From leadership research to district action: Multilevel Factors Impacting U.S. School Nurses’ Support of LGBTQ+ Youth: A Qualitative Analysis

AI-assisted editorial implementation guide. Proposed district actions are separate from the original authors’ findings and recommendations. Independent peer review of this guide is not asserted.

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Evidence and transfer

Education-related source: verify which participants, institutions and outcomes were actually studied before district adoption. Source publication type: research-article. License and identity checks do not establish study quality or causality.

Original authors’ abstract, reproduced under the source license:

Abstract School nurses (SNs) can play important roles in supporting LGBTQ+ youth. Prior research has emphasized individual and interpersonal factors influencing SNs’ interactions with LGBTQ+ youth, showing mixed results regarding cultural competency, knowledge, and youth satisfaction. However, higher-level factors (e.g., structural and political) shaping these interactions remain underexplored in the United States at a national level. To address this gap, we analyzed open-ended responses from a survey distributed by the National Association of School Nurses in May 2023, receiving responses from 672 nurses (49 states and one U.S. territory). Analysis revealed five key themes: (1) personal stake and the SN role; (2) perspectives on school and community climate; (3) policies as supportive versus challenging; (4) LGBTQ+ resources and education; and (5) barriers and facilitators to learning. Findings illustrate the interconnectedness of policy, leadership, school culture, and education, highlighting areas for targeted improvements to enhance SNs’ capacity to effectively support LGBTQ+ youth health. Keywords: school nurse knowledge/perceptions/self-efficacy, LGBTQ, policies/procedures, qualitative research, school nurse

Study methods

To capture diverse SN perspectives on the topic of caring for LGBTQ+ youth, our team designed a cross-sectional, national survey in consultation with relevant adolescent medicine, LGBTQ+ youth, health disparities, and psychometrics experts. In conceptualizing our survey, we were informed by the NASN School Nursing Practice Framework that states that school nurses should champion health and academic equity and provide culturally sensitive, inclusive, and holistic care (National Association of School Nurses, 2024). We sought specifically to assess the knowledge and attitudes of school nurses in addressing the needs of the marginalized population of LGBTQ+ youth. We distributed our survey to active members of the National Association of School Nurses (NASN) who opted into a listserv to receive research study participation opportunities. The survey asked SNs about their perspectives on topics such as knowledge of LGBTQ+ youth health issues, attitudes toward LGBTQ+ topics pertaining to data collection and continuing education, and specific SN practices that support LGBTQ+ youth. We also asked five open-ended, optional questions to explore policy and educational experiences surrounding care for LGBTQ+ youth. These questions were: (1) if you would like, please describe your experiences with SCHOOL DISTRICT-WIDE policies and caring for LGBTQ youth; (2) if you would like, please describe your experiences with STATE-WIDE policies and caring for LGBTQ youth; (3) please describe one or more BARRIERS to your learning about LGBTQ youth health needs; (4) please describe one or more FACILITATORS to your learning about LGBTQ youth health needs; and (5) What else you would like us to know?

Limitations

This study captured diverse perspectives from SNs across 49 states and one U.S. territory. A randomized participant selection approach combined with a 59.5% response rate indicates substantial population interest. Additionally, the anonymous, open-ended questions enabled SNs to authentically express their experiences supporting LGBTQ+ youth, yielding rich, multilevel insights into sociopolitical and structural factors influencing LGBTQ+ care in U.S. schools.

A 90-day district inquiry

Days 1–15 · Appraise. Read the source methods, recruitment, comparator, outcomes and limitations. Record how the study setting differs from your district and which claim the design can support.
Days 16–30 · Design. Choose one school improvement question with teachers. Protect a short shared planning cycle, agree an instructional change and use a common rubric for examining student work. Agree participation, privacy protections, baseline and stopping rules before starting.
Days 31–60 · Observe. Collect the pre-agreed measures, keep a log of implementation changes and invite confidential voluntary feedback. Preserve existing support for staff and learners.
Days 61–90 · Decide. Review implementation fidelity, teacher time and independently scored student work against a recorded baseline. Examine access differences and competing explanations before attributing changes to leadership. Make a dated decision to stop, revise or extend the inquiry.

Board decision brief

Present the local problem, source setting, evidence limits, intervention, responsible owner, total cost, measured changes and uncertainty. Separate staff perceptions, implementation measures and student learning outcomes.

Attribution and reuse

April J Ancheta; Alora N Del Duca; Dominique G Ruggieri; Catherine C McDonald; Dalmacio Dennis Flores; Nadia L Dowshen. Multilevel Factors Impacting U.S. School Nurses’ Support of LGBTQ+ Youth: A Qualitative Analysis. The Journal of School Nursing (2025-07-04). https://doi.org/10.1177/10598405251351297

Prepared 2026-11-07. Source authorship and DOI are preserved. The abstract and source passages are attributed extracts; this editorial guide is offered under the same CC BY 4.0 license.