School Health Services

School nurses serve in a pivotal role that bridges healthcare and education. As the main health contact in the school setting; school nurses address the physical, mental, emotional and social health needs of students. The resources below include information about the Nurse Practice Act, Texas Board of Nursing rules and regulations, and other resources related to school nursing and school health services roles.   

What is School Nursing? 

A specialized practice of nursing, protects and promotes student health, facilitates optimal development, and advances academic success. School nurses, grounded in ethical and evidence-based practice, are the leaders who bridge healthcare and education, provide care coordination, advocate for quality student-centered care, and collaborate to design systems that allow individuals and communities to develop their full potential. Approved by the NASN Board of Directors February 2017.  

The Texas Education Agency defines a school nurse in 19 Texas Administrative Code (TAC) § 153.1022 (a) (1) (D) as “… an educator employed to provide full-time nursing and health care services and who meets all the requirements to practice as a registered nurse (RN) pursuant to the Nursing Practice Act and the rules and regulations relating to professional nurse education, licensure, and practice and has been issued a license to practice professional nursing in Texas.”   

The Board of Nursing believes that school nursing is a professional RN specialty. The RN has the educational preparation and critical thinking skills as well as clinical expertise which are essential to nursing in the school setting. These activities involve the comprehensive assessment of the nursing/health care needs of the student, the development of a plan of care, implementation of the plan, and evaluation of the outcomes. The provision of these services by the RN contributes directly to the students' education and to the successful outcome of the educational process. These essential components of professional nursing practice are the responsibility of the RN in compliance with 22 TAC §217.11(3)(A).   

Primary Resources 

• Texas Board of Nursing (BON) 

• BON – Nursing Practice Act 

• BON – Nursing Statistics 

• BON – Rules and Regulations 

• National Association of School Nurses(NASN) 

• NASN – Scope and Standards for School Nurse Practice 

• Texas School Nurses Organization – School Nursing: Scope and Standards of Practice 

• Additional Nursing Practice Resources  

• DSHS School Nurse Notes 

Delegation in the School Setting 

• Texas School Nurse Delegation  

• ANA and NCSBN Joint Statement on Delegation, Principals, and Decision Tree 

• NASN Position Statement: Nursing Delegation to Unlicensed Assistive Personnel in Schools  

• Delegation Resource Packet 

• Nursing Delegation in Schools 

Evaluation and Appraisals 

• NASN Position Statement: Supervision and Evaluation of the School Nurse 
   

Peer Review 

• BON Safe Harbor Forms 

• IBPR vs SHPR Statute and Rules References 

• Nursing Peer Review FAQs 

• Texas Administrative Code, Rule §217.20 

• Peer Review: Incident-Based or Safe Harbor   

Responsibilities 

• School Health Documentation 

• School Nurse’s Role in Electronic Health Records 

• Six Step Decision Making Model for Determining Nursing Scope of Practice 

• Guide to Medication Administration in the School Setting [pdf]

Roles 

• Advanced Practice Registered Nurse Practice 

• Licensed Vocational Nurse Practice 

• Registered Nurse Practice 

• Recommended School Health Services Staff Roles [pdf]   

• Eight Rights of Medication Administration 

Other 

• Establishing and Maintaining Professional Boundaries in School Nursing - Staying in the Zone