Pilot Grants

Understanding the Experiences of School Nurses in Caring for Sexual and Gender Minority Youth

Statement of Problem

Across the United States, 132,000 school nurses play critical roles in the public health of youth and adolescents, serving as a bridge between our health care and education systems. School nurses not only help treat and manage students’ physical health conditions, but they also conduct behavioral assessments and can be key mental health providers for students—often for those who do not have access to other mental health providers. 

Sexual and gender minority (SGM) youth—those who identify as lesbian, gay, bisexual, asexual, transgender, Two-Spirit, queer and/or intersex—experience well-documented disparities in suicidality, depression, anxiety, bullying and school victimization. Prior literature has shown that SGM youth may seek out school nurse services at higher rates than their heterosexual, cisgender peers for reasons such as feeling safer using a school nurse’s bathroom, seeking counseling services from school nurses, and looking for quality information on sexual and reproductive health specific to the experiences of SGM youth.

Despite the potential of school nurses to serve as resources for crisis management and guidance counseling for SGM youth, very little is known about the care school nurses provide for these youth. More specific research on school nurses needs to be conducted as they have the potential to serve as informed providers and advocates for SGM youth and their specific needs in schools and can also help foster safer, more inclusive school climates.


Through this study, we plan to describe and understand the experiences of school nurses in caring for SGM youth across the U.S., including to explain barriers and facilitators to education and/or the provision of quality care. We also seek to contextualize the care provided by school nurses to SGM youth by school setting, geographic location, sociopolitical climate and nurse practice characteristics. 

In May 2023, we sent a survey to 2,000 randomly sampled school nurses who are members of the National Association of School Nurses. We received a large number of responses to this survey and will recruit for this pilot grant study from participants who expressed interest in follow-up interviewing. Our interviews will follow a semi-structured interview guide that contains questions centered around five domains: (1) close relationships with students and providing psychosocial support; (2) general mental health of youth and the mental health of SGM youth; (3) the school nurse’s perception of their role in caring for SGM youth; (4) the interfacing of the school nurse role with the roles of other professionals; and (5) the influences of district-, local-, and state-level policies on providing care for SGM youth. We will then analyze data from the interviews through thematic analysis, a technique used in grounded theory that involves the identification and use of theoretical codes to achieve a framework to understand a social phenomenon.

Findings from this study have the potential to uncover useful information on the knowledge, attitudes, and practices of school nurses in caring for SGM youth in the U.S., and importantly, to further our understanding of how school district-, local- and state-level policies influence the use of best practices.

Next Steps

Our team plans to formalize an interview guide that will ask focused questions to school nurses and that ensures trust and confidentiality. We will then begin to recruit eligible school nurses that participated in our first survey to participate in this pilot study, as well as train research assistants and other staff.

Suggested Citation

Children's Hospital of Philadelphia, PolicyLab. Understanding the Experiences of School Nurses in Caring for Sexual and Gender Minority Youth [Online]. Available at: http://www.policylab.chop.edu [Accessed: plug in date accessed here]. 

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