School Nurse Competency

About the School Nurse Role

School nursing is a unique and challenging specialty within the nursing profession. The school nurse is often the only licensed healthcare professional in a school district, providing health services oversight for district students ranging from grades Pre-K to 12. With expertise in health improvement and health management, primary prevention, emergency response, care coordination, and team collaborations, school nurses are uniquely qualified to support school and student efforts toward academic success. On a day-to-day basis, the school nurse conducts student assessments of physical and behavioral issues and social determinants of health status, develops healthcare plans and emergency care plans, conducts staff training, connects with parents, connects with student support staff, such as counselors, therapists and special education teachers, connects with providers, conducts a wide range of service referrals to meet student needs, ensures screening and reporting requirements are met, ensures that medication management and administration and treatments are performed safely, collects district, state and national health data, manages health room activities, and serves as the health consultant on issues impacting student and staff health and safety. The work is varied, rewarding and fast-paced, with a workload impacted by school nurse-to-student ratios, student health conditions, and potentially limited contract hours. School nurses adhere to nationally-defined scope and standards of practice and are required to maintain competence in the position.

Employment Categories

Classified School Nurse Position

A nurse in a classified position may hold a Bachelor of Science degree in Nursing (BSN) or advanced nursing degree from an accredited program or an Associate Degree in Nursing (ADN), a Washington State Registered Nurse license, or a Licensed Practical Nurse (LPN) license. Classified positions are district support positions that do not require certification or licensure (or are not eligible for WA State certification) to perform a job. Classified nurse positions align with non-teaching support staff under a district’s classified employee contract and pay scale.

Certificated School Nurse Position

A school nurse in a certificated position holds a Bachelor of Science degree in Nursing or advanced nursing degree from an accredited program, a Washington State Registered Nurse license, and Educational Staff Associate (ESA) certification from the Office of the Superintendent of Public Instruction (OSPI). Certificated school nurse positions align with the district’s teacher contract and pay scale. A district may require their school nurse to obtain and maintain school nurse ESA certification.

School Nurse Certifications

WA State ESA Certification for School Nurses

Educational Staff Associate (ESA) certificates are awarded to qualified registered nurses by the Office of Superintendent of Public Instruction (OSPI) under administration of the State of Washington Professional Educator Standards Board (PESB). For information on ESA certification qualifications, various levels of certification, renewal requirements, and temporary permits, refer to: OSPI Educational Staff Associate (ESA) Certificates.

To obtain initial ESA certification, new school nurses must complete a Professional Transitions course approved by PESB. Nurses are encouraged to complete a course that focuses specifically on school nursing. Approved nursing courses are offered by Pacific Lutheran University Center for Continued Nursing Learning, University of Washington School of Nursing, and Washington State University School of Nursing. For information about approved courses and course contacts, see: Professional Transitions to the Public Schools: Initial ESA Certification

All school nurses, particularly those new to the school nurse role or new to school nursing in Washington State, are encouraged to complete an ESA certification course for school nurses, whether or not their position requires ESA certification. These courses introduce:

  • National, state and local school and special education laws and policies and their application to decision-making processes in the educational setting
  • Professional school nursing standards and code of ethics to inform practice
  • Appropriate strategies to support student outcomes, including scientifically-based practices, collaborative teaming, and ethical decision making
  • How to work within a schools culture to create an environment that fosters student safety, health and learning
  • How to collaborate with team members, including parents, teachers, counselors, administrators, and others to support learning outcomes for all students
  • How to access resources in the school setting and community

WA State Conditional ESA for School Nurses

A Conditional ESA Certificate is available for employers that would like to hire a nurse to a certificated school nurse position on the basis of experience and expertise, recognizing that the nurse does not meet the required qualifications to obtain ESA Certification. The Conditional ESA Certificate is valid for two years or less and may be renewed. This certificate must be initiated by the employer. Once the employer request has been submitted to OSPI, the nurse can submit an application for a conditional certificate. See the OSPI Conditional ESA webpage for information

Maintaining ESA Certification

Continuing education is a requirement for ESA certification renewal. For educators, continuing education units of credit are referred to as “clock hours”. For ESA certificated staff who hold a WA State Department of Health registered nurse license, acceptable units of credit for ESA renewal include other credit types – those that satisfy the continuing education requirements for their nursing license. ESA certificated school nurses may use continuing education units (CEUs), college credits and clock hours to meet ESA renewal requirements. For additional information, see “Department of Health License Hours as Clock Hours” on the OSPI Continuing Education Clock Hours webpage. ESA certificated nurses are encouraged to check professional development events to determine whether units of credit are available and to maintain documentation of professional development completion in a professional portfolio.

Maintaining Competency for State Licensure

All registered nurses and licensed practical nurses in Washington State are required to actively practice and to earn continuing education hours to meet the clinical competency requirement for licensure renewal. A range of professional development activities meet the continuing education requirement for licensure renewal. See Nurse Licensing Continuing Competency.

National School Nurse Certification

The National Certified School Nurse (NCSN) credential is awarded by the National Board for Certification of School Nurses (NBCSN). Obtaining national certification in the school nursing specialty is a mark of professional distinction for a school nurse, reflecting competence and professionalism.


pdEnroller is a web service used by all Washington State Educational Service Districts to manage professional development courses. pdEnroller supports a course calendar that is searchable by state and by ESD region, course descriptions, course enrollment, course payment, course enrollment cancellation, course evaluations, clock hour purchases, and clock hour tracking. Users are responsible for creating their personal pdEnroller account and maintaining accurate profile information. See NCESD pdEnroller

Professional Practice Resources

Continuing Education and Resources

National Association of School Nurses (NASN)

NASN has many resources, tools, and continuing education opportunities. Some materials and continuing education are also available to non-members.

NCESD CE Credits Online

CE Credits Online offers courses that are approved for clock hours through NCESD and are eligible for graduate-level professional development credit towards Washington State License Renewal from our regionally-accredited university partners. Purchase courses and clock hours through NCESD and graduate credits through CE Credits Online.


HEAL WA is Washington State’s online library for all health practitioners. Create your own free HEAL WA account and access ejournals, ebooks, toolkits, databases, drug information, and continuing education, including Nursing Reference Center Plus.