National School Nurse Licensing and Education Standards

By Nick Dobrzelecki, MBA, BSN, RN, Managing Partner and co-founder

Last month, we wrote about what we believe to be a significant issue in the United States: the need for school nursing reform and standards. Quite literally, the mental and physical health of the next generation is at stake. The National Association of School Nurses identifies schools as primary locations to address student health issues, since a school nurse is the health care provider that many students see on the most regular basis. The American Academy of Pediatrics has recognized the crucial role that school nurses play in children’s health and has called for having a full-time school nurse every day and in every school building.1

In our December 2022 blog, we called for three things that need to happen to improve school nursing in our country:

  1. National standards for school nurse education requirements
  2. National standards defining the school nurse’s scope of care
  3. National standards for insurance reimbursement for in-school healthcare services in order to decrease the financial burden on the school system

Allow us to expand today on the first issue: licensing and education requirements.

The lack of universal standards for what it takes to become a school nurse in the United States is astonishing. A random look at a few states offers glaring examples of this:

  • In Minnesota you have to register as a public health nurse (PHN) which requires you to have a bachelor’s degree and then you can apply to be a licensed school nurse (LSN).2
  • To become a school nurse in North Carolina you have to be a RN and obtain your bachelor’s degree and NCSN within three years.3
  • Florida only recommends school nurses to have an NCSN.4

Granted, there are standards of care within the nursing profession, in general. Standards of nursing practice developed by the American Nurses’ Association (ANA) provide guidelines for nursing performance. They are the rules or definition of what it means to provide competent care. Additionally, there are standards for national patient safety goals within several areas of nursing (home health, laboratory services, office-based services, etc.). To their credit, the National Association of School Nurses offers Scope and Standards of Practice for the profession, including a Code of Ethics .5

It’s important to note that the National Board for Certification of School Nurses (NBCSN) has been trying to push through a rigorous national certification process for school nurses for a number of years. In May 2008, the Nationally Certified School Nurses (NCSN®) certification program was granted accreditation by the Accreditation Board of Specialty Nursing Certification (ABSNC). As the administrator of the Nationally Certified School Nurse® (NCSN) credential, NBCSN establishes and measures, through examination, whether an individual has acquired the level of knowledge required to be granted certification in school nursing .6

With no national best practices or requirements to become a school nurse, the people who have access to the majority of this country’s children on any given week day, our nation’s children are getting a wide variety of care quality and knowledge. A national standard for education level should be applied to the school nursing profession.

By establishing national standards for licensing and education, we would be able to give our nation’s children equal access to quality care. In our opinion, each school would have at least one nurse and that nurse needs to be a RN (preferably with a Bachelor’s degree). If a school has additional nursing staff we propose they should at least be LPNs, reporting to the RN/Head Nurse. Lastly, it’s clear that the process for coming up with a national standard needs to be iterative. We cannot move an entire iceberg quickly. We should all be working toward a goal of “an RN in every school” over a period of the next 10 years

We welcome any comments from you — do you agree with these thoughts? What would you include as national licensing and educational standard-setting for school nurses?







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