School nursing is the practice of nursing inside an educational institution, and it is the most solitary licensed nursing job in the country. The school nurse is usually the only healthcare professional in the building, frequently covers several buildings, and makes clinical decisions with no colleague to consult.
What the job contains
Children with chronic conditions. Asthma, type 1 diabetes, epilepsy, severe allergy, and increasingly complex conditions that once kept a child out of school entirely — tracheostomies, feeding tubes, ventilators. Federal disability law requires schools receiving federal funds not to discriminate on the basis of disability and to provide accommodations, and the school nurse is a large part of how a child with a health condition actually attends.
Individualized health plans. Written nursing plans for each child with a health condition, coordinated with the accommodation and education plans that give a child services. This is where the nurse's clinical judgment becomes a legal document.
Medication administration, at volume, under state law that governs who may give what in a school.
Emergencies. Anaphylaxis, seizure, asthma attack, diabetic crisis, injury, and cardiac arrest — managed alone, with a class watching, until an ambulance arrives.
Screening and surveillance — vision, hearing, scoliosis, immunization compliance, and communicable disease control, including exclusion decisions and outbreak management.
Mental health. In many schools the nurse is the first adult a child in crisis reaches, and often the one who notices self-harm, an eating disorder, or abuse. Mandatory reporting duties sit here.
Health education and the health office as refuge. A meaningful share of visits are children who are not physically ill and need somewhere to go — which is itself useful assessment data.
Delegation is the legal core
A school nurse cannot be in three buildings at once, so much of what happens is delegated to unlicensed school staff: a secretary giving a scheduled medication, a teacher trained to use an epinephrine auto-injector, an aide checking a blood glucose. The nurse trains them, documents competency, supervises, and remains accountable for the outcome.
State law on this varies more than in almost any other area of nursing practice, and the differences are consequential: which tasks may be delegated at all, to whom, with what training, and how often competency must be reassessed. Several states also give a school nurse a specific statutory role that a general practice act does not describe. See scope of practice and nurse practice acts and boards of nursing.
Staffing
There is no national requirement that a school employ a nurse. Coverage is set by state law and by district budget, and it ranges from a full-time registered nurse in every building to one nurse covering thousands of students across several schools, sometimes with unlicensed health aides in between.
The professional association for the specialty has moved away from a fixed nurse-to-student ratio toward a model that accounts for the acuity of the student population — a school with twelve children on insulin pumps is not the same as a school with none. The underlying argument mirrors acuity-based staffing everywhere else. See patient acuity and staffing systems.
Certification and preparation
The credential is the NCSN, from the National Board for Certification of School Nurses.
Requirements to hold the job itself vary by state: some require a bachelor's degree, some require a state school nurse licence or educational credential in addition to the registered nurse licence, and some require only registered nurse licensure. Anyone moving between states should check both the board of nursing and the state education agency, because the second one is easy to miss.
The trade-offs
School nursing offers a schedule almost no other nursing job does — school hours, weekends, holidays, and summers — which is why it draws nurses with children of their own. Pay is generally on the education salary scale rather than the healthcare one, which usually means less than hospital nursing.
The isolation is the real cost. There is no charge nurse, no rapid response team, and no second opinion; there is a child having a seizure and one nurse. Nurses entering the specialty from acute care consistently describe that as the adjustment that takes longest.
Related
Sources
- National Board for Certification of School Nurses — on the NCSN credential and recertification. Accessed September 9, 2026.
- National Guidelines for Nursing Delegation — National Council of State Boards of Nursing and American Nurses Association, 2019. Accessed September 9, 2026.
- Section 504 — U.S. Department of Education, on the prohibition of disability discrimination in programmes receiving federal funds. Accessed September 9, 2026.