School Nurse At a Glance
What you’ll do: Promote the physical well-being of students so they can succeed academically. School nurses conduct student assessments; administer first-aid, medication, and treatments; and educate students about their health.
Where you’ll work: K-12 public, private, vocational, and alternative schools; health departments, military bases, and community, state, and federal organizations
Degree you’ll need: Depending on state and school requirements, an Associate Degree in Nursing (ADN) or a Bachelor of Science in Nursing (BSN)
Median annual salary: $75,330
School nurses provide a bridge between students, parents, and teachers to address the physical, mental, emotional, and social health needs of students so they can thrive in the classroom.
In this Article
Steps to Become a School Nurse
Use these steps as a guide to pursue a career as a school nurse.
1: Find the Right School
There are many factors to consider when choosing a nursing school. While you’ll want to find a program with a location, cost, student-to-faculty ratio, and programming to meet your needs, you’ll also want to look for:
- Accreditation: A degree from an accredited nursing school meets requirements for state nursing licenses and professional certifications. It also ensures that your credits are transferable to other accredited institutions toward advanced degrees and that your eligible for federal financial aid.
- Job placement and career counseling: These services can help you set career goals, network, and find your first role.
- Online programs: Many nursing programs offer online courses for the classroom-based portion of your education. This flexibility is important if you must work or juggle family responsibilities while you complete your education.
2: Choose a Degree
While you can be a school nurse with an Associate Degree in Nursing (ADN) and a registered nurse (RN) license in some states, the National Association of School Nurses (NASN) recommends that schools hire nurses with a Bachelor of Science in Nursing (BSN). A BSN is also required to qualify for professional certification as a school nurse, though this credential isn’t always required for employment.
“The additional education is always beneficial so if one does not have a BSN, it is important to get one as most employers are requiring it for work anyway,” says Emily Hunter, BSN, RN, CSN, a certified school nurse and founder and author of Your Favorite School Nurse blog.
3: Apply to School
Admission requirements for BSN programs vary by school. If you already have an ADN, you may be able to reduce the time you’ll need to finish a BSN with an RN-to-BSN bridge program.
Depending on the BSN program you choose, you may have to meet some or all of the following admission requirements:
- High school diploma or GED
- Advanced math, biology, and chemistry prerequisites
- Professional and/or academic recommendations
- Personal statement of purpose
- In-person or virtual interview
- Standardized test scores from the SAT or ACT
- Passing score on HESI Admission Assessment (A2) Exam
4: Complete Your Coursework and Clinicals
A BSN includes advanced science coursework and helps nurses develop a broad skillset in patient-centered care, clinical judgment, physical assessments, leadership, and community—all critical to working as a school nurse.
As part of your nursing program, you’ll get hands-on training in nursing care through clinical hours in a healthcare setting. Clinical requirements can total 700 to 800 hours, though hours can vary widely by program.
5: Take the NCLEX-RN
After you graduate, you’ll need to obtain an RN license from your state board of nursing. To qualify, you must pass the National Council Licensure Examination (NCLEX-RN) administered by the National Council of State Boards of Nursing (NCSBN). It will cost $200 to register for the exam.
The NCSBN offers a practice NCLEX-RN exam. You may also benefit from other types of test preparation, including review courses, flashcards, and/or study groups.
Here’s a general breakdown of what the exam covers.
- Safe and Effective Care Environment
- Health Promotion and Maintenance
- Psychosocial Integrity
- Physiological Integrity
The NCLEX-RN is a computerized test that you’ll have five hours to complete. Most of the questions are multiple-choice, with some fill-in-the-blank, multiple-response, and drag-and-drop-style questions.
The NCLEX is also “computer adaptive.” This means that the questions you receive are determined by your response to the previous question. If you answer a question incorrectly, the next question is slightly easier. If you answer correctly, your questions increase in difficulty. You continue to answer questions, from a minimum of 75 to a maximum of 265, until the computer determines your level of competence, or your time runs out.
In addition to passing the NCLEX-RN, you’ll need to meet any other state-specific criteria before you receive a license. These requirements may include:
- Comprehensive background check
- Professional references
- Proof of good moral character
- Resolution of back payments for child support or other unfavorable marks on your records
6: Gain Experience as a Nurse
While most schools don’t require nurses to have specific experience, working in a clinical environment could give you invaluable experience to bring to the role of school nurse.
“Many of us do come from hospitals and have experience in emergency, ICU, labor and delivery, home care, or peds,” says Hunter. “I think it is important to get a good handle on your skills in a more hands-on nursing position before doing this job.”
While you can strengthen your skills in many types of clinical settings, working in pediatrics can give you the best foundation for school nursing, Hunter says. “I worked as a medical assistant for 11 years in a pediatric primary care office and learned so much that I apply today to my job such as looking in ears, understanding rashes’ behavior, ADHD, disabilities, various childhood ailments, and understanding immunizations intimately.”
You’ll have many options for gaining clinical experience. Here are the top three employers of registered nurses, as reported by the U.S. Bureau of Labor Statistics (BLS):
- Hospitals: 61%
- Ambulatory services, such as physicians’ offices and outpatient care centers: 18%
- Nursing and residential care facilities: 6%
7: Become Eligible for Certification
The Nationally Certified School Nurse (NCSN) certification is an optional credential, but some states require it. Earning the certification is considered proof that you’ve demonstrated your competency to work as a school nurse based on established professional standards.
The National Board for Certification of School Nurses (NBCSN) administers the certification exam. To qualify, you must:
- Have an academic transcript with proof of one of the following:
- A bachelor’s degree or higher in nursing from an accredited program
- A Master of Education (M.Ed.) with a concentration in school nursing or school health services from an accredited institution approved by the NBCSN
- Have at least 1,000 hours of work experience in the last three years
- Submit an application online within 30 days of the start of one of three annual test dates
- Pay the $360 exam fee.
8: Prepare for Certification
There are free and fee-based resources to help you prepare for the exam.
The NBCSN Handbook for Candidates is a great place to start. It will give you access to these free exam prep materials:
- Test Prep Infographic, a guide that includes a roadmap for studying during the weeks before the exam
- National Exam Candidates Discussion Group/Online Study Group
- Challenge the School Nurse archived questions, which are similar to questions on the exam
- Test Taking Techniques e-course from Nurse Builders
You may also find it worthwhile to purchase an online practice exam from NBCSN. Professional exam prep instructors and organizations also offer study books, online courses, and video or in-person review courses.
9: Pass the Certification Exam
The four-hour exam is administered during two- to three-week periods at computer-based testing facilities across the U.S. and Canada.
NBCSN also offers remote proctoring, which allows you to take the exam at home. You’ll need a camera, microphone, and a quiet and well-lit room for this option.
The certification exam includes a maximum of 200 multiple-choice questions on these topics:
- Health Appraisal—26%
- Health Problems and Nursing Management—27%
- Health Promotion/Disease Prevention—20%
- Special Health Issues—14%
- Professional Issues—13%
10: Meet State Requirements
Some states require certification to work as a school nurse, and states in general may have other requirements, such as:
- A BSN
- Current certification in basic life support (BLS)
- Criminal record background check
You can check your state’s requirements on a database maintained by the National Association of State Boards of Education (NASBE).
11: Get a Job
Job opportunities in your local public schools could depend on local funding. School districts that have tight budgets and limited resources may have a higher student-to-school nurse ratio. As a result, nurses in these districts may be responsible for more students and perhaps more than one school.
Competition for jobs can vary by district. And if a school doesn’t have a nurse, it may be due to a lack of funding rather than a lack of qualified candidates.
If full-time opportunities aren’t immediately available, you may be able to gain experience in a part-time position, which some districts use to save money. Working at a boarding school, summer camp, or alternative school could be options as well.
12: Keep Certification Current
You’ll need to renew your NCSN credential every five years. To qualify for recertification, you’ll need to provide documentation of:
- Current RN license
- Employment as a school nurse or related position, including at least 2,000 hours of clinical practice in school nursing during the past five years, with at least 750 of those hours in the last three years
- 75 approved hours of continuing education or professional activities
- Payment of the $245 recertification fee
13: Advance Your Training
Earning certification doesn’t have to be the end of your education. There are many ways to expand your skills if you want to move up or into related roles.
If you take post-graduate coursework in school nursing after earning a BSN, you may be able to apply those credits toward a master’s in nursing, education, or public health. A graduate degree may be required for supervisory roles across school districts or larger geographical areas.
“We take classes to become a certified school nurse and then, for me, those credits counted toward my master’s degree in education: school health services,” says Hunter.
If you have a BSN, you’re also positioned to pursue specialty certifications that may boost your pay. For example, school nurses are typically required to have BLS certification, says Hunter. Becoming certified as a CPR instructor could open opportunities to train and certify school staff in CPR, which could mean higher pay, she says.
Decide if School Nursing Is Right for You
Like any new career journey, you’ll need to decide if school nursing is right for you. Talking to current school nurses and potentially shadowing them while they work is one way to get a firsthand perspective of the role before you invest time and money in training.
“I have found that this role is much like being an ER nurse in that you have often very little information and supplies and have to make do with what creativity you can come up with,” says Hunter. “You never know what’s going to come in your office—is it a bellyache because we hate math or is it a kid who punched glass and needs stitches? A pregnant teen or a kid that fell and maybe has a broken bone?”
In addition to being able to respond in any situation, it also helps to have certain personality traits. “I think the personal characteristics needed for this role would include organization skills, time management skills, and the ability to be flexible and adapt,” says Hunter. “You have to be able to see through some stories and get to the real issues at hand.”
What You’ll Do
While your role may vary depending on the size and type of school, here are some common responsibilities and duties of a school nurse:
- Administer medication and treatment for chronic conditions such as asthma, diabetes, seizures, and sickle cell disease
- Conduct annual vision, hearing, health, and mental health screenings
- Oversee school infection control standards
- Respond to health emergencies involving children and staff
- Maintain student health records, including immunizations
- Develop educational plans for students who need accommodations due to their ability to learn
- Identify child abuse, bullying, and drug abuse
- Connect students and families with social services related to healthcare, food, shelter, and other support
“School nursing can be extremely rewarding. There is so much more than giving out band-aids and ice packs—that’s the easy part!” says Hunter. “We have to be ER nurses, special ed teachers, mommies, counselors, and even teachers.”
Pros and Cons to a Career as a School Nurse
There are many reasons to pursue a career as a school nurse, including:
- Regular work hours, generally 8 a.m. to 3 p.m. Monday through Friday
- Opportunity to be home on snow days, holidays, and during summer break
- Autonomy to do things your way since most school nurses work alone
- Rewards of helping children in need
- Potentially less stressful environment versus working in a hospital
- Opportunity to make an impact and develop relationships with students
And as with any job, there also are challenges to being a school nurse:
- Potentially lower salary than other nursing specialties
- Sometimes heavy workload if you’re the only school nurse on staff
- Lack of recognition as an important part of the school community
- Little administrative help with forms and paperwork
- Less opportunity to interact with other healthcare professionals
- Responsibility to make potentially life-saving decisions without oversight
- Potential to be assigned across multiple schools
- Likelihood of dealing with the messiness of vomiting, colds, lice, and other common childhood health issues
School nurses serve as an important link among students, teachers, coaches, and parents. This requires effective communication and collaboration.
In addition to handling everyday injuries and illnesses, you’ll work to prevent a student’s medical issue from interfering with their ability to learn.
“If the student also has educational issues in addition to the medical issues, then the nurse will be on the IEP (individualized education program) team to help manage the medical accommodations,” Hunter says.
In addition to handling everyday injuries and illnesses, you’ll work to prevent a student’s medical issue from interfering with their ability to learn.
On a broader level, a school nurse contributes to the school environment by educating staff and students on a range of health care issues, including infection control, recognizing signs of distress, and first-aid.
Elementary School vs Middle School vs High School
While many of your duties will be the same no matter the school, elementary, middle, and high school students can present different challenges. “Those are three totally different jobs!” says Hunter.
Here’s a look at responsibilities that can differ by age.
- Address issues affecting proper growth
- Coordinate medication and treatment for chronic conditions
- Handle a higher number of bumps, bruises, and common conditions like stomachaches and fever than likely at older grades
- Address issues related to physical and emotional bullying
- Deal with more complex behavioral issues
- Identify and educate students and staff about the dangers of fads like TikTok challenges
- Less hands-on care for chronic conditions like diabetes since teenagers can often manage on their own
- Address issues related to sexual activity, including STDs, date rape, and teen pregnancy
- Provide alcohol and drug education and identify substance abuse
According to the BLS, the annual median salary for RNs is $75,330, with those in the lowest 10% of the profession earning $53,410 and those in the top 10% making $116,230.
Annual Median Salary for RNs:
While the BLS doesn’t report salaries by specialty for RNs, earning a BSN and certification may increase your salary potential and help you stand out among job candidates, especially in a field that values advanced education. Where you work, your experience, and other factors also can influence your salary.
Pursuing a nursing career may be a wise investment of your time and money. The BLS predicts 9% growth in jobs for nurses from 2020 to 2030, slightly above the average rate for all occupations.
Your employment opportunities as a school nurse will vary depending on the school districts in your area. While some districts hire nurses part time and pay lower salaries, others employ nurses as part of their teachers’ union and pay them on a scale that aligns with teacher salaries, Hunter says.
Written and reported by:
With professional insight from:
Certified School Nurse and founder and author of Your Favorite School Nurse blog