School Nurse Domain 1: Nursing Process
Component
1a. Assessment: Collects and
analyzes data to identify the
needs of the individual, group
or situation.
Does not meet standard
Nurse fails to assess the
individual, group or situation.
Developing proficiency
Nurse assessments are basic
and meet immediate needs.
Proficient
Nurse collects, analyzes and
synthesizes comprehensive
data pertinent to the
individual, group and/or
situation.
1b. Diagnosis/judgment:
Forms conclusions/judgments
based on analysis of
assessment data and on
knowledge base.
1c. Planning: Develops
plans/protocols to provide
care and/or support the
health and academic
potential for the individual or
group.
1d. Evaluation: Evaluates the
performance of care plans
and the quality and
effectiveness of nursing
practice in the school setting.
1e. Flexibility( re-evaluation):
Adjusts care plans and
systems of delivery of service
as needed to improve
outcomes.
Inadequate or absent
assessment and knowledge
base results in inaccurate
conclusions.
Conclusions, judgments are
generally accurate and
appropriate for immediate
needs.
Nurse draws on gathered
data and knowledge base to
develop consistently accurate
and appropriate conclusions.
Nurse fails to identify needs
and develop plans/protocols
to address them, or plans are
not safe or appropriate for
the student or situation.
Nurse plan/protocols are
rudimentary, safe and at least
partially suitable to the
student and/or situation.
Nurse plans/protocols are
clear, safe, easy to
understand and follow, and
consistently appropriate to
the student and situation.
Nurse fails to evaluate the
performance of care plans or
general nursing practice.
Evaluation of care-plan
performance and/or practice
is rudimentary, disorganized
and sporadic.
Nurse adheres to the plan of
care or program despite
evidence of its inadequacy or
poor outcomes.
Nurse makes modest changes
when confronted with
evidence of need for
improvement but cannot
provide rationale for changes.
Regularly makes accurate
evaluations of care-plan
performance/effectiveness.
Is attentive to outcomes of
nursing practice at school.
Updates care plans/systems
of care-delivery based on
current data and best
practices. Communicates
changes and rationales.
Guiding questions
 How does the nurse gather data/information?
 How is data recorded/stored?
 How are individual health-care plans written and shared with staff?
 Does the nurse perform physical assessments/confer with family?
Exceeds standard
Assessment includes search
for current best practices.
Student/group/situation
needs are anticipated as
nurse collects, analyzes and
synthesizes comprehensive
data using a variety of
modalities.
Nursing judgment is based on
best practices, deep
knowledge base and holistic
in-depth assessments.
Plans/protocols are highly
appropriate, developed in
collaboration with the
student, group, parent,
colleagues and health care
professionals if needed.
Develops systems for
outcome evaluation and/or
conducts and shares research
to advance school nurse
practice.
Aggregates data from
outcomes to effect change to
plans, procedures and
policies. Systems of care are
continuously improved.
Evidence Examples
 Health-care logs.
 Health-care plans.
 Student health files/documentation.
 Documentation of updates/adjustments to plans.
School Nurse Domain 2: The Environment
Component
2a: Creating an
environment of
respect and
rapport.
Does not meet standard
Interactions with students
and staff are negative
and/or the nurse permits
inappropriate talk/behavior
in the health room.
Developing proficiency
Interactions with students and
staff are a mix of negative and
positive. Inappropriate talk or
behavior is not permitted in the
health room.
2b: Establishing a
culture of health
and wellness in
the school
setting.
2c: Delegates
appropriately and
supervises
ancillary staff.
Nurse makes no attempt to
provide positive health and
wellness information and
input for students and
staff.
Does not follow state nurse
delegation standards. Does
not provide training or
supervision for ancillary
staff.
Office is in disarray and not
conducive to efficient first
aid, health procedures and
medication administration.
Nurse attempts to promote health
and wellness for students and/or
staff via at least one venue,
medium or event.
Limited knowledge of
minority cultures.
Inconsistently applies cultural
awareness to practice with
minority students and families.
2d: Organizing
physical space
and supplies.
2e: Positive
cultural
awareness.
Proficient
Interactions with students and
staff are positive and respectful
the majority of the time.
Behavior/talk in the health room is
guided towards being respectful
of others.
Nurse actively promotes a culture
of health and wellness for
students and/or staff via at least
two venues, media or events.
Exceeds standard
Students and staff seek out the
nurse, reflecting a high degree of
comfort, trust and respect in the
relationship. The health room is a
safe and positive space for all who
come in.
Nurse takes a leadership role in
health and wellness by participating
in a safety or wellness group in
addition to the previous.
Delegates appropriately and
monitors associates care
sporadically.
Adheres to OSBN guidelines for
delegation. Regularly and
systematically monitors the care
of associates. Fosters collegiality.
Supplies are stocked with some
evidence of thought and
organization. Medications are
stored appropriately but are
difficult to locate.
Office is well-organized and is
conducive to efficient triage, first
aid, procedures and medication
administration. Meds are
properly stored and wellorganized.
Adjusts practice to safely
incorporate cultural awareness
and sensitivity.
Associates work independently,
performing delegated tasks
competently and safely. Nurse
supervision is professional,
collaborative and ongoing.
Office is efficiently organized and
highly appropriate to the necessary
activities of all staff. Medications
are properly stored and organized.
Labels make location of supplies
easy.
Proactively participates in cultural
diversity trainings and events, and
is able to apply learning to practice.
Guiding questions
 Does the health room have a climate of respect, health and wellness?
 Are supplies and equipment organized and in stock?
 Are interactions with staff and students positive and constructive?
 Have ancillary staff been trained and are they able to carry out
delegated duties?
 Does the nurse use cultural sensitivity and adjust accordingly?
Evidence examples
 Bulletin boards, posters, newsletters, announcements.
 Health room storage systems.
 Delegation records.
 Observation of delegated tasks being performed.
 Observation of nurse interactions.
 Observation of practice involving minority students and families.
School Nurse Domain 3: Delivery of Service (Implementation phase of nursing process)
Component
3a: Care
plan/protocol
implementation.
Doesn’t meet standard
Fails to inform staff of
care plans/protocols.
Does not follow
protocols.
Developing proficiency
Distributes care plans/protocols to
staff checking sporadically for
understanding and compliance.
Follows protocols.
3b: Administering
medications.
Meds are administered
with no regard to state
or district policy.
Medications are secure,
administered and documented
appropriately with signed consent
forms on file.
3c: Promoting
wellness through
classroom instruction.
Nurse is not available
to teach health topics
in the classroom.
3d: Triage/managing
emergent health
situations.
Nurse has no
contingency plans for
emergencies. Unable
to manage emergent
situations.
Nurse fails to track
immunization lack-ofcompliance resulting in
a high exclusion rate.
Classroom presentations are
partially organized without stated
objectives or checking for
understanding and application.
Plans have been developed for
high frequency emergencies. Able
to demonstrate good judgment
and safe care in most emergent
moments/situations.
Nurse is aware of immunization
requirements and makes at least
one attempt to update records
and notify families prior to
exclusion.
Able to organize, conduct and
document screenings with
assistance from peers and school
staff.
3e: Managing state
immunization
requirements.
3f: Conducting school- Demonstrates lack of
wide screenings.
awareness of
mandates, screening
tasks and organization.
Guiding questions
 Are protocols and emergency plans written for students/situations?
 Are medications administered and stored appropriately?
 Does the nurse participate in classroom instruction?
 How does the nurse manage state-immunization requirements?
 Does the nurse conduct mandated and other school-wide screenings?
Proficient
Distributes protocols to all applicable
staff. Checks for understanding and
compliance regularly. Promptly
updates all pertinent staff with any
changes. Follows protocols.
All staff administering medications
have had documented training.
Medications are well-organized,
easily-accessible, secure and
accompanied by consent forms.
Classroom presentations are
organized, include stated objectives
and opportunities to check for
understanding.
Plans developed for a myriad of
emergent potentialities. Safely
demonstrates confident guidance
and care for staff and students in the
emergent moment/situation.
Nurse has a system to update
records, identify lack-of-compliance
and provide family notifications at
least twice prior to exclusion.
Organizes, and conducts screenings.
Documents results and sends
referrals in a timely manner.
Exceeds standard
Seeks feedback from staff,
student and family on a regular
basis to verify comfort,
compliance and appropriate
outcomes for student health.
Students are encouraged to
take an active role in
medication responsibility and
compliance.
Students are able to verbalize
learning and application of
wellness topic to their personal
life and activities.
Takes a leadership role in
school, district and/or
community emergency risk
management. Trains staff in
emergency care/protocols.
With staff, encourages
compliance at intake. Updates
records and communicates
with staff and families regularly
resulting in low exclusion rates.
Uses community collaboration
and mentors health-occ.
students. Provides resources
and follow-up to referrals.
Evidence examples
 Health care protocol notebook/folders.
 Nurses medication delivery system and records.
 Class dates. Classroom teacher feedback. Classroom observation.
 Exclusion rates. Nurse description of process and system.
 Screening dates. Staff/community feed-back. Observation.
School Nurse Domain 4: Professionalism and Ethical Practice
Component
4a. Documents
nursing care and
interventions
appropriately.
4b.Utilizes effective,
professional
communication.
4c. Leadership and
participation in
professional
community setting.
4d. Maintains
current evidencebased content
knowledge and
nursing practice.
4e. Makes referrals
appropriately as
needed.
4f. Adheres to
federal and state
laws/mandates and
district policies and
procedures in school
nurse practice.
4g. Maintains
professional
integrity in practice
through honesty,
confidentiality and
appropriate role
Does not meet standard
Documentation is
absent or incomplete.
Developing proficiency
Documentation is not timely
and may have minor
inaccuracies or be difficult
to understand.
Fails to communicate
Communication is limited
effectively with peers,
and may be ineffective at
students, families, staff
fully relating concerns and
and care providers.
reaching consensus.
Avoids involvement in
Participates in school,
school, district or
district and/or regional
regional events and
events and projects when
projects.
specifically asked to.
Does not participate in
Pursues some educational
activities to remain
opportunities related to
current in school nurse
school nurse practice but
practice.
does not consistently apply
new learning to practice.
Fails to note need for
Recognizes need for referral
referral. Unfamiliar with but limited awareness of
local resources. Does
procedures or resources.
not assist families in
Requires support in assisting
accessing care.
families to access care.
Unaware of or fails to
Needs assistance in the
follow federal, state and comprehension and
district laws, mandates, application of laws,
policies and procedures. mandates, policies and
procedures. References
correct and current sources
with peer support.
Has deliberately given
Sometimes skews
inaccurate information. information for self-serving
Does not protect staff or reasons. Confidentiality
student confidentiality.
protected when possible.
Does not maintain
Aware of role boundaries
appropriate role
and attempts to maintain
Proficient
Documentation is effective,
accurate, timely and
complete.
Exceeds standard
Develops systems of documentation that are
highly efficient, accurate and yield records that
are clear and informative to others.
Consistently and effectively
communicates with peers,
students, families, staff and
health care providers.
Actively participates in
school, district and regional
events. Takes the lead in
areas of expertise.
Actively stays abreast of
current health and nursing
issues and applies new
knowledge and current
research to practice.
Accurately recognizes need
for referral. Knowledge of
resources and procedures
is thorough. Directs family
in how to access care.
Aware of and adherent to
current federal and state
laws and mandates, OSBN
and ANA practice acts, and
district policies and
procedures.
Communicates through a variety of methods.
Communication is well-received by peers,
families, staff and care providers. Mentors peers
in effective communication strategies.
Initiates substantial involvement in school,
district and regional events. Assumes leadership
roles with school colleagues and among
professional peers.
Initiates innovative ideas that improve
practice/program. Develops and presents
training materials for colleagues and staff,
and/or conducts and implements research to
support evidence-based nursing practice.
Stays in contact with family during referral
process. Helps problem-solve any barriers to
care. Advocates for family with care givers if
needed. Sees problems through to resolution.
Transparent practice.
Thorough and accurate
records are maintained.
Confidentiality is studiously
protected. Maintains
professional role
Staying knowledgeable of current federal and
state laws and mandates, OSBN and ANA
practice acts and district policies and
procedures, as well as current research and bestpractices, the nurse actively advocates for
change and improvement in rules if indicated for
the improvement of school nurse practice.
Respected by peers and associates for honesty
and integrity. Provides leadership with peers in
records maintenance techniques, confidentiality
supports and professional role boundary
maintenance. Looks for ways to improve
practice and protections for staff and students
boundaries.
boundaries.
professionalism.
Guiding questions
 Does the nurse keep thorough and accurate records?
 Does the nurse communicate effectively?
 Does the nurse participate in building activities?
 Does the nurse pursue continuing education to remain current?
 Does the nurse make appropriate referrals?
 Does the nurse adhere to laws, mandates, policies and procedures?
 How does the nurse demonstrate integrity in professional practice?
boundaries at all times.
served.
Evidence examples
 Student files, logs, medication records.
 Observation, newsletters, e-mail examples.
 Storage of records.
 Continuing education records, professional certifications,
memberships, subscriptions.
 Referral records.
 Nurse practices confidentiality, appropriate role boundaries, honesty.