The Relentless School Nurse: The Story Behind the JOSN Manuscript – Surveying School Nurses on Firearm Violence Prevention

In July 2023, I had the privilege of delivering a general session presentation at the NASN Conference, focusing on the vital role school nurses play in stemming gun violence through prevention efforts. During that session, I invited attendees, school nurses from across the country, to participate in a survey designed to capture their experiences, attitudes, and training needs related to firearm violence prevention in schools.

Today, I am excited to share that the results of that survey have just been published in the Journal of School Nursing (JOSN). The co-authored article, “Understanding School Nurses’ Perspectives on Firearm Violence Prevention: Attitudes, Beliefs, and Training Needs,” marks a significant step in amplifying the voices of school nurses on this urgent public health issue. 

From Conference Floor to Peer-Reviewed Publication

The survey was designed to capture the real-world experiences, attitudes, and training needs of school nurses regarding firearm violence prevention. Using a QR code displayed during the session, we invited approximately 560 school nurses to participate. The response was robust: 363 nurses completed the survey, yielding a 65% response rate.

The idea for the survey grew out of ongoing collaborative work with colleagues at Mass General Hospital Gun Violence Prevention Center, with support from the Rutgers New Jersey Gun Violence Research Center and Northeastern University School Health Academy. Our goal was to better understand the real-world challenges and perspectives of school nurses regarding firearm violence, and to use those insights to inform the development of effective, culturally informed training and resources. The survey instrument was carefully developed with input from public health survey experts to ensure validity and relevance.

Key Findings from the Survey

The published results offer a comprehensive snapshot of the current landscape:

• Demographics: Respondents were predominantly female (98%) and non-Hispanic (94%), with a majority over age 50. Nearly half owned firearms, and 80% had lived in a home with firearms.

• Exposure and Concerns: 81% of school nurses expressed concern about the possibility of a shooting at their school; 39% had experienced incidents of a student bringing a firearm to campus, and 13% had seen staff bring firearms to school.

• Training Gaps: While 86% reported their schools had an emergency plan for firearm incidents, only 41% had received any firearm safety training, and just 8% had been trained to counsel students or families on firearm safety.

• Prevention Strategies: Open-ended responses highlighted a strong desire for more education and training (56%), as well as support for providing free firearm locks (15%), investing in mental health resources (13%), and advocating for stricter firearm laws (13%).

• Attitudes Toward Policies: Most nurses strongly disagreed with arming teachers (56%), while there was divided opinion on metal detectors and armed security guards. There was overwhelming support for mental health resources and firearm safety education for students and families.

• Interest in Solutions: 85% expressed interest in learning more about firearm violence prevention strategies for schools. 

The Impact and Importance

Our findings reveal a profession deeply concerned about firearm violence, yet underprepared and under-resourced to address it. The consensus among respondents-regardless of firearm ownership-was clear: school nurses want and need more training, resources, and support to effectively champion firearm violence prevention in their communities.

This manuscript, now published in JOSN, is the first to provide national-scale data on school nurses’ perspectives on this issue. It underscores both the urgency of the problem and the readiness of school nurses to be part of the solution, given the right tools and training.

Reflections on the Journey

The journey from conference presentation to peer-reviewed publication was both inspiring and humbling. It was made possible by the willingness of school nurses to share their experiences and by the dedication of a multidisciplinary research team. The publication of this work in JOSN not only amplifies the voices of school nurses but also provides a foundation for advocacy, curriculum development, and policy change.

I am deeply grateful to every school nurse who participated in the survey and to the colleagues and mentors who helped bring this work to fruition. Your stories and insights are shaping the future of school health and safety. I am especially grateful to Drs. Peter Masiakos and Cornelia Griggs for devoting their time, energy, and resources to focus on the role of school nurses in gun violence prevention. 

As we look ahead, the message is clear: equipping school nurses with targeted, medically accurate, and culturally informed training is essential for advancing firearm violence prevention in schools. This work is just the beginning, and I am grateful to everyone who contributed to making it possible. No matter the current political climate, our work will endure beyond the obstacles in our way. Our students’ safety hangs in the balance. 

Let’s continue this conversation-because as school nurses, we are not only witnesses to the impact of gun violence, but also powerful agents of change in our communities.

For more on the research and the ongoing work to empower school nurses in gun violence prevention, see the published article in the Journal of School Nursing and previous coverage on The Relentless School Nurse blog.

Reference:
Zhivotovsky, S., Nzenwa, I. C., Cogan, R., Hallowell, S. G., Robbins, R., Kaplan, A. J., Sacks, C. A., Masiakos, P. T., & Griggs, C. L. (2025). Understanding School Nurses’ Perspectives on Firearm Violence Prevention: Attitudes, Beliefs, and Training Needs. Journal of School Nursing. DOI: 10.1177/105984052513396552.