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

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.