Several organizational factors impeding development of school nursing in New York are identified, including educational preparation, the primary care role, administration of school nursing, professional allegiances, and state legislation. Statistics reveal attrition of more highly educated certified nurses and a rapid influx of noncertified diploma nurses, while employment of other personnel in schools--health educators, school psychologists, and social workers--remains stable or increases. Two national movements in school health nursing have been incorporated in New York: state certification of school nurses and implementation of school nurse practitioners at selected sites. However, the status of school nursing has not improved. School nurses have not been socialized through education to deal with organizational impediments to their role development. Consequently, changes they promoted have proven ineffective.