School Nursing Practice Framework™: The Origin Story and the Data Behind It.

In response to evolving school nurse roles, the National Association of School Nurses (NASN) evaluated and updated its Framework for 21st Century School Nursing Practice™ using a three-phase process that included surveys, qualitative feedback, and interest-holder engagement. Among 878 survey respondents, most (80%) were familiar with the Framework and found it useful for guiding practice. Strong evidence of associations was observed between Framework familiarity and school nurse demographics, including licensure (χ2(3) = 21.51, p< 0.001), years of experience (χ2(4) = 58.03, p<0.001), and certification (χ2(1) = 35.22, p<0.001). Qualitative responses (n = 469) identified areas perceived as underemphasized (e.g., mental health) and sources of misconceptions or confusion. Iterative revisions informed by focus group input addressed these findings, resulting in an updated School Nursing Practice Framework™, which clarifies conceptual relationships and better reflects contemporary practice. This structured, participatory process provides a model for updating professional practice frameworks and highlights the importance of aligning conceptual tools with real-world practice.