The Relentless School Nurse: When the Work Outgrows the System

Over the last 25 years, I have seen how the needs inside our school health offices have multiplied. What once was manageable is now layered, constant, and inseparable from the complexities students bring with them. Students arrive carrying more health concerns, more anxiety, more instability, and, too often, fewer supports. So do the adults…

The stark reality is that the systems that previously met the needs of our students have not kept pace. School nursing in 2026 is operating from a model built in a different era, one that assumed there was a safety net beyond the school doors, with families, healthcare systems, and communities ready to share the load. As those networks have frayed, the work has shifted. Nurses have adapted, as we always do, because a child in need does not wait for a system to change.

Our adaptability has always been our strength, but it is also a warning sign: the work has outgrown the structures that were supposed to hold it.

This is not a story centered on burnout. It is a story about escalation and misalignment, and what becomes possible when we name that tension without apology. When the work expands, but the system stays fixed, the strain we feel is not a personal failing; it is information pointing to where change is needed.

School nurses have held immense complexity with professionalism, heart, and quiet courage. We have absorbed the impact so that schools can keep running and students can keep learning, often masking the depth of the gaps underneath. That matters deeply. But our competence has also made it easier for others to look away.

Adaptability cannot become an expectation of endless endurance. It has to become a foundation for redesign.

When we name how the work has changed, we open space to imagine and demand what needs to change next. We can say clearly that being present is not the same as being supported, and that “making it work” is not the same as having what we need. We can draw a boundary between professional commitment and structural neglect and begin to place responsibility where it belongs: on systems that must evolve.

This moment is about stepping forward with sharper focus and collective purpose. The future of school nursing will be shaped in many places: in the health office, where we document what we are truly doing, not just what the old job description says; in conversations with administrators, where we bring data, stories, and clear recommendations, not just problems; in policy rooms, public testimony, op-eds, and coordinated advocacy that refuse to let school nursing remain invisible. It will be defined by what we name clearly, what we refuse to normalize, and how we direct attention toward systemic accountability and investment.

This is leadership born from proximity, compassion, and truth-telling. The story of school nursing is still being written every day in every health office, in every conversation with a worried student or a trusted colleague. And part of that story is the courage to say: the work has changed. So must the system.

Naming that truth does more than reclaim our voice; it points us toward our shared possibility. This is not the end of the story. It is a point of reorientation, a moment where clarity meets courage and both are turned toward what comes next.

An Action to Consider
Name one way your work has outgrown the structures meant to support it. Then move that clarity into action by choosing one specific step:

• Document it in writing. Describe the situation, what you did, how long it took, and what was missing (staffing, time, resources). Use this as part of your annual report, a data tracker, or a running “gap log.”

• Bring it to your administrator with a concrete ask. Pair the story with 1–2 specific solutions: additional nursing hours, a health aide, updated protocols, or a care coordination plan.

• Share it with your school nurse colleagues. Compare experiences, look for patterns, and identify 1–2 shared priorities you can bring forward together, rather than alone.

• Translate it into advocacy language. Turn your example into a brief narrative for a board of education comment, a state association testimony, or a letter/email to a policymaker explaining what students are facing and what would help.

• Connect it to an existing standard or recommendation. Link your experience to professional guidelines, such as staffing ratios, chronic disease management expectations, or mental health supports, to show this is not just a personal preference, but a recognized need.

• Add to the body of data that NASN is collecting through Every Student Counts (National School Health Data Set) – https://www.nasn.org/research/everystudentcounts – so your local experience strengthens the national picture of what students truly need.​

The solutions already exist within our profession, in our documentation, our stories, our standards, and our collective wisdom. What this moment calls for is the resolve to name them clearly, align around them, and put them forward together.