School-Based Health Centers and School Nurses: Co-Location and Collaboration

Abstract

School-based health centers (SBHCs) and school nurses are often the only healthcare providers available to youth; however, they typically operate within parallel, yet distinct, systems. This study examined how many SBHCs serve schools with school nurses and the association between their co-location and collaboration. We examined survey data from the 2021–2022 school year for 1,486 SBHCs. Multivariable logistic regression identified characteristics associated with school nurse presence and levels of collaboration with SBHC staff. Half of the SBHCs (53%) served schools with school nurses located outside the SBHC, 33% had school nurses located inside, and 14% served schools without school nurses. The odds of reporting high collaboration were nearly four times higher when school nurses were located inside the SBHC versus outside (AOR:3.83, CI:2.45–5.98, p < 0.001), after controlling for other SBHC characteristics. Co-locating school nurses within SBHCs may increase collaboration and maximize limited resources to meet students’ health needs.

The authors' abstract, as published at the source. The Journal of School Nursing, 2026 · DOI ↗