Supervision and Evaluation of the School Nurse

Supervision and Evaluation of the School Nurse

Position Statement

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It is the position of the National Association of School Nurses (NASN) that the clinical practice of the registered professional school nurse (hereinafter referred to as the school nurse) be supervised and evaluated by a registered nurse knowledgeable about school nurse practice in accordance with School Nursing: Scope and Standards of Practice (NASN, 2022) and the Framework for 21st Century School Nursing PracticeTM (NASN, 2016; NASN, 2020). Nursing supervision and evaluation of school nursing foster professionalism, competency, and quality standards of school nursing clinical care necessary to equitably promote the health, safety, and learning of all students and the school community (Campbell & Minor, 2017a).


While school nurses are accountable for their own practice (NASN, 2022), stipulations in individual employee contracts may require supervision and evaluation. Like teachers and others who provide services for students, school nurses can benefit from self-assessment, peer review, and supervision and performance evaluations that focus on fostering continuous development of practice competencies and professional growth. Just as having highly qualified, effective teachers matters (Robinson, 2023) so does having highly competent school nurses. School nurses’ clinical competence affects nursing care quality which can impact student outcomes. Strengthening school nursing services “improves the health of students and leads to better educational outcomes” (American Academy of Pediatrics, 2023). The provision of effective school nursing care is a matter of equity, particularly for under-resourced communities (Gratz et al., 2021).

Since Congress enacted the Every Student Succeeds Act (ESSA) in 2015, states bear the responsibility for guiding local education agencies (LEAs)/school districts in developing employee supervision and performance evaluation systems. Though school nursing evaluation is not specifically addressed in ESSA, school nurses are recognized by ESSA as specialized instructional support personnel (SISP) who contribute to fair, equitable, and high-quality education that promotes learning and academic achievement for all students (ESSA, 2015).

In the school setting, it is important to distinguish non-clinical from clinical nursing supervision and evaluation (NASN, 2022). Non-clinical aspects of school nursing may include adherence to school and district or other employing agency procedures and policies, state and federal educational regulations, organizational skills, oral and written communication, teamwork, collaboration, and classroom teaching methods (NASN, 2022). These types of non-clinical capabilities may be supervised and evaluated by non-nursing administrators such as a building principal, a district supervisor, or an agency administrator (NASN, 2022; Combe & Clarke, 2019; Dandridge, 2019; Campbell & Minor, 2017a; Campbell & Minor, 2017b).

However, school nurses’ function under additional state and federal nursing and public health laws, statutes, and regulations, including each state’s Nurse Practice Act. These legal factors, in addition to the defined specialized practice of school nursing within the nursing profession (NASN, 2023), set the school nursing scope of practice uniquely apart from other professionals in the education setting. While non-nursing administrative oversight may help to increase general understanding and appreciation of the essential role of school nurses, an individual without an RN license may not supervise or evaluate clinical aspects of school nurses’ practice (NASN, 2022; Combe & Clarke, 2019; Dandridge, 2019; Campbell & Minor, 2017a; Campbell & Minor, 2017b). “Non-clinical staff are not sufficiently qualified to evaluate clinical nursing competency. Districts should shift this specific responsibility to nurse leadership” (Dandridge, 2019, p. 17).

When school nursing clinical practice competency is supervised or evaluated, it must be done by a professional nurse (RN) with knowledge about school nursing. Ideally, this individual has supervisory-level certification and serves in an administrative leadership role such as director, supervisor, coordinator, team leader, or as a coach, mentor, or preceptor (NASN, 2022; Combe & Clarke, 2019). School nursing practice requires specialized application of the nursing process and nursing critical thinking, decision making, and judgment relevant to student health needs in the educational setting (McCabe et al, 2022; Davis et al., 2021; Wallin & Rothman, 2020; Dandridge, 2019, Campbell & Minor, 2017b). Supervision and evaluation of these types of clinical school nursing competencies, knowledge, and skills should be based on the most current school nursing standards of practice as delineated in both the School Nursing Scope and Standards of Practice (NASN, 2022) and the Framework for 21st Century School Nursing Practice™ (NASN, 2016; NASN, 2020). These established standards provide an authoritative framework for performance competencies and evaluation of school nursing (NASN, 2022).

Appropriate clinical supervision and evaluation of school nurses is essential for delivery of high quality and safe care in school communities everywhere (Campbell & Minor, 2017a; Campbell & Minor, 2017b). Developing and strengthening school nursing clinical competencies such as responding to students’ healthcare needs and implementing evidence-based protocols and best practices positively impact student health and academic success (Shin & Roh, 2020; Campbell & Minor, 2017a; Dandridge, 2019).

School administrator input regarding non-nursing responsibilities, along with self- and peer-evaluation, contribute to a well-rounded, interprofessional evaluation of the school nurse. However, school nursing clinical supervision and professional performance evaluation supporting quality school nursing care should be conducted by a registered nurse leader who is well-versed in the specialty practice of school nursing. This should take place for every school nurse in every school, to further the goal of essential and equitable access to quality school nursing care that enhances health, safety, and learning for every student.


American Academy of Pediatrics. (2023). About TEAMS (The Enhancing School Health Services through Training, Education, Assistance, Mentorship, and Support project).

Campbell, T. & Minor, L. (2017a). Supervision of school nurses. In C. Resha, & V. Taliaferro (Eds.), Legal resource for school health services (pp. 49-54).

Campbell, T. & Minor, L. (2017b). Performance evaluation of school nurses. In C. Resha, & V. Taliaferro (Eds.), Legal resource for school health services (pp. 55-59).

Combe, L. & Clarke, Y. (2019). Management of school health staff. In J. Selekeman, R. Shannon & C. Yonkaitis (Eds.), School Nursing: A Comprehensive Text (3rd ed., pp. 936-957). F.A. Davis.

Dandridge S. (2019). Improving school health services for children in Philadelphia: An evaluation report for the school district of Philadelphia. PolicyLab at Children’s Hospital of Philadelphia.

Davis, D., Maughan, E., White, K., & Slota, M. (2021). School nursing for the 21st century: Assessing scope of practice in the current workforce. The Journal of School Nursing, 37(5), 374-386. doi:10.1177/1059840519880605

Every Student Succeeds Act (ESSA). (2015). Public Law No: 114-95 (12/10/2015).

Gratz, T., Goldhaber, D., Willgerodt, M. & Brown, N. (2021). The frontline health care workers in schools: Health equity, the distribution of school nurses, and student access. The Journal of School Nursing. Advance online publication. doi:10.1177/10598405211024277

McCabe, E., Jameson, B. & Strauss, S. (2022). School nurses matter: Relationship between school nurse employment policies and chronic health condition policies in U.S. school districts. The Journal of School Nursing, 38(5), 467-477. doi:10.1177/1059840520973413

National Association of School Nurses. (2016). Framework for 21st century school nursing practice™. NASN School Nurse, 31(1), 46-53. doi: 10.1177/1942602X15618644

National Association of School Nurses. (2020). Framework for 21st century school nursing practice™: Clarifications and updated definitions. NASN School Nurse, 35(4), 225-233. doi: 10.1177/1942602x20928372

National Association of School Nurses. (2022). School nursing: Scope and standards of practice (4th ed.). Author.

National Association of School Nurses. (2023). About NASN.

Robinson, S. (2023). Teacher evaluation. why it matters and how we can do better. Frontline Education.

Shin, E. & Roh, Y. (2020). A school nurse competency framework for continuing education. Healthcare (Basel). 8(3), 246. doi: 10.3390/healthcare8030246

Wallin, R. & Rothman, S. (2020). A new framework for school nurse self-reflection and evaluation. NASN School Nurse, 35(1), 35-42. doi: 10.1177/1942602X19852295.

Acknowledgement of Author(s)
Wendy A. Doremus, DNP, RN, FNP-BC (retired), PHNA-BC (retired)

Review Team:
Susan Chaides, MEd, RN, CPNP
Julie Hudson, MSN, RN, BSN, NCSN

Adopted: July 1970
Revised: June 1982; June 1985; June 1995; November 2003; June 2008, June 2013, June 2018, June 2023

Suggested citation: National Association of School Nurses. (2023). Supervision and evaluation of the school nurse (Position Statement). 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.