To Improve Student Mental Health, Stop Overlooking School Nurses

My office is Switzerland—just like many school nurse offices across the country.

What do I mean by that? It’s neutral ground. I’m not an administrator or a teacher. I’m not a disciplinarian or someone handing out grades. Students see the nurse’s office as a safe zone, where they won’t get in trouble and don’t have to explain themselves too much. And because of that neutrality, they let their guard down. They cry. They breathe. They talk. Sometimes, they say things they haven’t said to anyone else.

Yet despite this critical role, school nurses are frequently overlooked until something goes wrong. Too often, we’re invisible until there’s a crisis—a child in distress or a medical emergency. But those quiet, everyday interactions in the nurse’s office are when the real impact happens—especially when it comes to student mental health.

Post-pandemic, we’ve seen mental health concerns among students skyrocket. 

Anxiety, depression, trauma, and even suicidal ideation show up not just in the counselor’s office, but in ours. The stomachaches and headaches that don’t go away. The student who visits every morning just to “rest.” The one who suddenly withdraws from friends or bursts into tears without explanation. These are more than physical symptoms—they are red flags. And often, the school nurse is the first to spot them.

Why? Because our relationship with students is different. It’s one-on-one. It’s based on trust. They don’t have to perform or produce in the nurse’s office. They just have to show up. And when they do, we’re ready to listen. We’re trained not only in physical care but in the emotional and behavioral health of children. When a student repeatedly visits for vague symptoms, I know it’s time to ask deeper questions, to gently check in and, when needed, initiate support beyond my office walls.

On the front lines

I remember one student who came in with his aunt after having minor surgery. He was returning to school, and on the surface, it was a routine visit—just reviewing post-op instructions and making sure he was cleared to come back. But from the moment they walked in, I could tell something else was going on. Their body language. Her expression. The exhaustion written all over both their faces. I paused and gently asked, “Is everything okay?”

That’s when his aunt broke down and told me that the student’s older brother had died over the weekend of a suspected drug overdose. Their eyes were swollen. Their voices were shaking. The weight of their grief was visible. They ended up sitting in my office for over 30 minutes, telling me everything that had happened.

“Student support systems are often overwhelmed. School counselors, social workers, and psychologists are stretched thin....school nurses bridge the gap. We make the referrals. We call the parents. We help families navigate resources. And we advocate—hard—for what students need, especially when they can’t articulate it themselves.”

In that moment, it wasn’t about medication or charting in the system. It was about listening—giving a family that was completely overwhelmed a safe space where they would be heard.

I gently suggested that maybe the student wasn’t ready to be at school yet. He was clinging to her, visibly distraught. I recommended that she take him back home until arrangements had been made and he felt more emotionally stable. She agreed. She went to the front office and signed him out.

Right after, I sent an email to my principal and then alerted him in the hallway, letting him know we needed to talk. Days went by, and I never received a response. In the meantime, the administration had received a different version of events and issued a “Handle with Care” alert containing incorrect information.

It was deeply frustrating. I had spoken directly to the student and his aunt, and I had the real story. One brief conversation with me—just one brief meeting—could have improved the school’s response.

A seat at the table

Student support systems are often overwhelmed. School counselors, social workers, and psychologists are stretched thin, assigned to multiple buildings or managing overwhelming caseloads. In those moments, school nurses bridge the gap. We make the referrals. We call the parents. We help families navigate resources. And we advocate—hard—for what students need, especially when they can’t articulate it themselves.

Which is why it was so shocking to find out, after well over a school year of being at my school, that there was a Student Support and Attendance Team meeting regularly to address student concerns—and I hadn’t even been told it existed. When I asked why I wasn’t included, the answer stunned me: “The team decided it’s best for you to be in your office.”

I was angry. Angry not just because I had been excluded, but because of what that exclusion represented. I thought about the students I had seen struggling—emotionally, mentally, socially, and academically—whose stories never made it to that table. Stories I could have shared. Insight I could have offered. Connections I could have helped build. Being left out wasn’t just an oversight—it was a missed opportunity to support students more holistically.

School nurses must be included in decision-making spaces. We’re not just healthcare providers—we are frontline observers of student wellness. Our perspective is grounded in lived, daily experience. When nurses are part of the conversation, schools can create more effective, informed, and compassionate systems of support.

NEA and the National Association of School Nurses have long championed a whole-school, trauma-informed approach to student wellness. This moment is an opportunity to build on that work by formally recognizing the critical mental health role that nurses play. It’s time for school leaders, policymakers, and education advocates to ensure nurses have not only the tools to care for students, but also a seat at the table where decisions about their well-being are being made.

The mental health crisis isn’t going away. But with the right support, school nurses can help turn the tide. We are not on the sidelines—we are in the heart of the school, where trust is built, needs are revealed, and healing begins.

Paulette Luckett is a school nurse in St. Louis, Missouri.