School Nurses' Perceptions of Mental Health Responsibilities Within School Nursing Practice: A Q Methodology Study

School nurses frequently encounter student mental health concerns, but little is known about how they prioritize mental health responsibilities relative to other nursing duties and local team structures.

This Q methodology study examined shared viewpoints about school nurse duties that most support positive student and school outcomes. Seventy nurses from six rural, high-poverty US school districts ranked 25 duties aligned with the National Association of School Nurses framework. Q sorts were analyzed using centroid extraction and Varimax rotation; post-sort comments informed viewpoint interpretation.

A three-viewpoint solution explained 71% of the variance, with 52 nurses loading significantly. Viewpoint 1 prioritized suicide-risk response and mental health work as safety responsibilities. Viewpoint 2 emphasized medical expertise and crisis-oriented mental health involvement. Viewpoint 3 prioritized planning and care coordination while ranking direct mental health duties lower.

Findings support clear role expectations, aligned referral and crisis protocols, appropriate staffing, and targeted professional learning for school nurse participation in mental health teams.

Nurses agreed on core safety duties but differed in how mental health responsibilities fit within routine school nursing practice.