January 16, 2008
SCHOOL NURSE QUALIFICATIONS
By: Saul Spigel, Chief Analyst
You asked about the qualifications required for school nurses and school nurse assistants.
State law requires each local or regional board of education to appoint at least one school nurse. State Board of Education (SBE) regulations establish the qualifications for school nurses. With some exceptions, these regulations require a school nurse to (1) be a licensed registered nurse (RN), (2) have the equivalent of at least one year of full-time employment as an RN within the past five years, and (3) have academic preparation in specified areas.
School boards can employ licensed practical nurses (LPNs) to assist their school nurses. SBE regulations do not establish any qualifications for such LPN assistants. But they permit LPNs to administer medications to students if they have (1) training in medication administration, (2) training and supervised experience in pharmacology, or (3) supervised experience in medication administration in a health care facility.
School boards can also hire unlicensed people to assist school nurses. No regulations or guidelines specify qualifications for such assistants.
In 1997, a Connecticut Advisory School Health Council published guidelines for additional RN qualifications and for qualifications for LPNs and unlicensed personnel. The guidelines have no formal status.
SCHOOL NURSE QUALIFICATIONS
State law requires each local or regional board of education to appoint at least one school nurse or nurse practitioner (another title for advanced practice registered nurse or APRN). School nurses must meet the qualifications established in regulations adopted by the State Board of Education in consultation with the Public Health Department. And they must submit to a criminal history record check (CGS § 10-212).
With some exceptions, these regulations (Conn. Agency Regs., 10-212-1 to -7, adopted in 1982 and incorporated in the Public Health Code) require a school nurse to be an RN with a current Connecticut license. The nurse must have the equivalent of at least one year of full-time employment as an RN within the immediate past five years. And the nurse must have among his or her educational experience at least 12 college credits, 18 continuing education units (CEUs), or 180 workshop or in-service training hours distributed as follows:
1. Half of the credits, CEUs, or training hours must be in at least two of the following subject areas:
● growth and development
● health assessment
● public or school health
2. The other half of the credits, CEUs, or training hours must be in two or more of the following subject areas:
● health or school services administration or organization
● child or adolescent psychology
● crisis intervention
● growth and development
● handicapping conditions
● health assessment or health education
● mental health, public health, or school health
● sports medicine
A school nurse must participate in at least 10 hours of board-approved professional development activities or programs every two years.
Provisional Qualification. A licensed RN or APRN can qualify provisionally as a school nurse if he or she has either (1) one year of full-time employment as an RN within the immediate past five years or (2) three college credits, 4.5 CEUs, or 45 training hours in any of the above academic areas within the five years immediately preceding employment as a school nurse. Provisional qualification lasts for up to three years.
Alternate Compliance. A school board in a town with (1) fewer than 10,000 people and (2) a physician as a school medical advisor (boards in such towns have the option of appointing a medical advisor) can ask the SBE to approve an alternate form of compliance with any of the above regulatory requirements.
Advisory Council Recommendations
The Connecticut Advisory School Health Council recommended that in addition to holding a current RN license a school nurse also:
1. have successfully completed a BA in nursing or 30 credits toward an MA in nursing at a National League for Nursing-accredited school;
2. have successfully completed (a) two years of full-time equivalent (FTE) employment in nursing in the past five years with at least one year in pediatric, adolescent, community, or public health nursing or (b) one year of FTE work in one of these nursing field in the past five years and 15 semester hours in a graduate nursing program;
3. have current certified in cardio-pulmonary resuscitation (CPR) certification; and
4. when eligible, be certified in school nursing by a national nursing certification body.
SCHOOL NURSE ASSISTANTS
A November 1998 letter from Mark Stapleton, chief of the State Education Department's Legal and Government Division, to the Association of School Nurses of Connecticut states that districts can also hire people, such as LPNs, to assist their school nurses. By law, LPNs must practice under an RN's direction; they cannot function independently in any setting, including schools.
SBE regulations permit LPNs to administer medications to students under a local board of education's policy if they can demonstrate evidence of one of the following:
1. training in medication administration as part of their basic nursing program;
2. successful completion of a pharmacology course and subsequent supervised experience; or
3. supervised experience in medication administration while employed in a health care facility (Conn. Agency Regs. 10-212a-3).
The Advisory School Health Council recommended that an LPN should be currently licensed, be currently certified in CPR, have taken first aid courses, and have pediatric or adolescent work experience.
The advisory council recommended that unlicensed aides, in addition to general job skills and abilities, have:
1. a high school education and proficiency in reading and writing English;
2. current first aid and CPR certification, and
3. certification as a nursing assistant or home health aide, if their job responsibilities include any delegated nursing tasks or activities.
It recommended that a school board consider employing an unlicensed aide only when assured that a qualified school nurse would provide full-time, on-site supervision.