The Journal of School Nursing2025, Vol. 41(5) 646–648© The Author(s) 2025Article reuse guidelines:sagepub.com/journals-permissionsDOI: 10.1177/10598405251360760journals.sagepub.com/home/jsn
It is the position of the National Association of School Nurses to promote evidence-based policies and practices that foster culturally sensitive, safe, inclusive, and equitable learning environments for students of every gender identity and sexuality. Professional registered nurses (RNs), hereinafter referred to as school nurses, provide essential leadership, advocacy, and care that address physical, mental, social, and emotional health needs across the gender and sexual diversity continuum so that all students can learn, grow, and thrive.
For the purpose of this position statement, the overarching phrase gender and sexual diversity (GSD) is used to refer as inclusively as possible to the spectrum of characteristics, identity, expression, and sexuality of individuals or groups including those who are lesbian, gay, bisexual, transgender, queer, or other. With this comes acknowledgement that current understandings, definitions, social norms, and the dismantling of bias continue to evolve. Commitment to ongoing learning is essential to creating a culture that supports the principles of acceptance, respect, inclusivity, justice, and equity (Salguero & Morse, 2024).
A person’s sexuality and gender are important influences on health and well-being (International Council of Nurses, 2021), and the formation of many aspects of identity and sexuality actively develops during the school-age years (Mattey, 2019). Students may use various terms to describe their gender identity or sexuality which can change over the course of their lives. It is important to address students using their self-identified name, pronoun, and expression as part of respectful and affirming practices (American Psychological Association, 2023; McGeough et al., 2023; Rioux et al., 2022).
All students need and deserve safe, supportive, and inclusive learning environments (U.S. Department of Education, 2023). Federally funded schools in every state have legal obligations to protect each student’s right to participate in all school-sponsored education programs and activities safely and fully without discrimination or harassment on the basis of sex. These federal civil rights regulations known as Title IX of the Education Amendments of 1972 were amended in 2020 to include school accountability for responding to reports of sexual harassment (Nondiscrimination on the basis of sex in education programs or activities receiving federal financial assistance, 2024). Additional clarification of Title IX in 2024 expanded protections for sexuality, gender identity, and transgender status, though some states have challenged this ruling (U.S. Department of Education, 2024). These protections are essential to sustaining supportive and inclusive schools and serve to benefit all students (Kaczkowski et al., 2022).
Despite these laws, a 2021 National School Climate Survey found that 83% of GSD youth experienced discrimination in the forms of bullying, verbal and physical harassment, stigmatization, victimization, assault, or violence (Kosciw et al., 2022). As a result of these types of mistreatment inflicted by others, youth who are GSD are more likely than their peers to experience anxiety, depression, substance use, homelessness, self-harm, or suicidality (Kosciw et al., 2022; Ryan & Slesaransky-Poe, 2023; The Trevor Project, 2023). Outcomes such as these are similar for students in families with a parent, parents, or caregivers who are GSD (Glsen et al., 2023). In states that allow discriminatory policies, rates of attempted suicide are demonstrably higher in young people who are transgender or nonbinary (Lee et al., 2024). Policies, treatments, and attitudes that are intolerant of GSD individuals can adversely affect the health and wellbeing of this population and result in widening disparities in health outcomes.
As public health leaders, school nurses advocate for and support implementation of evidence-informed policies and practices so that all students across the GSD continuum can be healthy, safe, and ready to learn (NASN, 2022; NASN et al., 2024). Using this approach, policies should be carefully and thoughtfully developed to address salient issues such as access to bathrooms, participation in athletic competitions, and managing documentation if a student’s self-identified name doesn’t match their legal name.
The presence of a school nurse every day, all day provides access to an accepting, supportive adult in a safe, nonjudgmental space, which is a positive factor in school culture and climate (Nieman et al., 2023; Shattuck et al., 2025). School nursing care incorporates assessment, recognition, and interventions for physical and behavioral signs of bullying and related threats to students. In collaboration with educational and healthcare partners, school nurses provide trauma-informed care and multitiered levels of prevention. As RNs, school nurses provide leadership for evidence-based training and education for staff, families and community members and are reliable resources for evidence-based training and education for staff, families, and community members on GSD-related topics. School nursing expertise is also an important contributor to developmentally appropriate, inclusive student sexual health education curricula (Sellers, 2024). These policies and practices are critical for addressing the physical and mental health needs of GSD youth (Gunderson et al., 2021).
School nurses are vital team members in promoting safe, supportive, and inclusive learning environments that provide equal protection for the education of students of every gender identity and sexuality. These conditions are fundamental to student health, safety, well-being, and academic success.
National Association of School Nurses1
1 NASN, MD, USA
Adopted: 1994
Revised: 2003; 2012; 2016; 2021; June 2025 (Formerly titled “LGBTQ Students” and “Sexual Orientation and Gender Identity/Expression [Sexual Minority Students]: School Nurse Practice).
All position statements from the National Association of School Nurses will automatically expire five years after publication unless renewed, revised, or retired at or before that time. To access additional NASN professional practice documents including position statements, position briefs, and joint and endorsed statements, please go to https://www.nasn.org/nasn-resources/professional-practice-documents
Wendy A. Doremus DNP, RN—NASN Clinical Writer
Sarah Portle, MEd, RN, NCSN
Jeff Perotti, Director - Safe Schools Program for LGBTQ Students
Wendy A. Doremus https://orcid.org/0000-0001-7584-0192
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Gunderson, L. M., Shattuck, D. G., Green, A. E., Vitous, C. A., Ramos, M. M., & Willging, C. E. (2021). Amplification of school-based strategies resulting from the application of the dynamic adaptation process to reduce sexual and gender minority youth suicide. Implementation Research and Practice, 2(e2633489520986214), 1–15. https://doi.org/10.1177/2633489520986214
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Neiman, T., Sieve, L., Stenberg, L., Molesky, N., & Rider, G. N. (2023). “Bridging the gap”: School nurse experiences providing care for transgender and gender diverse students and their parents/guardians. The Journal of School Nursing, 39(5), 377–384. https://doi.org/10.1177/10598405211025442
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Ryan, C., & Slesaransky-Poe, G. (2023). Q&A for helping educators & school providers to provide guidance & support for parents & caregivers of LGBTQ students. Family Acceptance Project. https://familyproject.sfsu.edu/sites/default/files/documents/FAP_Q%26A%20for%20Educators%20%26%20School%20Providers_Increasing%20Family%20Support%20for%20LGBTQ%20Students2.pdf
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Sellers, W. L. (2024). The school nurse and sexual health education. In C. Resha, & V. L. Taliaferro (Eds.), Legal resource for school nurses (2nd ed., pp. 663–646). Schoolnurse.com.
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