Changes in the health care needs of American children over the past two centuries have engendered school health programs. Issues related to the role and responsibilities of school nurses within these programs have existed from the beginning. Current societal pressure for schools to assume even greater responsibility for providing health care has necessitated a precise definition of these roles and responsibilities. The purpose of this article is to review existing literature related to school nursing in this country and to describe the results of a study documenting state mandates for health education programs and the role of nurses within these programs.