The Roles and Challenges of School Nurses Caring for Children with Medical Complexity in Japan

The number of children with medical complexity has been increasing annually, resulting in a growing demand for appropriate support from nurses in school settings. However, the lack of standardized criteria and clearly defined job descriptions presents a significant challenge in securing and retaining personnel. This study aimed to clarify the current status of school nurses, their perceptions of professional roles, and barriers to effective care. A paper-based questionnaire survey was conducted, followed by semistructured interviews with school nurses in City A, Japan. Responses were obtained from 34 participants (response rate: 71%). Witnessing students' growth and ensuring their safety were identified as key sources of professional fulfillment and motivation. In contrast, many participants described themselves as "extra workers," reflecting low self-esteem and role ambiguity. These findings indicate that school nurses experience considerable anxiety and role-related challenges, highlighting the need for guideline development, systematic support, and structured training programs.