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The Role of the Credentialed School Nurse

The California School Nurses Organization (CSNO) position statement:

“The California School Nurses Organization believes that the credentialed school nurse, as a pivotal member of the coordinated school health system, answers the health care needs of school children as they relate to education. If a child is not healthy, then that child’s ability to learn is compromised. The credentialed school nurse, as the supervisor of health, is a leader in supporting student success in the multifaceted role of planner, coordinator, provider of care, communicator, educator, and advocate. The scope of practice of the credentialed school nurse is dynamic and ever changing as laws are enacted to address the complex health needs of students.

The credentialed school nurse is a bachelor’s degree prepared registered nurse, licensed by the California Board of Registered Nursing and credentialed with a specialization in health authorizing services as a school nurse by the Commission on Teacher Credentialing.

The role of the credentialed school nurse is defined in Education Code 49426. It reads in part: “School nurses strengthen and facilitate the educational process by improving and protecting the health status of children and by identification and assistance in the removal or modification of health related barriers to learning in individual children. The major focus of school health services is the prevention of illness and disability, and the early detection and correction of health problems. The credentialed school nurse is especially prepared and uniquely qualified in preventive health, health assessment and referral procedures.”

Within this broad definition, the credentialed school nurse uses her nursing skills and professional judgment to design and implement a health services program, which ensures that all students receive the maximum benefit from their educational experience. This is accomplished by working collaboratively with students, families, teachers, other members of the multidisciplinary team, and utilizing resources within the community, to meet the physical, mental, emotional and social health needs of students.

On a daily basis the credentialed school nurse’s role may include the following:

  • Assessing and evaluating the health and developmental status of students
  • Communicating with students, families and health care providers
  • Interpreting assessments and medical information to school staff working with the student
  • Designing and implementing an Individualized School Health Plan, Emergency Care Plan, Individual Educational Plan or Section 504 Plan related to physical health care needs or chronic illnesses
  • Determining the appropriate level of care for students with specialized health care needs and training, monitoring and supervising licensed and unlicensed staff
  • Providing case management services for students
  • Counseling students and parents regarding health or school related issues and providing information and referral to community services
  • Administering and monitoring medications
  • Serving as a resource to staff and providing in-services on a variety of health topics
  • Developing curriculum and delivering comprehensive health education to students
  • Promoting a healthy school environment for the emotional and physical safety of students
  • Providing direct services to students through screening programs and care for illnesses and injuries

RATIONALE
California schools must address the diverse and complex health problems of today’s students. In addition to health issues, schools must cope with problems related to immigration, homelessness, substance abuse and poverty. Many of our children come with issues that make learning difficult. In addition to societal pressures, they may have undetected health conditions, poorly managed chronic illnesses or complex medical problems that were at one time only managed at inpatient settings. Economic conditions and increased demands upon credentialed school nurses have required, in many instances, the addition of licensed and unlicensed personnel to assist in meeting the health care needs of students.

As the heath care expert within the school and an advocate for students and families, the credentialed school nurse uses professional skills, nursing judgment and leadership ability to create a safe school environment, which supports the well-being, academic success and life-long achievement of students.”

CA School Nurses Organization
(See position statement for references)

Below is the National Association of School Nurses description of school nursing roles:

School nurses facilitate normal development and positive student response to interventions.

The school nurse serves as the health care expert in the school to meet student health needs with an understanding of normal growth and development in children and youth as well as students with special needs. The school nurse develops plans for student care based on the nursing process, which includes assessment, interventions, and identification of outcomes and evaluation of care (Wolfe, 2012).

School nurses provide leadership in promoting health and safety, including a healthy environment.

The school nurse provides health-related education to students and staff in individual and group settings and provides consultation to other school professionals, including food service personnel, physical education teachers, coaches, and counselors. Responsibilities in the provision of a safe and healthy school environment include the school nurse’s monitoring of immunizations, managing communicable diseases, assessing the school environment for safety to prevent injury and spearheading infection control measures. The school nurse is also a leader in the development of school safety plans to address bullying, school violence, and the full range of emergencies that may occur at school (Wolfe, 2012).

School nurses provide quality health care and intervene with actual and potential health problems.

Health care for chronic and acute illness, as well as injuries in the school setting, is a major focus of the role of the school nurse. The school nurse is responsible for medication administration, health care procedures, and the development of health care plans. Students often have multiple needs that should be examined in order for the student to be able to be successful in the classroom, and school nurses often engage in health screenings that include vision, hearing, body mass index, mental health index or other screening procedures (often based on local and state regulations) to address those issues (Wolfe, 2012).

School nurses use clinical judgment in providing case management services.

The school nurse receives medical orders to guide the health care needed to assist each student to be safe and successful at school. As in other clinical settings, the nurse develops Individualized Healthcare Plans (IHPs) in nursing language to direct nursing care for students as well as Emergency Care Plans (ECPs) written in lay language to guide the response of unlicensed personnel in a health-related emergency. Both plans are tailored to the individual needs of a
specific student to improve expected care outcomes. The nurse makes decisions related to the appropriate delegation of healthcare tasks as directed by state laws and professional practice guidance (American Nurses Association [ANA]/National Council of State Boards of Nursing [NCSBN], 2006). As medical and information technology advance and change, it is imperative for the school nurse to pursue professional development so the school nurse is able to provide the best possible care for the student population (Wolfe, 2012).

School nurses actively collaborate with others to build student and family capacity for adaptation, self-management, self-advocacy and learning.

Coordinating the linkage between the medical home, family and school is an important aspect of the role of the school nurse. The school nurse has health expertise that is essential to school educational teams, such as the Committee on Special Education, the Individualized Educational Plan (IEP) team and the Section 504 Team so that health-related barriers to learning can be reduced for each student. The school nurse can provide families with referral information along with available community resources to improve access to health care. The school nurse can also assist families in obtaining health insurance as needed and can represent the school on community coalitions to advocate for school-based health care (Wolfe, 2012).

The school nurse may take on additional roles as needed to meet the needs of the school community.

Healthy children are successful learners. The school nurse has a multi-faceted role within the school setting, one that supports the physical, mental, emotional, and social health of students and their success in the learning process. It is the breadth of nursing activities contained within the role of the school nurse and the unique non-medical setting that differentiates school nursing from other nursing specialties.”

Role of School Nurse - NASN

See position statement for summary, history, references and acknowledgement of authors
The American Academy of Pediatrics (AAP) has also made a statement in regard to the role of the school nurse.

AAP School Nurse Role

“The school nurse has a critical role within this school health program and provides acute, chronic, episodic, and emergency health care.

In addition, the school nurse provides health education and health counseling and advocates for students with disabilities. School nurses are well positioned to take the lead for the school system in partnering with community physicians,
community organizations, and Medicaid and State Children's Health Insurance Program staff to assist families and students to enroll in the state health insurance programs and find a medical home for each student.”

For more see the entire AAP policy:

American Academy of Pediatrics – The Role of the School Nurse in Providing School Health Services (2001)