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    Texas School Health Program
    P.O. BOX 149347, MC1925
    Austin, TX 78714-9347
    1100 West 49th
    Austin, Texas 78756

    Phone: 512-776-7279
    Fax: 512-776-7555


School Health Services - Nursing Practice Resources

Photo of an apple with a stethoscope and a Doctor's chart

The resources listed on this page will assist the school nurse or other healthcare and school professionals in promoting health and providing health services to students. 

Frequently Asked Questions

Q. Are school nurses required in Texas? 

A.  There is no statutory requirement for Texas schools to employ a nurse except as indicated in Federal Individuals with Disabilities Education Act, but if the school DOES, it must comply with this section of the Texas Education Code: 

§ 21.003.  Certification Required
(a) A person may not be employed as a teacher, teacher intern or teacher trainee, librarian, educational aide, administrator, educational diagnostician, or school counselor by a school district unless the person holds an appropriate certificate or permit issued as provided by Subchapter B.
(b) Except as otherwise provided by this subsection, a person may not be employed by a school district as an audiologist, occupational therapist, physical therapist, physician, nurse, school psychologist, associate school psychologist, licensed professional counselor, marriage and family therapist, social worker, or speech language pathologist unless the person is licensed by the state agency that licenses that profession and may perform specific services within those professions for a school district only if the person holds the appropriate credential from the appropriate state agency. 

If a school district hires a licensed vocational nurse (LVN), the LVN must be supervised in accordance with Chapter 301 of the Occupations Code. Supervision must be provided by a registered nurse, a physician, a physician’s assistant, a podiatrist, or a dentist.  

According to the Texas Board of Nursing (BON), “The licensed supervisor is responsible for overseeing the LVN’s nursing practice and actively engages in a supervisory process that directs, guides, and influences the LVN’s performance of an activity. 

The NPA and Board rules and regulations prevent an LVN from practicing in a completely independent manner (that is, without a licensed supervisor); however, the NPA and rules are silent as to the proximity of the licensed supervisor. There are many factors to be considered in determining how quickly the licensed supervisor needs to be available to the LVN. Factors to be considered should include: (1) the type of practice setting; (2) the stability of the patient’s condition; (3) the tasks to be performed; (4) the LVN’s experience and (5) any laws and regulations that apply to the specific practice setting.  The proximity to the LVN’s practice setting and the type of licensure of the licensed supervisor should be determined on a case-by-case basis with input from the LVN and his/her licensed supervisor. The appropriate licensed supervisor must be accessible to the LVN at least telephonically or by similar means. To illustrate, compare the LVN who performs routine nursing tasks or nursing tasks learned through ongoing continuing nursing education (such as intravenous therapy) with an LVN who performs a delegated medical act (such as Botox administration). These are different situations and will differ in who (RN or physician) is appropriate to supervise the LVN as well as the proximity of the licensed supervisor. Other regulations, such as those related to reimbursement, may also be a factor in the latter situation.”

Q. What is the ratio of school nurses to students in Texas? 

A.  The Texas Department of State Health Services utilizes data from the Texas Board of Nursing, in which RNs (and LVNs) self-report as being employed in either school or college health services.  Compared to the number of public school children in the state for the 2014 school year (5,135,880), the ratio would appear to be 784 students per school nurse (RN).  However, remember that the RNs include "college" health and the student count used above includes only public schools.  Hence this ratio is not accurate, but is an estimate.  The Texas Higher Education Coordinating Board has data on the number of students enrolled in higher education institutions.  They can be reached via telephone at: 512-427-6101 or through their web site at www.thecb.state.tx.us.

Last updated November 15, 2017