Supervision and Evaluation of the School Nurse
It is the position of the National Association of School Nurses (NASN) that the practice of the registered professional school nurse (hereinafter referred to as the school nurse) be supervised and evaluated by a registered nurse knowledgeable of school nurse practice in accordance with the School Nursing: Scope and Standards of Practice (American Nurses Association [ANA] & NASN, 2017) and the Framework for 21st Century School Nursing PracticeTM (NASN, 2016a). To promote proficiency, professionalism and quality improvement initiatives, supervision and evaluation of school nurse performance should support the specific roles and responsibilities necessary to promote the health, safety, and learning of individual students and unique school communities.
Many school nurses practice autonomously as the only healthcare provider in the educational environment with limited or no access to a nurse supervisor. Only 36.2% of school nurses report being supervised by a registered nurse (Mangena & Maughan, 2015). Therefore, many school nurses are supervised and evaluated by non-nursing personnel, such as school administrators, who may have limited understanding of the role of the registered nurse in the school setting.
Clinical nursing competency should be evaluated based on established practice standards. These standards provide a framework through authoritative statements and associated performance competencies of the duties and responsibilities of the school nurse (ANA & NASN, 2017).
Competence in nursing practice requires evaluation by the individual nurse (self- assessment), nurse peers, and nurse supervisors, mentors, or preceptors. Supervision and evaluation should also be distinguished between clinical supervision and administrative supervision (ANA, NASN, 2017). Practice documents, such as the School Nursing: Scope and Standards of Practice (2017), suggest that non-nurse supervisors may contribute to the supervision and evaluation of non-nursing activities, such as “interpersonal and communication skills, team collaboration and networking, and classroom teaching” (ANA & NASN, 2017, p. 32); however, these professionals do not have the qualifications to evaluate clinical nursing competency. In fact, some state boards of nursing offer specific language prohibiting non-nurse personnel from evaluating the clinical skills of nurses (Kansas Board of Nursing, 2011).
McDaniel, Overman, Guttu, and Engelke (2013) also suggest that, when the standards are fully integrated into practice, school nurses are more likely to adhere to them and are less likely to focus only on the tasks hence further advancing their competency. Finally, collaborative, interprofessional, clinical, and administrative evaluation processes may also help to increase non-nursing administrators’ knowledge and appreciation of the expansive role of school nurses (Haffke, Damm, & Cross, 2014; McDaniel, Overman, Guttu & Engelke., 2013).
“Clinical supervision requires specialized, professional knowledge, skills and related credentials for the practice of school nursing. It promotes, enhances and updates the professional growth of school nurses in terms of their professional and clinical skills and knowledge” (CSDE, 2014, p. 13). Ideally, clinical supervision begins with an alignment of the job description, the school nurse’s orientation and professional development, and an evaluation tool reflective of both the Scope and Standards of School Nursing Practice (ANA & NASN, 2017) and the Framework for 21st Century School Nursing Practice™ (NASN, 2016a). Clinical supervision fosters professional and clinical development by supporting and evaluating the school nurse’s response to the healthcare needs of students and school community and attention to best practice and evidence-based protocols (Campbell & Minor, 2017a). Evaluation processes and tools should reflect the wide array of roles and responsibilities of school nursing practice, as well as goals for professional growth and development in accordance with national standards and state nurse practice acts (Connecticut State Department of Education [CSDE], 2014; McDaniel, et al., 2013; Southall et al., 2017).
Administrative supervision, i.e., supervision of non-clinical skills, may be provided by the registered nurse or by school administrators, such as a building principal or district administrator (ANA, 2014). Activities and attributes, adherence to school policy and state and federal regulations, organizational skills, oral and written communication skills, teamwork, collaboration, and the day-to-day nonclinical duties are examples of areas of practice that are appropriately supervised by non-nursing administrators.
SUPERVISION AND EVALUATION MODELS
According to ANA (2014), “there is not one tool or model that can guarantee competency; … employers are responsible and accountable to provide an environment conducive to competent practice” (p.6). Evaluation and performance appraisal processes, methods, and tools include the following:
- Measurable objectives based on job descriptions, scope and standards of practice, competencies, and applicable state laws;
- Input and goal-setting by school nurses, school nurse supervisors (if available), and school administrators;
- Evidence-based protocols, state and/or national certification, nursing practice portfolios, and outcomes from continuing education; and
- Performance review at least annually, or sooner if indicated, within a continuous quality improvement context (ANA, 2014; Campbell & Minor, 2017a, 2017b; CSDE, 2014; McDaniel et al., 2013; Southall, et al., 2017; Wisconsin Department of Public Instruction, 2016).
School nursing clinical competency and professional performance should be evaluated by an experienced registered nurse who is competent in the specialty practice of school nursing and accompanied by self- and peer-evaluation. Input from school administrators regarding non-nursing responsibilities contributes to a well-rounded interprofessional evaluation of the nurse employed in a school system. Clinical supervision and evaluation of nursing practice require nursing knowledge and skill. Evaluation of school nurse practice by school nurses is crucial to promote safe, high quality, competent care for all school children and their school communities. Quality school nursing care in every school all day will optimize student health, safety, and learning (NASN, 2016b).
American Nurses Association. (2014). Professional role competence (Position Statement). Retrieved from https://www.nursingworld.org/practice-policy/pro-issues-panel/professional-role-competence/
American Nurses Association & National Association of School Nurses. (2017). School nursing: Scope and standards of practice (3rd ed.). Silver Spring, MD: Author.
Campbell, T. & Minor, L. (2017a). Performance evaluation of school nurses. In C.A. Resha, & V.L. Taliaferro (Eds). Legal resource for school health services, (pp. 55-59). Nashville, TN: Schoolnurse.com.
Campbell, T. & Minor, L. (2017b). Supervision of school nurses. In C.A. Resha, & V.L. Taliaferro (Eds). Legal resource for school health services, (pp. 55-59). Nashville, TN: Schoolnurse.com.
Connecticut State Department of Education. (2014). Competency in school nursing practice. Hartford, CT: Author. Retrieved from http://www.portal.ct.gov/-/media/SDE/School-Nursing/Publications/Competency_in_School_Nurse_Practice.pdf
Haffke, L.M., Damm, P., & Cross, B. (2014). School nurses race to the top: The pilot year of how one district’s school nurses revised their evaluation process. The Journal of School Nursing, 30(6), 404-410. doi: 10.1177/1059840514536581
Kansas Board of Nursing (2011). Legal frequently asked questions. Retrieved from http://www.ksbn.org/legal/faq.htm
Mangena, A. S. & Maughan, E. (2015, November). The 2015 NASN School Nurse Survey: Developing and providing leadership to advance school nursing practice. NASN School Nurse, 30(6),329-335. doi: 10.1177/1942602X15608183
McDaniel, K.H., Overman, M., Guttu, M., Engelke, M.K. (2013). School nurse evaluations: Making the process meaningful and motivational. The Journal of School Nursing, 29(1): 19-30. doi: 10.1177/1059840512469407
National Association of School Nurses. (2016a). Framework for 21st century school nursing practice. NASN School Nurse, 31(1), 46-53. doi: 10.1177/1942602X15618644
National Association of School Nurses. (2016b). The role of the 21st century school nurse (Position Statement). Silver Spring, MD: Author. Retrieved from https://www.nasn.org/advocacy/professional-practice-documents/position-statements/ps-role
Southall, V., Wright, V., Campbell, T., Bassett, M., Strunk, J. & Trotter, S. (2017). School nurse evaluation: Developing a tool that both school nurses and administrators can use. NASN School Nurse, 29 (1), 87-90. Doi: 10.1177/1942602X16684848
Wisconsin Department of Public Instruction (2016). Wisconsin pupil services evaluation system: School nurse rubric. Retrieved from https://dpi.wi.gov/sites/default/files/imce/sspw/pdf/psschoolnurserubric.pdf
Acknowledgement of Authors:
Cheryl Resha, EdD, MSN, RN, FNASN
Elaine Mauter, BSN, RN
Elizabeth Zeno, MA, BSN, RN, LSN
Tina Miller, BSN, RN
Adopted: July 1970
Revised: June 1982; June 1985; June 1995; November 2003; June 2008, June 2013, June 2018
Suggested citation: National Association of School Nurses. (2018). Supervision and evaluation of the school nurse (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.