Frequently Asked Questions (FAQs)

Below are the most frequently asked questions by applicants and NCSNs - and are posted here for your convenience from previous issues of the NCSN Newsletter. Additional questions may be directed to or to the email address of the President listed on the NBCSN Leadership web page.

Questions regarding the examination:

Do I have to be working full time to be eligible to take the exam?
To be eligible to sit for the examination the applicant must show a minimum of 1,000 hours of clinical practice in the area of school nursing during the past three years; however, NBCSN recommends a minimum of 4,000 hours (or three full time academic years).

Clinical practice in school nursing means actively employed or contracted to provide a direct or indirect professional contribution to the health and education of students and their families in public or private school settings.

Direct clinical practice in school nursing is defined as involvement in the nursing process in a school setting where the nursing actions and judgments are focused on a particular student, family, school community, or group of students or their families where there is continuing professional responsibility and accountability for the outcomes of these actions.

Indirect clinical practice in school nursing is defined as involvement that: (1) includes clinical supervision of school nurses, education and clinical supervision of baccalaureate/master's nursing students in school health, administration of school health services, research, consultation or other engagement in the field of school nursing that contributes to the specialty's body of knowledge or enhances the quality of school nursing practice; and (2) entails continuing professional responsibility and accountability for the outcomes of the involvement.

Not eligible as clinical practice in school nursing includes: substitute nursing in a school, except as full time substitute working consecutive days for the required clinical practice hours; one-to-one nursing as the nurse's sole responsibility within a school; employment in the direct sales, marketing or distribution of school nursing-related products or services in pharmaceutical, technology or other school health-related industries; community health screenings; work in a camp setting; preceptorship/mentor; and jobs unrelated to school nursing.

Why must you have a bachelor degree to take the NCSN exam?

  1. Few criteria have generated as much discussion as the eligibility requirement of a baccalaureate degree for the certification exam. For the first few years of the exam, from about 1986 to 1991, all registered nurses, from every educational background, were allowed to take the certification exam. In 1991, when NBCSN separated from NASN, the Board reviewed the Scope and Standards and position statements of both the NASN and the ANA, and established the criteria that the baccalaureate degree would be one of the eligibility requirements for the certification exam.
  2. Respect for the long-established community-nursing model that required bachelors-level preparation.
  3. Greater equity in negotiating for comparable pay compared to educators. To do so, school nurses must be able to demonstrate equivalent academic preparation.

The American Board of Nursing Specialties does report some certificates granted by exam for some nursing specialties; however, the NBCSN Board believes the scope of these hospital-based specialties to be narrow and limited when compared with the breadth of knowledge and practice of the specialty of school nursing.

The NBCSN Board also strongly supports the Scope, Standards and Position Statements of the National Association of School Nurses, Inc., and frequently refers to NASN and its publications to sustain the decisions of the Board and its expert panels on issues of practice, research and standards.

While the statement below is the current position statement of NASN, it has not deviated from earlier versions supporting the baccalaureate degree as the minimum recommendation for the practice of school nursing:

...For nurses, the minimal level of education for preparing for preparation in independent practice, leadership/management, and community health nursing is the baccalaureate degree, and licensure as a registered nurse. In addition, certification at the state and national levels reflects more than a minimal knowledge base. As a nursing specialty, school nursing requires advanced skills that include the ability to practice independently, supervise others, and delegate care in a community health setting. (ANA, 2001).

It is the position of the National Association of School Nurses that every school-aged child deserves a school nurse who is a graduate of a baccalaureate degree program from an accredited college or university and licensed by that state as a registered nurse. These requirements are the minimal preparation for the skills needed at the entry level of school nursing practice. Additionally, NASN supports state certification, where required, and promotes national certification of school nurses through NBCSN...

NASN Position Statement: Education, Licensure and Certification of School Nurses (2002)

What are acceptable degrees to sit for the examination?
Accepted Health-Related Baccalaureate Degrees to be Eligible to take NCSN examination:

  • Arts: Natural Sciences: Biochemistry, Chemistry, Human Ecology
  • Biology: Evolution-Behavior, Human Biology, Microbiology, Cell Biology, Neurobiology
  • Communication Sciences and Disorders
  • Counseling
  • Education: Applied Learning and Development (Early Childhood through grade 6, Special Education), Health Education, Health Promotion, Health and Physical Education
  • Geosciences: Environmental Sciences
  • Health Education, Community Health Education
  • Health Organization Management, Healthcare Administration
  • Human Development: Early Childhood, Child Development, Families and Personal Relationships, Families and Society
  • Liberal Arts: Biochemistry, Biology, Chemistry, Human Ecology
  • Nursing Informatics
  • Nutrition: Including Dietetics, Nutritional Sciences, International Nutrition
  • Occupational Therapy
  • Pharmacy: Including Medicinal Chemistry, Pharmaceutics, Pharmacology and Toxicology, Pharmacotherapy
  • Physical Therapy
  • Psychology
  • Public Health
  • Social Work
  • Sociology

What are the Eligibility Requirements to take NCSN examination for non-BSN or non health-related Baccalaureate degrees? 
The following must be submitted to the NBCSN Board, c/o President (email is listed on the "Leadership" page), for review and approval prior to submission of application to take the NCSN exam:

  • Baccalaureate academic transcript
  • Transcript/course completion of a total of six (6) credits of graduate course in any combination of the following subjects:
    • Management of primary health care problems of children and/ or adolescents
    • Health assessment of children and/ or adolescents
    • Public health/community health/epidemiology
  • Narrative related to experience in school nursing and demonstration of leadership in school health activities

I am interested in taking the examination to become an NCSN. Is there a class available to prepare for the exam?
There are no review classes for the exam that are supported or formally approved by the NBCSN. However, many NASN affiliate organizations have study groups and review courses to assist school nurses prepare for the examination. In addition, some colleges offer online and graduate courses related to school nurse preparation and content. For more information, contact the NBCSN liaison in your state for more information.

The National Association of School Nurse publishes a School Nurse Certification Review manual through its publications. Contact for ordering information.

I just received my testing results and did not pass. I would like to know how the passing score is determined, as it seems it changed from last year. I also have some questions about some individual items that I would like to discuss with someone.
I am sorry that you did not pass the exam. I can only imagine how disappointed you are. The results are un-appealable. In special circumstances, we have allowed individuals to retake the exam at no further expense upon receipt of a written request to retake the exam and a review of the circumstances by the Board, but the scores obtained for the exam that you took will not change and the results will remain the same.

There are several issues that I must explain--the first being that board members and our staff do not discuss individual items. This is to protect the integrity of the exam. So I cannot comment on the questions that you have related to individual questions. I can, however, describe the process under which they are developed and tested. Items are solicited from NCSNs and others throughout the year, especially as a part of the application to participate in the Item Writing Workshop held during the NASN Conference. During that Workshop, additional items are developed by participants who represent a diversity of school nurse roles across the United States. The facilitator leads the group in developing items that reflect real life situations, have an answer that can be verified in current school nursing literature, texts and research, and that are developed preferably to utilize the analytical skills of the school nurse rather than rote knowledge. After the items have been reviewed, they are then reviewed by a panel of practicing school nurses--again verifying that the situation is current and real, the answer designated is correct, that the question is as clear and straight-forward as possible (i.e. no trick questions) and can be categorized into the content outline described in the NBCSN Candidate Handbook. In December, the Board reviews each version of the tests that will be given in the next year. The test items are weighted by psychometric measures to ensure that they are balanced (equal difficulty), that the questions are clear and the answers are validated by current school nursing literature. Following a review of the demographics and the disaggregated data, the Board then applies a psychometric tool called the Angoff method to identify the cut score and the passing score is set. From this description, you can see that the exams differ from year to year, and each version given in one year contains different items. Also, the passing score is based on the current Board's review of all the data and the exam. So you can see that the passing score can change from year to year, based on our process. Remember too, that the Board represents a diversity of school nursing practice areas from across the United States. Our public member does not participate in the review of the exams nor the activities that set the passing score, as s/he is not a school nurse.

As a final review, the exams that are taken during any testing window are scored together, to ensure that there is not anything abnormal that is observed in the scoring process (for example, everyone missing a certain question). If so, the item is reviewed again by the testing corporation and referred to the Board to determine if the item should be pulled and all the tests re-scored. This process allows us to provide the greatest flexibility and fairness to our candidates--it is possible, from the time when the Board reviews the exam in December, that the standards of practice or approach to a school nursing issue may change completely by the testing window in the following summer.

Our process has been reviewed and has met the standards of accreditation of the American Board of Nursing Specialties, which includes the use of psychometric methods to develop, review and set the passing score for the exams.

I would like to know the answers from the test in order to learn the missing content. How can I get that information to better prepare for the next exam?
NBCSN policy prohibits the release of the exams or specific items. Just as with RN state-boards, the validity of the test can only be maintained if its confidentiality and security are not breached, which includes not releasing any portion of the examination to individuals outside of the NBCSN Board and the test development company. We do share the statistics related to the five areas of the exam with the individual candidate in order that the individual would be able to note content areas of weakness, so you may study in that area more.

Questions regarding liaisons:

Can you give me contact information for the NBCSN liaisons?
You can find your state liaison on the liaison page of this site.

I am interested in becoming a liaison, what is the next step?
We allow a maximum of two state liaisons per state. Please fill out an application to become a state liaison from the Forms & Applications page and return to the board office. The Vice President reviews your application. You are required to submit an annual report which can also be downloaded from the Forms & Applications page. For further information please visit the Liaison page.

Questions regarding recertification:

What type of continuing education credits are acceptable for re-certification?
NCSNs are required to renew their certification in order to demonstrate that they have kept current with new practices, methodologies, equipment, medications, and terminology in the field.

To apply for recertification through continuing education, 75 hours of continuing education (CE) related to school nursing practice must be reported. These hours of CE must be related to the practice of school nursing, sponsored by an approved national accrediting agency, and must have been completed during the five (5) years prior to the expiration date of the candidate's certification. Continuing Education Programs may include workshops, seminars, professional development offerings, home-study courses, and state/national conferences, which are school health related.

CE hours may be accumulated in any combination of the following:

  • Continuing Education Credits
    • All contact hours must be in subjects related to school health practice and be approved by a national accrediting agency (as described above), state department of health or education, accredited universities or colleges, etc. These may include workshops, seminars, professional development offerings, and state/national conferences. Online courses, teleconferences, and "webinars" are acceptable, provided they are approved by a national or state accrediting agency.
    • Single–offering courses, seminars, workshops or conferences listed as twenty (20) hours or greater must be accompanied by a course outline or content agenda attached to the recertification application.
    • For conferences with multiple concurrent sessions, each session attended must be identified individually on the certificate or agenda.
    • Self-paced or online CE programs are acceptable for credit if approved by one of the credentialing organizations recognized by the NBCSN.
    • Courses which are considered basic nursing preparation or staff development are not accepted. Activities NOT ACCEPTABLE for continuing education credit include:
      • Basic CPR, first aid, blood-borne pathogens training and other state certification and screening courses, as vision, hearing, Acanthosis Nigricans, spinal assessment, etc.
        • PALS, ATLS, ACLS will be accepted for credit only one time during the five-year recertification period.
      • Basic computer technology courses, such as Windows, Word, Excel and PowerPoint, including computer training for district specific record keeping.
      • In-service programs that provide specific information about the work setting"s philosophy and procedures, including orientation to a work setting, department and district staff development courses, workshops and committee meetings—unless pre-approved by an accredited provider as described above.
      • On-the-job training and equipment demonstration.
      • Refresher courses designed to update knowledge.
      • Courses that focus on self-improvement, changes in attitude, self-therapy, self-awareness.
      • Personal weight loss, yoga or personal appearance, etc.
      • Economic courses for financial gain, such as investments, retirement, preparing resumes and techniques for job interviews.
      • Liberal Arts course in music, art, philosophy, etc, when unrelated to patient/client/student care.
      • Courses for lay people.
  • Academic Credits
    • Academic courses must be taken within the framework of a curriculum that leads to an academic degree in nursing or any academic course relevant to nursing practice. An academic course taken for credit may be used to meet NBCSN requirements if a grade of "C" or better or "pass" on a pass/fail system is achieved.
    • Each individual academic credit, from an accredited institution of higher learning, will be considered as ten (10) contact hours.
    • A transcript of successful completion of each course must be submitted with recertification documentation.
    • On-line academic courses from accredited institutions will be accepted.
    • Prerequisite courses, such as mathematics, government, anatomy, physiology, languages, literature, etc. cannot be accepted to meet any part of the continuing education requirements for a registered nurse.
  • Miscellaneous activities
    • The NBCSN recognizes and supports endeavors that promote and enhance the role of the certified school nurse and grants credits to non-academic or typical continuing education events.
    • Additional activities are listed on the Recertification page and in the recertification guidelines.

All courses are subject to review. Applicants may be requested to demonstrate how the course content promotes expertise in school health or is relevant to the school nursing practice of the certificant.

All CE information must be listed on the Application for Recertification of School Nurses through Continuing Education and must include date, program title, CE provider or sponsor (i.e. approved national accrediting agency), and the number of CE hours awarded.

Do you accept home study course credits from Nursing Education of America towards re-certification?
The important issue for NBCSN related to any organization providing nursing or continuing education credits is that the agency must be accredited by a national, state or regional accrediting association. For example, units must be approved by organizations such as the American Nurse Credentialing Center (ANCC), Continuing Medical Education (CME), a state health or education agency, or a college or university accredited by a regional or national accrediting board or listed by the US Department of Education.

I recently submitted my recertification documentation and was told that some of my units were not acceptable, as they were not from an "accredited provider"? What does that mean? My school district accepts all of our staff development hours, why can"t I use these for my recertification credits?
The Board reviewed the policies and procedures related to recertification. In doing so, they were also mindful of the standards required by the American Board of Nursing Specialties and the need to ensure that the NCSN recertification process reflected that the certified school nurse continued to meet the established standards of maintaining expertise in the specialty field. While most programs offered by districts and campuses provide excellent information, they often do not have the review process and criteria established by accredited providers. In addition, the Board noted that many NCSNs were obtaining credit from online courses and commercial vendors, whose workshops did not have any documentation related to the validity of the information presented or the expertise of the faculty. Programs that are accredited by state health and education departments, or national organizations such as those that provide continuing education courses for counselors, psychologists, physicians and nursing, are reviewed to ensure that they meet established criteria related to content, presenters, learners" objectives, etc. They are standardized in format to ensure that contact hours meet definitions of time spent in "class", speakers" objectives, and the evaluation process. Courses taken in an academic setting also must meet the standards established by the college or university accrediting body.

In addition, the Board felt that programs related to orientation, vision/hearing/CPR/BMI measurements and other skills training were basic and not reflective of information that would enhance the certified nurse"s practice and knowledge.

Certified school nurses need to become discriminating consumers and select courses that enhance their specialty practice. Courses submitted for recertification credit must be school health related. This is not to limit any nurse from taking any course for relicensure—but courses submitted for NCSN recertification must be school health related—a wide range when one considers sociology, psychology, education and other topics that fall within the school "health" community. Documentation of attendance at any course should include the number of contact hours and the name of the accredited provider, such as the ANCC (American Nurses Credentialing Center), CME (Continuing Medical Education organization), university, etc.

For more information, see