Explore state school nurse consultants' pivotal position during the COVID-19 pandemic to shape school policy and support frontline school nurses.
An inductive qualitative study.
Members of the National Association of State School Nurse Consultants in the United States participated in focus groups and a written survey from January to April 2023. Standard content analysis was used to identify patterns and themes. COREQ guidelines were followed.
Data from 14 participants revealed 5 themes and 29 subthemes: State School Nurse Consultants walk in two worlds, bridging health and education. They built collaboration and trust and functioned as interpreters and gatekeepers. State consultants were resources, advocates and supports for school nurses. They witnessed and experienced trauma. State consultants defined lessons learned and described how their national organisation supported them. Few sources describe state consultants' role from 2000 to 2022; therefore, this study fills a gap.
State consultants advocated for school nurses, students and school staff, whose needs were not well understood by public health or education leaders.
School nurses' workload increases exponentially in the absence of state consultants who provide resources to deliver effective and efficient school health services.
Policy leaders should recognise state school nurse consultants' intersectionality which strengthens the public health infrastructure, critical to meeting current and emerging public health challenges.
System-wide leadership at regional, state and national levels provides consistency in policy and programmes, reduces duplication of effort and potential error and ensures school nurses benefit from shared resources, problem-solving and support.
National Association of State School Nurse Consultants leaders instigated the study and approved the design and open-ended questions. Preliminary findings were shared with members at a national online meeting and feedback affirmed that the results resonated with their experiences.