The Journal of School Nursing2025, Vol. 41(4) 519–521© The Author(s) 2025Article reuse guidelines:sagepub.com/journals-permissionsDOI: 10.1177/10598405251332806journals.sagepub.com/home/jsn
It is the position of the National Association of School Nurses (NASN) that all students should have equitable access to school health services (SHS) team support and care every school day to be healthy, safe, and ready to learn. Professional registered nurses, hereinafter referred to as school nurses, are instrumental leaders of SHS teams that identify and address students’ physical, mental, behavioral, and social–emotional health needs to promote student well-being and academic achievement.
SHS teams are pivotal in identifying and addressing students’ physical, social, emotional, and mental health needs that impact learning (Temkin, Piekarz-Porter et al., 2021a; Temkin, Steed et al., 2021b). However, national laws governing the provision of minimum standards for SHS do not currently exist. States, communities, and school districts determine SHS program funding and budgets, goals, organization, composition, and operation, resulting in varied delivery models (Center for School Health Innovation & Quality, 2023; Tiu et al., 2021). Other factors that contribute to SHS program differences include the extent of student needs, community resources, local preferences, and the support of administrative leaders and other key school system decisionmakers (Uhm et al., 2020; Webster et al., 2020).
Attending to student healthcare needs in school requires a broad range of practices and interventions provided by SHS professionals. Members of the interprofessional SHS team vary across school districts (McCabe et al., 2022). As experts in health, school nurses are well-qualified to serve as SHS team leaders. In addition to school nurses, SHS team members may include other professionals such as a school physician (usually in a consultative role), social workers, guidance counselors, psychologists, physical and occupational therapists, speech-language pathologists, athletic trainers, and nutrition services providers (Blanco, 2022). In addition, SHS teams may incorporate educators from the disciplines of physical education, health, or special education. If allowed by state law, the State Nurse Practice Act, and school district policies, licensed practical nurses/licensed vocational nurses provide care within a limited scope of practice and under the clinical direction of a school nurse. Again, depending on state and local regulations, nursing assistants, health clerks, health aides, paraprofessionals, or unlicensed assistive personnel perform some health-related tasks that do not require professional nursing assessment or judgment if delegated and supervised by a school nurse (Combe & Clark, 2019). Another facet of healthcare available in some schools is school-based health centers (SBHCs), which deliver primary care services to students on or near school sites. Though SBHCs function in coordination with SHS, SBHCs operate under independent provisions and funding mechanisms, so SBHC entities are not addressed within this position statement.
The SHS team collaborates with families, educators, other healthcare professionals, and the broader community. Together, they identify and address physical, mental, and behavioral health-related stressors, barriers to care, and unmet needs that impact student health and learning (Centers for Disease Control and Prevention [CDC], 2024). SHS teams provide data-informed, evidence-based health prevention, education, screening, identification, management, and treatment to address acute, chronic, and communicable conditions. Interventions such as care coordination, medication administration, emergency care and planning, referrals, and monitoring assist and support students in learning (American Academy of Pediatrics [AAP], 2022b; Tiu et al., 2021). SHS members support students with disabilities by contributing to the development, implementation, and evaluation of individualized healthcare plans, emergency action plans, educational accommodation plans, and special education individualized education plans (Johnson, 2022).
As SHS team leaders, school nurses provide a critical perspective that aligns education and health when advocating for, developing, and implementing school district policies on health, safety, and wellness (AAP, 2022a). These efforts contribute importantly to other fundamental school district objectives such as school improvement plans and goals, emergency preparedness, reducing absenteeism, staff health promotion, restorative justice practices, traumainformed care, social–emotional learning, and building and sustaining a positive and supportive school climate and culture.
Though federal standards and comprehensive, sustained funding for SHS are lacking, several evidence-based frameworks provide guidance for the provision of quality physical and psychosocial healthcare in schools that promote positive conditions for learning. These include public health-based multi-tiered systems of support (AIR American Institutes for Research, 2024), local school wellness policies and school health advisory councils (U.S. Department of Agriculture Food and Nutrition Service, 2022), the School Nursing Practice Framework™ (NASN et al., 2024), the Whole School, Whole Community, Whole Child model (Association for Supervision and Curriculum Development [ASCD] & CDC, 2014), and NASN’s School Nursing: Scope and Standards of Practice (2022). For SHS to be effective, sufficient staffing of school nurses, social workers, and other related service providers along with appropriate local and state-level infrastructure resources and services supports are necessary (AAP, 2022c; Doremus, 2023; Hoover & Bostic, 2020).
School-aged children and youth benefit when SHS teams work collaboratively and continually to strengthen SHS policies and practices, and adapt to the evolving needs of pupils (AAP, 2023). Students with sufficient access to quality SHS have better chronic disease management, fewer absences, and improved educational outcomes demonstrated by higher grades, test scores, and graduation rates. These impacts are particularly evident for students with, or at risk for, chronic health issues (Healthy Schools Campaign, 2020; Tiu et al., 2021). By improving access to quality care for all students, SHS teams help to address health inequities, reduce overall healthcare costs, and close educational achievement gaps, especially in low-resourced communities (Tiu et al., 2021).
The provision of high-quality, evidence-based SHS team care in schools depends on sufficient professional SHS staffing, infrastructure services resources, and district administrative support. School nurse-led SHS teams are essential for fostering student health and well-being so that every student may fully participate in learning and have equal opportunities to reach their full potential.
National Association of School Nurses11 NASN, MD, USAnasn@nasn.org
Adopted: 2020Revised:2025
All position statements from the National Association of School Nurses will automatically expire five years after publication unless renewed, revised, or retired at or before that time. To access additional NASN professional practice documents including the most up-to-date position statements, position briefs, and joint and endorsed statements, please go to https://www.nasn.org/nasnresources/professional-practice-documents
Wendy A. Doremus DNP, RN – NASN Clinical Writer
Elizabeth Pray, MSN-Ed., RN, NCSN
Anneke Collins, BSN, RN
Sharon-rose Gargula, MSN, RN, NCSN
Donnis Harris, MSN, RN, NCSN
Wendy Doremus https://orcid.org/0000-0001-7584-0192
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