistics provides salary figures for all registered nurses combined rather than for particular specializations. As of the May 2019 BLS report, the mean hourly wage for registered nurses, in general, was $35.24 while the average annual salary was $73,300, though conditions vary by area.

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    The BLS identifies the following as the highest paying states for nursing:

    State Hourly mean wage Annual mean wage
    California $51.42 $106,950
    Hawaii $47.16 $98,080
    District of Columbia $44.40 $92,350
    Massachusetts $44.30 $92,140
    Oregon $43.79 $91,080

    In the same year, the BLS ranked the highest mean annual salaries for nurses, and the top ten were in California. The top five from the list are as follows:

    Metropolitan area Hourly mean wage Annual mean wage
    Salinas, CA $65.68 $136,610
    San Francisco-Oakland-Hayward, CA $60.06 $124,920
    San Jose-Sunnyvale-Santa Clara, CA $59.80 $124,380
    Santa Cruz-Watsonville, CA $58.02 $120,680
    Sacramento-Roseville-Arden-Arcade, CA $57.75 $120,120

    Overall, pay generally correlates with cost of living for a specific geographical area as is evident in the pay in different parts of the country. Areas were cost of living is higher will see a higher hourly rate than areas with lower costs. 

    Unlike other jobs in the nursing field, there is little to no chance for overtime in school nursing. Most positions are a yearly salary and do not have overtime built into the contract. There is some increase in earning potential according to experience and additional education. 

    Regardless of workplace setting, school nurses enjoy similar benefits. While actual benefits may vary depending on the institution must include the following:

    • Health, Vision, and Dental Insurance
    • Retirement Options
    • Family Leave of Absence (FMLA)
    • Maternity Leave
    • Discounts
    • Certification Reimbursement
    • Professional Organization Reimbursement
    • Tuition Reimbursement
    • Attendance at nursing conferences
    • CEU Reimbursement

    Part Four How to Become a School Nurse

    As with any nursing career, students must first complete and receive Bachelor of Science in Nursing from an accredited university. Associate degrees in Nursing will not qualify an individual to become employed as a School Nurse.

    After passing the NCLEX (National Council Licensure Examination) exam, individuals must become licensed in their state of practice. The NCLEX is a nationwide examination for the licensing of nurses in the United States and Canada. This schooling may take 2-4 years depending on the length of the program.

    Most schools prefer for nurses to have several years of clinical experience prior to working in the school districts. This allows individuals to work on critical thinking skills and become more independent in their nursing abilities. 

    Educational requirements are subject to the state of employment. Due to this, it is common for state requirements to vary greatly. Furthermore, it is very common for school nurses to possess a Master’s in Science of Nursing or a Master’s in Education. 

    A few examples of school nurse pre-employment requirements include:

    • Arizona: School nurses must obtain a school nurse certificate issued by the Arizona Department of Education 
    • California: Must possess a current credential in school nursing, which requires 26 credits beyond the bachelor’s degree in nursing
    • New Mexico: School nurses must possess an RN license and a bachelor’s degree, whereas a school nurse supervisor must also possess a master’s degree.

    States that require a credential in school nursing  (ex. California, Pennsylvania, West Virginia) often take the certification examination during an MSN program. 

    Individuals interested in school nursing in the aforementioned states should fully investigate the requirements to become a professional school nurse. Those interested in a supervisory role are generally required to have an MSN and Certification in School Nursing.  If an MSN in School Nursing is required, individuals would study:

    • School Nursing
    • Community Mental Health
    • Adolescent healthcare
    • Theory and practice in School Nursing
    • Primary health care of the young family
    • Introduction to Education: Theory and Practice

    The following schools offer Certified School Nursing Programs in combination with MSN programs:

    • Rutgers University School of Nursing
    • Slippery Rock University
    • Arizona State University
    • Eastern University
    • Fairmont State University
    • University of Delaware
    • Cedar Crest College
    • New Jersey City University
    • University of Illinois at Chicago

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    Part Five Certifications for School Nurses

    Nurses can pursue a certification in School Nursing. Some jobs will require this prior to applying for a position while others will want the nurse to earn this certification once hired. It is important to look at all of the job requirements prior to applying. 

    The National Certified School Nurse (NCSN) is credentialed through the National Board for Certification of School Nurses (NBCSN). In order to become certified, individuals must take and pass a computer examination. Applications to sit for the exam are cut off 30 days prior to exam dates. Exams are held three times a year during two-week testing windows. 

    According to the NBCSN website, to be eligible to sit for the NCSN examination, candidates must meet the following requirements:

    • At least 1,000 clinical hours within the past 3 years (this number is roughly the number of hours worked by a school nurse during a full school year averaging 6 hours a day),
    • A current RN license, AND
    • A bachelor’s degree or higher degree in nursing, OR
    • A bachelor’s degree in a health-related field relevant to school nursing, including 6 credits in the following subjects:
      • Management of primary health care problems among children and/or adolescents
      • Health assessment of children and/or adolescents
      • Public health/community health/epidemiology

    Upon application for the exam, all of the aforementioned will be verified. The certification is valid for five years. Recertification is more specific for this certification. It is strictly based on clinical practice hours. Individuals are required to maintain a current RN license and at least 2,000 hours of clinical practice in school nursing in the past 5 years, of which 750 hours must be in the past 3 years. 

    Currently, the examination is $360.00. Most places of employment will reimburse the cost of the exam as it is directly related to job roles. The exam consists of a maximum of 200 multiple-choice questions, lasting approximately 4 hours. According to the website, the exam consists of the following:

    • Health Appraisal
    • Health Problems and Nursing Management
    • Health Promotion/Disease Prevention
    • Special Health Issues
    • Professional Issues 

    Part Six School Nurse Resources

    To learn more about school nursing and certifications – check out these websites.

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