Supervision and Evaluation of the School Nurse
It is the position of the National Association of School Nurses (NASN) that the registered professional school nurse (hereinafter referred to as the school nurse) should be clinically supervised and evaluated by a registered nurse knowledgeable of the scope and standards of practice for school nursing. The school nurse job description and performance evaluation should be based on the standards of school nursing practice, the standards of professional performance, and related competencies described in the current version of “School Nursing: Scope and Standards of Practice” (American Nurses Association [ANA] & National Association of School Nurses [NASN], 2011).
The school nurse is often the only healthcare provider in a school. However, school nurses may be supervised and evaluated by school administrators who have little or no knowledge and understanding of the school nurse role. Liability exists when school administrators, who do not fully understand the scope and standards of school nursing practice, are responsible for supervising and evaluating the clinical competency of the school nurse (Hootman, 2013; McDaniel et al., 2013).
NASN, in collaboration with the ANA, has developed standards of practice that apply to the specialty practice of school nursing. These standards provide a framework for the expansive scope of practice and authoritative statements of the duties that school nurses are expected to competently perform. To be truly meaningful, the standards statements and the accompanying competencies must be further refined to reflect the context of practice, district policies, and state nurse practice acts. The standards of practice and professional performance for school nursing provide the tools to focus on the tasks that promote the health and academic achievement of all students (McDaniel, Overman, Guttu & Engelke, 2013) and guide the evaluation of competencies needed to meet these standards.
In order to meet students’ health needs and to function effectively with school and community team members, school nurses need supervision and evaluation to maintain and improve competence in this independent practice. Accurate job descriptions and an evaluation process that includes both an administrative and a clinical nursing component are essential and should be based on the standards of practice and professional performance for school nursing practice. School nurses are instrumental in creating and revising job descriptions and the competencies to be included in a performance evaluation (McDaniel et al., 2013).
As the health needs of today’s students have increased in the school setting, school nurses have expanded their base of knowledge and skills to safely care for them (Resha, 2009). School nurses need the support provided by clinical supervision, which 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” (Connecticut State Department of Education, 2009, p. 20).
The National Association of State School Nurse Consultants’ (NASSNC) 2007 position paper supports clinical supervision of school nurses by licensed, experienced registered nurses rather than a non-nurse supervisor. NASN and the NASSNC recommend that school nurses be supervised and evaluated by a school nurse because the integrity and quality of nursing practice is enhanced when clinical supervision is provided (Somerville, 2013).
If school districts do not have an administrator who is a school nurse, it is recommended that a designated lead school nurse provide clinical supervision.
School nurses function as independent practitioners who are accountable under the scope of their professional license, applicable district policies and procedures and their state’s nurse practice act. For this reason, professional accountability through a performance evaluation process is essential to ensure professional competency and growth (Beirne, 2009).
In the 2008 position statement “Professional Role Competence” the ANA states,
The public has a right to expect registered nurses to demonstrate professional competence throughout their careers. ANA believes the registered nurse is individually responsible and accountable for maintaining professional competence. The ANA further believes that it is the nursing profession’s responsibility to shape and guide any process for assuring nurse competence. Regulatory agencies define minimal standards for regulation of practice to protect the public. The employer is responsible and accountable to provide an environment conducive to competent practice. Assurance of competence is the shared responsibility of the profession, individual nurses, professional organizations, credentialing and certification entities, regulatory agencies, employers, and other key stakeholders (para. 1).
Best practice requires a nurse in the role of supervisor, coach, mentor or preceptor to evaluate the clinical practice of the school nurse, identify the professional competencies outlined in the job description, and determine the need for professional development (Beirne, 2009; Hootman, 2013). Performance evaluations can also be enhanced through a process of self-evaluation and the development of a professional portfolio that documents competencies that meet standards of school nursing practice. Additional performance indicators, not related to the practice of nursing, can be evaluated by educational administrators and others (ANA & NASN, 2011; McDaniel et al., 2013).
In districts without school nurse administrators, a self-evaluation process and use of a professional portfolio become increasingly important. Contracting with a school nurse supervisor in another school district for the nursing component of a performance evaluation is recommended. School nurses without nurse administrators can take a leadership role in assisting their administration in developing a performance evaluation tool that includes a self-evaluation based on scope and standards of school nursing practice and non-nursing performance indicators. Co-development of a performance evaluation tool can increase the administration’s understanding of the school nurse role in the school setting (Green & Reffel, 2009).
Student health and safety and the continuous improvement of individual school nursing practice is the goal of performance management (Somerville, 2013), supervision and evaluation. The school nurse can “provide valuable, needed services to students if he or she has core skills and knowledge, mastery of competencies, and is supported by a supervisor who offers guidance, encourages professional development and provides evaluation” (Connecticut State Department of Education , 2009, p.25).
As the only healthcare provider in the school setting, the school nurse is often supervised and evaluated by a non-nurse staff member. According to the guidelines developed by the ANA and NASN’s (2011) scope and standards of practice, the school nurse’s performance evaluation should consist of three components: a self-evaluation completed by the school nurse, a clinical evaluation performed by another registered nurse and a non-clinical evaluation, which may be completed by a non-clinical supervisor.
American Nurses Association, Nursing World. (2008). Position statement: Professional role competence. Retrieved from http://nursingworld.org/MainMenuCategories/Policy-Advocacy/Positions-and-Resolutions/ANAPositionStatements/Position-Statements-Alphabetically/Professional-Role-Competence.html
American Nurses Association & National Association of School Nurses. (2011). School nursing: Scope and standards of practice (2nd ed.). Silver Spring MD: Nursesbooks.org.
Beirne, M. (2009). Using a professional portfolio to enhance school nursing practice. NASN School Nurse 24(5), 212-214. doi: 10.1177/1942602X09344198
Connecticut State Department of Education. (2009). Competency in school nurse practice. Retrieved from http://www.sde.ct.gov/sde/lib/sde/PDF/deps/student/health/Nursing_Competencies.pdf
Green R. & Reffel, J. (2009). Comparison of administrators’ and school nurses’ perception of the role of the school nurse. The Journal of School Nursing, 25, 62-71. doi: 10.1177/1059840508324248
Hootman, J. (2013). Staff management. In J. Selekman (Ed.), School nursing: A comprehensive text (2nd ed., pp. 1290--1321). Philadelphia, PA: FA Davis Company.
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 State School Nurse Consultants (NASSNC). (2007). Position statement: Clinical supervision of school nurses. Kent, OH, NASSNC.
Resha, C. (2009). School nurse competencies: How can they assist to ensure high quality care in the school setting. NASN School Nurse, 24(6), 240-241.
Somerville, D. (2013). Managing school nurse performance for success. In C. Costante (Ed.), School nurse administrators’ leadership and management (pp. 231-255). Silver Spring, MD: National Association of School Nurses.
Acknowledgement of Authors:
Debra Robarge, BSN, RN, NCSN
Anne Coyle, BSN, RN, NCSN
Pat Endsley, MSN, RN
Elaine Mauter, BSN, RN
Adopted: July, 1970
Revised: June 1982; June 1985; June 1995; November 2003; June 2008, June 2013