NASN and AAP Issue Updated National Policy Statement on School Nursing | |
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On August 17, AAP and NASN published an updated policy statement, Role of the School Nurse in Providing School Health Services. The statement describes school nurses as essential members of the school health system, with responsibilities spanning direct care, care coordination, public health, leadership, quality improvement, and support for student attendance and learning.
The statement recommends at least one full-time registered nurse in every school and emphasizes that staffing should also reflect student acuity, community needs, and the complexity of services provided - not a single nurse-to-student ratio alone. The accompanying workforce data show that 65.7% of schools have access to a full-time school nurse, while 6.3% report no school nurse access.
| | NASN Reaffirms Commitment to Evidence-Based Childhood Immunization as Students Return to School | | |
NASN is deeply concerned by the August 10 Executive Order concerning the nation's childhood immunization schedule. Decisions that affect the health of children and school communities must be guided by transparent, rigorous scientific review and the best available evidence. Changes to longstanding vaccine recommendations should occur through transparent, established scientific and clinical review processes that include independent expert evaluation.
NASN's Position Has Not Changed
In its October 2025 position statement, Immunization and Vaccination Requirements, NASN stated that school immunization requirements should align with the best available, scientifically rigorous evidence. The position statement identifies reputable professional organizations, including the American Academy of Pediatrics (AAP) and the American Public Health Association (APHA), as sources state leaders can consult for scientifically backed, trustworthy information that safeguards the health of school-age youth and communities. For the full statement, see here.
Major medical organizations, including the American Academy of Pediatrics (AAP), strongly oppose the order, calling it unscientific and dangerous. NASN continues to recommend evidence-based childhood immunization schedules developed through independent scientific review. Existing FDA-approved combination vaccines remain available.
NASN in the News
NASN continues to bring the voice and expertise of school nurses to the national conversation about childhood immunization. Recent media coverage has featured NASN perspectives on changing vaccine policies and the important role school nurses play in protecting student and community health. See where NASN has been featured:
HHS Seeks Public Comment on Vaccine Recommendation Framework
The U.S. Department of Health and Human Services (HHS) has issued a Request for Information (RFI) seeking public input on the framework used for the new federal vaccine recommendations.
The RFI asks whether the three existing categories—routine, risk-based, and shared clinical decision-making—are clear and appropriate, or whether additional or revised categories should be considered.
What Can You Do?
NASN will be submitting its own comments but is also inviting members to contribute their own. Please either use NASN’s Action Center to submit our pre-populated message to HHS OR submit your own views and personal experiences here.
Comments are due by September 20, 2026.
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What Is In the Executive Order?
Reduced Recommendations: The order cuts the number of routinely recommended childhood vaccines from 18 down to 11, dropping routine guidance for shots like COVID-19, flu, and rotavirus.
Splitting the MMR Shot: It directs federal officials to create plans within 90 days to split the combined measles, mumps, and rubella (MMR) vaccine into three separate, single-disease injections.
Spacing Out Visits: The directive advocates for spacing out immunizations across multiple doctor visits rather than administering multiple shots in a single appointment.
Parental Choice and Exemptions: The order instructs the Department of Justice and other agencies to challenge state laws or school entry requirements that limit religious or medical exemptions.
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Practical Hurdles and Implementation
Logistical Challenges: Individual vaccines for measles, mumps, or rubella are not currently approved or licensed by the Food and Drug Administration (FDA) in the U.S.
Manufacturing Time: Pharmaceutical scientists note that re-manufacturing and testing individual shots would require extensive time and millions of dollars from drugmakers.
Not Legally Binding for Companies: Neither the White House nor federal health agencies can force private manufacturers to develop or seek approval for these specific single-component products.
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CDC: Dr. Erica G. Schwartz was confirmed by the U.S. Senate on August 5 as director of the Centers for Disease Control and Prevention. NASN will monitor CDC policy and guidance closely as schools navigate changing federal vaccine recommendations and ongoing infectious-disease activity.
NINR: Dr. Courtney F. Aklin became permanent director of the National Institute of Nursing Research on July 26 after serving as acting director and acting scientific director since April 2025. Her appointment is relevant to the future federal nursing research agenda, including opportunities to strengthen evidence on school health and nursing practice.
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The Grow Your Own Advantage: Cultivating Special Education Talent from the Inside Out Webinar
October 8, 2026 | 3–4 PM ET | Register here
Grow Your Own (GYO) programs are transforming how schools build and sustain their special education teacher and specialized instructional support personnel workforce. This free, virtual webinar, hosted by the National Coalition on Personnel Shortages in Special Education and Related Services (NCPSSERS), of which NASN is a member, highlights practical, real‑world GYO models that address critical staffing shortages.
Join school district leaders, educators, specialized instructional support personnel (SISP), and university partners for an interactive session that explores the importance of GYO programs and showcases pathways.
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Learning Without Limits - NASN's Virtual Conference
Opening Keynote: Maximizing Medicaid: Reimbursement Solutions and Methods for School Nursing Services
October 14 | 1–2 PM ET | Register here
This session will help school nursing leaders, administrators, school nurses, and policymakers understand best practices, compliance, documentation, and data-driven techniques to support accurate, maximized Medicaid reimbursement for eligible nursing services in schools.
Learning Without Limits is built around the real-world challenges school nurses face throughout the school year. School nurses will gain practical strategies, strengthen decision-making, and explore approaches they can put to work in their school communities.
With 17 educational sessions, Learning Without Limits combines scheduled learning opportunities with the flexibility to learn on your schedule.
Watch Together — Join 9 scheduled session premieres October 14–16, with opportunities to chat with fellow attendees and submit questions to presenters. Can’t join on those dates? Watch Together sessions will be recorded for later viewing.
Watch Anytime — 8 additional sessions will be available on demand beginning October 14, so you can watch when it works for you.
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| | States Revisit School Immunization Exemption Policies | | |
With most state legislatures having concluded their 2026 sessions, NASN continues its series of articles highlighting state legislative activities earlier this year. This month we will focus on immunization.
New Hampshire: HB 1584 was signed into law. It requires materials produced by the Department of Health and Human Services concerning immunizations for school or child-care enrollment to include a statement that medical and religious exemptions are available.
Utah: School nurses and other health care providers rallied against HB 152, and it failed to advance. It would have eliminated a requirement that parents seeking an exemption from school immunization requirements first complete an online education module or receive an in-person consultation.
When state legislatures resume in January, use NASN’s State Policy Map to track pending legislation. You can also review legislation that was introduced this cycle.
| Florida Rulemaking Could Roll Back School Vaccine Requirements | The Florida Department of Health has published a proposed rule updating school and childcare immunization requirements, related forms (including DH 680 and DH 681), and associated immunization guidance. The proposal was published on August 24, 2026, and is currently in the public comment phase, with comments and requests for a public hearing due by September 14, 2026. Read more. | | School Nurse Staffing Spotlight: Virginia and Alaska | | |
Virginia: Lawmakers and school health advocates are considering whether state standards should require a full-time licensed school nurse in every public school. Current law permits, but does not require, school nurse staffing. State data cited by WTOP indicate that 90.1% of Virginia public schools had a licensed nurse in 2024-2025. The issue is expected to receive additional attention this fall. For more information, see here.
Alaska: Anchorage School District is implementing a regional nursing coverage model for 2026-2027 while preserving an assigned nurse at each non-charter school. The model organizes backup coverage across regions and illustrates one approach districts are using to address vacancies and substitute shortages without abandoning school-based nursing coverage. For more information, see here.
| Cardiac Emergency Response Requirements Expand | | |
States are also strengthening school cardiac emergency response requirements. Minnesota schools begin implementing statewide cardiac emergency response plan requirements during the 2026-2027 school year. North Carolina enacted the Smart Heart Act, requiring public schools to maintain cardiac emergency response plans and improving access to automated external defibrillators (AEDs).
North Carolina's requirements include annual CPR/AED training for specified personnel, including school nurses, annual emergency drills, and at least one AED in each school. These laws reflect a broader shift from simply placing AEDs in schools to requiring coordinated planning, training, drills, and emergency-response infrastructure - areas in which school nurses frequently serve as clinical leaders.
| School Medicaid Expansion Continues Across States | | |
States continue to expand Medicaid reimbursement for health services delivered in schools. Healthy Students, Promising Futures reports that eight states have received federal approval since 2022 to broaden school-based Medicaid beyond the traditional model, limited primarily to services included in an Individualized Education Program, with additional state plan amendments still pending.
Recent examples include North Carolina, where a July state plan amendment expands eligible provider types and covered school-based services, and Georgia, where a July amendment aligns the state program with updated federal school-based services guidance. These changes can expand sustainable financing for nursing and other school health services while increasing the need for clear state implementation, provider enrollment, documentation, and billing processes.
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