The practice of school nursing has been on the fast-track of change. Those who have been school nurses for more than a few years are well aware that the students (and adults within the school community) who are in our schools today are presenting with far more complex medical, psychological and social needs than even five years ago. In order to provide the appropriate nursing services for the school community, the school nurse must come to this challenging practice with a strong background of knowledge in pediatrics, community health, chronic disease, the educational process and much more.

Until 6-18-93, the Massachusetts Board of Education had no standards or requirements for the practice of nursing. On this date, the Education Reform Act was passed, and with it, the inclusion of school nurses in the requirements for certification.

Certification is the recognition that a certain standard, set by a professional body, has been met by an individual in that profession. The overall purpose of certification is the assurance to the public that the individual has the necessary expertise of knowledge and skills in their professional specialty. The Massachusetts Department of Education certification of school nurses is based on those standards of practice and credentialing recognized by ANA, NASN and MSNO.

Certification and licensing are often confused. All nurses, no matter what their work setting, MUST be licensed in order to practice nursing in the state of Massachusetts. Teachers, guidance counselors, librarians, school psychologists, school nurses, etc. who are employed by public schools, are required to be certified by the Department of Education (DOE). If employed by non-public schools, alternative schools, etc, they may or may not be required to be certified. They are still able to work in a setting outside of the public schools. Certification is a requirement for the employment setting, not the practice. Licensing is a requirement for practice, wherever the setting.

The Massachusetts Department of Education initially granted three levels of certification:

1. Provisional: This level was not required for school nurse certification.
2. Provisional with Advanced Standing: This was the entry level for new school nurses and the certificate was granted for a period of five years. As of October 5, 2000, however, anyone who holds this certificate has the option of applying to the Department of Education (DOE) for an extension of another five years. If a nurse is working under this certificate, she/he may at the end of five years:
   1. request a five year extension from the Department of Education
   2. send a check for $25.00 along with
   3. a letter from his/her superintendent confirming actual dates of employment.
   This information is available on the DOE website www.doe.mass.edu.
3. Standard: This level included the requirement for a Master's Degree and the certificate was renewable every five years. Once a Standard Certificate was acquired, the educator/school nurse must gather Professional Development Points (PDP's) during the five year period. Since there has been some confusion about certification by those who are employing school nurses, as well as prospective school nurses, the following information provides the Massachusetts regulations.

Provisional Certificate with Advanced Standing

1. A valid license to practice as a Registered Nurse in Massachusetts.
2. Completion of a Baccalaureate Degree in Nursing or a Master's in Nursing Degree from an accredited institution.
3. A minimum of two years of child health, community health, or other relevant clinical nursing experience.
4. Completion of an orientation program based on the requirements for delivery of school health services as defined by the Department of Public Health.
5. Current certification in cardiopulmonary resuscitation and first aid from a recognized provider.
6. Qualifying score on the DOE communication and literacy test.

Standard Certification

1. Entry-level requirements for advanced school nurse, as described above.
2. Three years' experience as a school nurse.
3. Completion of a Master's degree or district equivalent or other program in nursing, education or other related field.
4. Maintenance of certification by a nationally recognized professional nursing association as a school nurse, community health nurse, or pediatric/family/school nurse practitioner.

As with all other educators, the Education Reform Act allowed for specific exemptions or "grandfathering" for school nurses. All nurses employed by a school district on or before 6-18-93 were not required to become certified.