Education, Licensure, and Certification of School Nurses
It is the position of the National Association of School Nurses (NASN) that every school‐age child should have access to a registered professional school nurse (hereinafter referred to as the school nurse), who has a minimum of a baccalaureate degree in nursing from an accredited college or university and is licensed as a registered nurse through a board of nursing. These requirements constitute minimal preparation needed to practice at the entry level of school nursing (American Nurses Association [ANA] & NASN, 2011). Additionally, NASN supports state school nurse certification and endorses national certification of school nurses through the National Board for Certification of School Nurses (NBCSN) (NASN, 2016a).
School nursing is a subspecialty of public health nursing, which is incorporated in the curriculum for baccalaureate nursing programs. Baccalaureate nursing education develops competencies in leadership, critical thinking, quality improvement, and systems thinking. It provides graduates with nursing theory and clinical experience and cultivates their ability to translate research into evidence-based nursing practice. Baccalaureate prepared nurses also address and analyze current and emerging healthcare issues, including the need for health policy and healthcare financing (National Advisory Council on Nurse Education and Practice, 2014; Institute of Medicine [IOM], 2010).
To practice as a professional registered nurse, graduates must pass the National Council Licensure Examination for the Registered Nurse (NCLEX-RN) in their state, territory, or country in which the exam is offered. In addition to nursing licensure by a board of nursing, post‐baccalaureate education and or certification approved by departments of education may be required to practice school nursing. Licensure protects the public by indicating that a nurse successfully completed an examination that demonstrated a minimal level of competency to practice professional nursing. Certification documents a higher level of competence and expertise in a focused area of practice. Requirements for state certification and the certifying bodies vary by individual state, territory, or county in which a school nurse practices.
In the 1980s, NASN developed a national certification examination and then established the National Board for Certification of School Nurses (NBCSN), which became an independent incorporation in 1991. The purpose was twofold: to promote and recognize quality practice in school nursing and to assure that certification criteria and examinations in school nursing are determined by experts in the specialty practice (NBCSN, 2015).
"School nursing, a specialized practice of public health nursing, protects and promotes student health, facilitates normal development, and advances academic success. School nurses, grounded in ethical and evidence-based practice, are the leaders that bridge health care and education, provide care coordination, advocate for quality student-centered care, and collaborate to design systems that allow individuals and communities to develop their full potentials” (NASN, 2016b). The ANA (2013) takes the position that the minimum preparation for beginning professional nursing practice in public health be a baccalaureate degree. The IOM (2010) recommends that nurses attain advanced education to be able to react to the increasing demands of nursing practice. School nursing requires advanced skills included in a baccalaureate program, which consists of the ability to practice autonomously, supervise others, and delegate care in a community, rather than a hospital or clinic setting if allowed by state laws (ANA & NASN, 2011).
NASN’s Framework for 21st Century School Nursing PracticeTM provides structure and focus for current, evidence- based school nursing practice. School nurses use these skills outlined in the practice components of each principle (NASN, 2016c). School nurses work with a vulnerable pediatric community population to achieve improved health outcomes (Kulbok, Thatcher, Park, & Meszaros, 2012). Williams and Counts (2013) found that the public benefits from the certification of nurses by way of improved client safety, increased nurse knowledge and skills, and focused nurse professional development throughout their career. “Certification for school nurses benefits the public by recognizing those nurses that have competence beyond the novice level” (Selekman & Wolfe, 2010, Preface).
Licensed registered nurses who work in the specialty practice of school nursing require advanced skills to address the complex health needs of students within a school community setting (ANA/NASN, 2011). These skills are attained through a minimum of a baccalaureate degree in nursing and validated by specialized certification in school nursing (IOM, 2011).
American Nurses Association. (2013). Public health nursing: Scope and standards of practice, (2nd ed). Silver Spring, MD: American Nurses Association.
American Nurses Association (ANA) and National Association of School Nurses (NASN). (2011). School nursing: Scope and standards of practice (2nd ed.) Silver Spring, MD: Nursebooks.org.
Institute of Medicine (IOM). (2010). The future of nursing: Report on education report brief. Retrieved from http://www.nationalacademies.org/hmd/~/media/Files/Report%20Files/2010/The-Future-of-Nursing/Nursing%20Education%202010%20Brief.pdf
Institute of Medicine (IOM), Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing. (2011). The future of nursing: Leading change, advancing health. Washington, DC: The National Academies Press.
Kulbok, P.A., Thatcher, E., Park, E., & Meszaros, P.S. (2012). Evolving public health nursing roles: Focus on community participatory health promotion and prevention. OJIN: The Online Journal of Issues in Nursing, 17(2), Manuscript 1. doi 10.3912/OJIN.Vol17No02Man01
National Advisory Council on Nurse Education and Practice. (2014). Public health nursing: Key to our nation’s health. 12th Annual Report to the Secretary of the U.S. Department of Health and Human Services and the U.S. Congress, March 2014. Retrieved from http://www.hrsa.gov/advisorycommittees/bhpradvisory/nacnep/Meetings/12thannualreportpublichealthnursing.pdf
National Association of School Nurses. (2016a). School nurse certification. Retrieved from http://www.nasn.org/RoleCareer/SchoolNurseCertification
National Association of School Nurses. (2016b). Definition of school nursing. Retrieved from https://www.nasn.org/RoleCareer
National Association of School Nurses. (2016c). Framework for 21st century school nursing practice. NASN School Nurse, 31(1), 218-231. doi: 10.1177/1942602X15618644
National Board for Certification of School Nurses (NBCSN). (2015). School nursing certification. Retrieved from http://www.nbcsn.org/
Selekman, J., & Wolfe, L.C. (2010). School nursing certification review. Silver Spring, MD: National Association of School Nurses.
Williams, H. F., & Counts, C. S. (2013). Certification 101: The pathway to excellence. Nephrology Nursing Journal, 40(3), 197-253,257. Retrieved from https://www.highbeam.com/doc/1G1-337717535.html
Acknowledgement of Authors:
Valerie Beshears, MSN, RN, NCSN
Elizabeth Clark, MSN, RN, NCSN
Patrice Lambert, MSN, RN, SNC
Jodi Sheets, BSN, RN
Carmen Teskey, MA, BSN, RN
Barbara Yow, MEd, BSN, RN, NCSN
Adopted: October 2012
Revised: January 2012, June 2016
Suggested citation: National Association of School Nurses. (2016). Education, licensure, and certification of school nurses (Position Statement). Silver Spring, MD: Author.
All position statements from the National Association of School Nurses will automatically expire five years after publication unless reaffirmed, revised, or retired at or before that time.