School Nurses: On the Front Lines of Student Health

School-Based Healthcare Professionals Series: Part 2

This article continues our School-Based Healthcare Professionals Series, an exploration of the many health career paths that intersect with education. These dedicated professionals are essential to maintaining student well-being, supporting learning, and nurturing the next generation's interest in healthcare.

More than a Bandage

For the 600,000 Michigan students with a chronic health condition, School Nurses (SNs) provide the essential care that helps keep students healthy, in school, and ready to learn. 

Like their counterparts in hospitals, SNs provide frontline care. They coordinate services, treat injuries, manage chronic illnesses, support communicable disease prevention, and oversee safe medication administration. They also train unlicensed assistive personnel (UAP) staff to assist with student medication needs when necessary.

But the role of a School Nurse is far more than bandages and ice packs. Guided by the Centers for Disease Control and Prevention’s Whole School, Whole Community, Whole Child framework, SNs help connect health and learning by supporting the conditions students need to thrive. Their work extends beyond immediate care to creating school environments where students are nourished, supported, and able to focus on learning.

That responsibility has grown even as the number of students with chronic conditions and complex health needs has increased. At the same time, the School Nurse workforce has not kept pace, leaving many nurses to triage students across multiple schools, and in some cases, multiple districts.

It is a multifaceted role that begins as the first student boards the morning bus and continues after the final bell.

Who Are School Nurses?

SNs serve in a wide range of roles, depending on the size, staffing, and needs of their district. 

Cindy Brummette, BSN, RN

In Grand Ledge Public Schools, Cindy Brummette, BSN, RN, serves as a district SN and president of the Michigan Association of School Nurses. 

“I am a boots-on-the-ground School Nurse. There are two of us in the district of approximately 5,400 students,” Brummette said. In her role, she provides both direct and indirect care to students from preschool through 6th grade, while also training unlicensed staff, supporting medication management, care coordination, and supervising delegated medical tasks.

Her work is fast-paced and constantly shifting. “I receive calls anywhere from 7:30 to 4:15 on any given day, and I’m managing the medical needs across 6 buildings along with our unlicensed school staff onsite,” Brummette said. From monitoring students with diabetes to traveling between schools or triaging issues from her central office location, her day is frequently shaped by the urgent health need that comes next. “I work closely with the onsite unlicensed staff, supervising medical care, care planning, documenting, and responding to emergencies — it’s continuous.”

Kindra Smith, BSN, RN

Brummette’s experience reflects just one version of school nursing. In Eaton Rapids, Kindra Smith, BSN, RN, took on direct student care while also helping lead school-based projects that reached beyond the nurse’s office. “I helped with grant writing and planning for school wellness, community outreach, and engagement, including events like Success Night, Science Night, and Safety Town, and launched an employee wellness committee,” Smith said. “We worked to make sure families knew that we were there, and how we could help.”

Dayna Bennett MSN, APRN, FNP-C

SNs also play an important role at the state level. Dayna Bennett MSN, APRN, FNP-C, serves as the SN consultant for the Safe and Supportive Schools Unit at the Michigan Department of Education’s Office of Health and Safety. In that role, she supports SNs across Michigan, helps families connect with health resources, and contributes to advocacy efforts. “I started working in schools while I was working at the Public Health Department as a Public Health Nurse. School nursing combined public health and teaching, which I loved,” Bennett said. “My background as a Family Nurse Practitioner helped me be a perfect fit for my role as the School Nurse Consultant for the state.”

Misconceptions About School Nursing

The roles and responsibilities of SNs are broad, but their impact is clear. Research shows that students with access to SNs are more likely to graduate, miss fewer days of school, and, in some cases, see improvements in grades and test scores.

School Nurses do more than respond to injuries or illness. They focus on the whole child and help create a supportive environment that fosters learning. 

“A School Nurse might be the first person to identify a mental health need in a student,” Brummette said. “They might also be the person who recognizes a medication concern or discrepancy and can verify orders with the Physician.”

For students who need mental health support, SNs can be an important first point of contact, helping connect them to Behavioral Health services. For students who take insulin or other medications during the school day, that oversight can help prevent serious errors and hospitalization.

SNs also save time for principals, teachers, and administrators by handling health concerns, contacting parents, and determining when students need to go home. That support matters, especially in a state like Michigan, where the School Nurse shortage leaves many Nurses responsible for far more students than recommended. During the 2024-2025 school year, Michigan had just one School Nurse for every 3,810 students (Michigan Center for Educational Performance and Instruction, n.d.), a ratio that far exceeds national recommendations and can limit the amount of individualized support students receive.

“A misconception about School Nurses is that they are a luxury rather than a necessity,” Smith says. “In reality, having a qualified School Nurse is standard and safer practice and an essential component for supporting student health, safety, attendance, and academic success.”

Workforce Challenges and Opportunities

Even though a whopping 600,000 Michigan students live with a chronic health condition, not to mention the injuries, illnesses, and allergic reactions that can happen during the school day, having an SN remains optional for schools. 

That reality runs counter to recommendations from both the American Academy of Pediatrics and the National Association of School Nurses, which call for a School Nurse in every school. In Michigan, the 2024-2025 School Nurse-to-student ratio far exceeds those recommendations, leaving many schools without the level of clinical support students need.

Cost and limited or dedicated state funding remain the most common reasons districts do not employ a School Nurse. Smaller and more rural schools often feel those pressures most acutely, especially when it is harder to justify the cost of a full-time Nurse for a smaller student population. 

The result is a patchwork of coverage across the state. In some areas, School Nurses are responsible for large caseloads spread across multiple buildings or even multiple districts, which can increase burnout and make it harder to provide consistent care. When Nurses are not available, health responsibilities fall to secretaries or paraprofessionals, who do not have the clinical training needed for every situation. As a matter of law, only a licensed medical professional can assess students; schools without an SN may end up calling parents to pick up students for conditions that could have been managed at school. 

“Ignoring a need doesn’t make that need disappear,” Brummette said. “We advocate for students to have equitable access to a School Nurse and for School Nurses to have an equitable workload. Fundamentally, it's about safe staffing levels and taking into consideration the increasing medical acuity of student needs.”

Even with those workforce challenges, school nursing remains a promising career path. There are open positions across the state, and the role offers a schedule that aligns with the school calendar, including summers off and a workday that aligns with the school day. Just as important, SNs get the chance to make a direct difference in students’ health, learning, and sense of security.

“We keep students healthy, safe, and in school ready to learn,” Brummette said. “I love it. It’s a very fulfilling career path within nursing. You're autonomous in your role and working independently within your scope of practice.”

The path to becoming an SN is also accessible. Many SNs begin in other nursing settings before discovering school nursing as a career that combines clinical care, education, and community impact.

Pathways Into School Nursing

Licensed Nurses with a range of educational backgrounds can practice as SNs in Michigan. The Michigan Department of Education requires SNs to be licensed Registered Nurses (RNs) and offers Department of Education certification as an opportunity for career advancement.

That means students can enter school nursing with a two-year, four-year, or advanced nursing degree. For many, school nursing is also a next step after gaining experience in another setting, such as pediatrics, public health, or hospital care. Already practicing RNs do not need to return to school before moving into a school-based role, which makes the transition more accessible for those who want to apply their skills in a new environment.

“I started as a Pediatric Nurse and transitioned into a Public Health Nursing role,” Brummette said. “The health department needed a nurse to work in schools, so I stepped into that role, which became a full-time career.”

Smith’s path was also shaped by timing, experience, and a conversation that opened the door. When she learned that her district had a School Nurse, she reached out to express interest in the role. Later, when a position became available, Smith’s school community connections helped her land her dream career in school nursing.

“When I grew up, I didn’t have a School Nurse. When I had children, I got curious if our district had a School Nurse,” Smith said. “When I was referred for the position, I was working on my bachelor’s degree and was able to do my preceptorship and capstone project with the School Nurse who referred me.”

Finding Success in School Nursing

Despite a similar educational pathway, the very different working environment for an SN means a successful SN needs to work well independently and autonomously, handle triaging and medication needs from afar, be willing to travel, and, most importantly, enjoy working with kids.

“Although there are many benefits of working in schools, it’s a challenging job. One has to be on point with their skills, able to multitask, and strong in communication and critical thinking,” says Brummette.

Advice for Future School Nurses

Interested in becoming a School Nurse? Gaining experience is key. 

“Look for an experience working with a pediatric population,” advises Bennett. “Partner with hospitals, volunteer with local health systems and associations, join student health associations, even take a CPR class.” 

“Get involved in student groups or clubs, like HOSA or Peer Assistance and Leadership Program (PALs),” echoes Smith, “Or attend a Nurse summer camp, and focus on getting involved in local community health events that are put on by a hospital or Rotary Club.”

Brummette emphasizes the importance of finding and having a mentor in her own career journey. 

“I had a mentor who, throughout my career, would guide me and give me feedback or career advice,” says Brummette. “When you’re in high school, see if you can shadow someone so you can ask those questions.”

A Career at the Intersection of Health and Education

School Nurses are important front-line professionals in schools, helping students to stay healthy and in their classrooms learning, and allowing education staff to focus on teaching. Yet many Michigan students will not have the support of an SN, especially students in Northern Michigan and the Upper Peninsula. While cost remains a barrier to equitable access, school nursing is a rewarding career with multiple educational entry points and the ability to have autonomy and lay down roots across Michigan. 

References

Michigan Association of School Nurses. (2024, August 9). Student-to-school nurse ratio across Michigan counties. [Map]. https://s3.amazonaws.com/nursing-network/production/files/128130/original/MASN_One_Pager_8.9.2024__281_29__281_29.pdf?1725565218

Michigan’s Center for Educational Performance and Information. (n.d.). Student/support staff ratio. [Trend graph showing the statewide student-to-School Nurse ratio each school year from 2020-21 to 2024-25]. Retrieved March 20, 2026, from https://www.mischooldata.org/michigans-education-staff/