In the United States, more than 40% of children and adolescents live with a chronic health condition, behavioral health need, or a specific learning disability that impacts their daily experience in the school setting. Among these conditions, type 1 diabetes (T1D) is one of the most prevalent chronic health conditions among youth. School nurses are essential in promoting student health and academic success by ensuring students have the support and resources needed to remain healthy and ready to learn. This exemplar describes an online back-to-school training for school nurses utilizing the school district's Google Workspace platform, providing school nurses with five evidence-based practice (EBP) resources and a recorded training on T1D management in a self-paced, online format. With the evolving landscape of technology, school districts should ascertain how to harness available technology in their district to create accessible and sustainable EBP resources and training materials for school nurses.
Excessive digital technology use among adolescents has become an increasing public health concern, with growing evidence linking problematic smartphone, internet, gaming, and social media use to sleep disturbances, anxiety, depression, reduced academic performance, cyberbullying exposure, and sedentary behaviors. While many school-based efforts have traditionally focused on preventing digital addiction, there is increasing recognition of the need to adopt a broader digital wellness promotion approach that encourages balanced, safe, and healthy technology use. School nurses, through their daily interactions with students and their role in school health promotion, are uniquely positioned to support adolescent digital health. This article briefly discusses the major health risks associated with excessive digital engagement among adolescents and highlights the expanding role of school nurses in promoting digital wellness through assessment, education, counseling, collaboration, and advocacy.
This article uses two analogies to frame school health and school nursing: the seven kingdoms of "Game of Thrones" and the unified crew in "The Boys in the Boat." The first portrays practice domains as separate territories competing for legitimacy, resources, and influence, weakening the profession. The second presents a coordinated, relational model in which diverse strengths move toward a shared goal. Because school nursing is too important, complex, and resource-limited to progress through fragmentation, school nurses must lead efforts to build a unified "boat" for school health and the profession. By emphasizing partnership, shared priorities, and children's well-being and learning, school nursing can move from isolated effort to collective impact.
The profession of nursing includes many specialty areas of practice. Several criteria specify the requirements for this designation. School nursing fulfills these requirements as a nursing specialty. These standards are important for advancing the practice of school nursing.
Hydrocephalus is a common pediatric neurosurgical condition. The causes of hydrocephalus are varied and treatment typically involves surgical placement of a shunt or an endoscopic third ventriculostomy. Both treatments have a high failure rate, often resulting in multiple surgeries. Hydrocephalus is associated with a number of physical, learning, and mental health challenges that may affect a child's success at school. School nurses play a pivotal role in identifying and managing medical complications, supporting students in managing day-to-day school life and providing resources to students and their families.
This fifth and final article in the Practicing with a Framework Mindset series describes the principle of Community/Public Health and its components, or actionable description statements. The specialty practice of school nursing has a long history with both community and public health. These two distinct, but related, concepts of community health and public health are defined, and we provide a rationale for the inclusion of both in the Community/Public Health principle. This article continues unfolding the case study of Jenny, a student with functional seizures, to illustrate the day-to-day steps school nurses can take to practice with a focus on the Framework and its Community/Public Health principle.
A continuing education program was developed by School of Nursing faculty at a Northeast Texas university to strengthen school nurses’ ability to use data for effective communication. The 8‑hr School Nurse Data Science Boot Camp included a keynote speaker introducing data science concepts, followed by morning skill‑building stations on data interpretation and communication strategies. Afternoon stations guided participants in applying these skills to create slide presentations tailored to specific school nursing scenarios. The 15 participants were divided into five groups, each assigned a scenario and stakeholder audience. Groups developed and delivered presentations that demonstrated their ability to translate school health data into meaningful messages. Participants reported high satisfaction with the boot camp and expressed interest in an advanced offering. This program provides a valuable local continuing education opportunity and supports a growing regional partnership among school nurses, School of Nursing faculty, and Education Service Center personnel.
School nurses play a key role in addressing the growing mental health crisis faced by school-age children. Rates of anxiety, attention deficit hyperactivity disorder, autism spectrum disorder, depression, and suicide continue to rise. These conditions reflect a complex interplay of genetic predisposition, environmental influences, and policy factors. School nurses can act at the federal, state, and local level to address the crisis. At the federal and state levels, nurses can engage policy discussions surrounding initiatives such as the 2025 MAHA report, universal screening mandates, school nurse staffing ratios, and cell phone legislation. At the local level, nurses can conduct mental health screenings using validated tools, coordinate referrals, manage individualized care plans, advocate for extended recess and digital literacy education, and pilot balanced daily routines. By collaborating with administrators and legislators and addressing the causes associated with the mental health crisis, school nurses are well positioned to support student well-being and academic success.
Firearm injury prevention efforts play a critical role in addressing both morbidity and mortality associated with firearms among children and adolescents. School nurses, through their clinical expertise and trusted relationships with students and families, are uniquely positioned to contribute to and influence these prevention efforts. Nurses can engage in meaningful, respectful conversations during initial or brief encounters and through ongoing communication. This article provides an overview of firearm violence among youth and offers practical tools and resources for school nurses. These resources empower school nurses as trusted messengers, strengthening their ability to lead courageous, life-saving conversations around sensitive health and safety issues, including firearm injury prevention.
School nurses are often the forward-facing health care practitioner for youth, simultaneously managing mental health and medical care for their students while also interacting with students’ families and navigating consequences of family dynamics, including health literacy, social support, and financial issues. Thus, it makes sense to train school nurses on how to best interact with and support adolescents diagnosed on the autism spectrum. Part one of this three-part series will include an overview of mental health diagnoses often co-occurring with autism, associated challenges for the autistic adolescent, and school nurse interventions that may be helpful. The second and third part of the series will address the medical health diagnoses, nursing interventions, and overall discussion on how to best care for autistic adolescents in the schools.
This article examines the unique position school nurses are in to identify and address medical child abuse as clinical awareness continues to grow. The lack of education available on the topic of medical child abuse and why cases are inherently difficult to diagnose is discussed. Information for school nurses on how to identify and intervene as well as resources available are provided.
Rural school nursing is inherently different from suburban or urban school nursing. This article describes the processes involved in becoming a Special Interest Group and identifying the specific needs of rural school nurses. We developed an online group focused on rural school nursing, provided a network of school nurses who experience similar contexts for mutual support and learning, and identified priorities for scholarship in the setting of rural and frontier school nursing. Rural school nursing was defined; additionally, characteristics of rural school nurse practice and unique challenges in this setting were identified. Solution-focused discussions provided professional development for rural school nurses, prioritizing the issues that were the greatest challenges. Topics included resource mapping, orientation to the role, mentoring needs, and training unlicensed personnel in the context of limited resources. The online focus group has since become an official Special Interest Group of the National Associatoin of School Nurses.
Vision disorders are prevalent among preschool children and can significantly interfere with early learning, literacy development, and school readiness. Although vision screening is mandated in many states, referral completion following failed screenings remains inconsistent, particularly in underserved populations. School nurses are uniquely positioned to address this gap through structured follow-up and family-centered communication. This article describes a school nurse-led quality improvement process using the Small Steps to Eye Care Action Plan to improve referral completion for preschool students.
This article provides an outline for a formal mentorship program within a large suburban school district designed to support new school nurses. Due to rapid growth in school nurse staffing numbers and postpandemic needs, the district revised its orientation and developed a multiyear mentorship program. This program integrates the NASN Framework, an appraisal rubric, and monthly educational meetings to build competence and a sense of belonging. Program feedback reveals a high satisfaction (82%) among new nurses with the current plan. New school nurses valued training on core topics, highlighting that the program needs to be focused on the basics of school nursing and regular accessibility to their mentors. Based on evaluations, the program will be enhanced with one-on-one mentorship and a leadership development committee. A structured, responsive mentoring program is a crucial strategy to improve retention, enhance job satisfaction, and grow future school nurse leaders.
Musculoskeletal disorders among preteen and adolescent students have been widely reported, with research highlighting the role of poor ergonomics in classrooms and school environments as a contributing factor. School nurses, through their regular interactions with students, are uniquely positioned to identify those at risk for musculoskeletal problems resulting from incorrect sitting postures or prolonged use of improperly sized desks and chairs. They can provide essential education to students, staff, parents, and teachers on the importance of proper body mechanics and sitting postures. This article aims to briefly discuss key ergonomic risk factors in schools and to offer recommendations for interventions that school nurses can implement to prevent musculoskeletal pain and injury among preteen and adolescent students.
This article examines the increasing popularity of energy drinks and the growing trend among young people to consume them. This trend persists despite evidence suggesting that caffeine consumption in the adolescent age group is not recommended, and if consumed, should be limited to no more than 100 mg daily. However, most energy drinks exceed 100 mg and contain additional ingredients that may contribute to health concerns and, in some cases, the need for medical care. Parents/guardians may not have a full understanding of the volume of caffeine they contain or their potential side effects. School nurses need to be knowledgeable about energy drinks to provide an appropriate assessment and an effective plan of care. Additionally, school nurses are well positioned to provide education to students, staff, and parents regarding the health concerns associated with energy drink consumption, especially when school policy doesn't address their accessibility or use during the school day.
Over the past decade, there have been many interventions to decrease chronic absenteeism in school-aged children; however, chronic absenteeism remains a significant problem. School nurses can use a multi-tiered system of support to address the chronic health conditions of students in school to improve school attendance. Forty percent of school-aged children have at least one chronic health condition, and school nurses can facilitate safe student attendance in school with necessary health-related support. School nurses are usually the only school personnel with the education and training to support students with health issues. School nurses should use data to help identify students with chronic health conditions, provide interventions to support these students, and subsequently improve attendance and academic performance.
