The Role of the School Nurse in Suicide Interventions: An Integrative Review

Student summary

Why This Research Matters

Youth suicide has been rising for over a decade, and schools are one of the few places where almost every child can be reached. This integrative review by Pestaner, Tyndall, and Powell, published in The Journal of School Nursing (2021), asks a simple but important question: what is the school nurse actually doing about it?

An integrative review is a research method that pulls together many different kinds of studies (quantitative, qualitative, and theoretical papers) to build a broader picture of a topic than any single study could give. The authors used this method to look across the existing literature on school nurses and suicide prevention. To organize what they found, they used the National Association of School Nurses' (NASN) Framework for 21st Century School Nursing Practice, which describes school nursing around five overlapping principles: care coordination, leadership, quality improvement, community/public health, and standards of practice. Sorting the literature into this framework let the authors see where school nurse involvement in suicide prevention is well documented and where it is thin.

The review's stated goals were threefold: first, to critically examine what role school nurses currently play in suicide interventions at school; second, to identify the barriers that keep school nurses from participating more fully in these interventions; and third, to recommend strategies that could build the profession's capacity to take on this work.

What the review found was, in some ways, a gap rather than a clear answer. Across the literature they examined, the authors report a lack of reported nursing interventions directly linked to student outcomes. In plain terms, even though school nurses are often assumed to be central to identifying and helping at-risk students, the published research does not clearly show what specific actions nurses take or whether those actions actually change outcomes for students. The review also concludes that there is real obscurity in the role of the school nurse when it comes to suicide prevention. Nurses are positioned to help with assessment, early identification, and intervention for students at risk, but the profession's exact responsibilities and scope in this area are not well defined in the literature or, it seems, in many school policies.

This matters because school nurses are frequently the only health professional a student sees regularly, and they are often present when a student first shows warning signs. If the nurse's role is unclear, there is a risk that identification and follow-up happen inconsistently from school to school, or that nurses hesitate to act because they are unsure what is within their scope. The authors' recommendations focus on closing this gap: building clearer role definitions, strengthening training and confidence for school nurses in mental health assessment, and encouraging more research that ties specific nursing actions to measurable student outcomes, rather than describing suicide prevention only in general terms.

For nursing students, this review is a useful reminder that having a role near a problem is not the same as having a well-documented, evidence-based practice for that problem. School nurses are structurally well placed to intervene in youth suicide risk, but this review suggests the profession has not yet built (or at least not yet published) the kind of outcome-linked evidence base that would let nurses, administrators, and policymakers know exactly what an effective school nurse suicide-prevention practice looks like. As a future nurse, especially one considering community, public, or school health, this is worth sitting with: proximity to a problem creates responsibility, but responsibility without a clear scope and evidence base can leave both the nurse and the student underserved. It also highlights how a recognized framework, like NASN's, can be a genuinely useful tool for organizing your own practice and identifying where your documentation and interventions may need to be stronger and more explicit.

One caveat for Canadian readers: this review and the NASN framework are American. Canadian school health is often delivered by public health nurses through regional health units rather than a dedicated in-school nurse, so this role obscurity may be even sharper here. Provincial scope of practice and RNAO resources are the natural anchors for defining the role.

Because this is a review article rather than a single study with its own participants, there is no new patient data, survey, or experiment to describe. Its evidence comes entirely from synthesizing prior published work, so its conclusions are only as strong as that underlying body of literature, which the authors themselves describe as underdeveloped in this area.

Faculty notes

Educational Relevance

This integrative review, published in The Journal of School Nursing (2021, Vol. 37, No. 1, pp. 41-50), addresses a persistent gap in school health scholarship: the actual, documented role of the school nurse in youth suicide intervention, as distinct from the assumed or idealized role. The authors, Pestaner, Tyndall, and Powell, frame the problem against the well-established rise in child and adolescent suicide rates over the preceding decade, positioning school nurses as uniquely situated for assessment, early identification, and intervention given their sustained contact with the student population.

Methodologically, this is an integrative review, a design that permits inclusion of diverse source types (experimental, non-experimental, theoretical) to construct a broader synthesis than a systematic review of homogeneous study designs would allow. This is an appropriate choice for a topic where high-quality experimental evidence on school nurse-delivered suicide interventions is likely sparse, but it also means the review inherits the methodological heterogeneity and variable rigor of its included sources. The authors used the NASN Framework for 21st Century School Nursing Practice (its five nonhierarchical principles: care coordination, leadership, quality improvement, community/public health, and standards of practice) as an organizing structure to categorize interventions and outcomes described in the literature. This is a sound choice for mapping practice-relevant literature onto a nationally recognized professional framework, and it gives faculty a ready-made lens for classroom discussion of scope-of-practice questions.

The review's central finding is not a positive practice recommendation but a documented gap: a lack of reported nursing interventions directly linked to student outcomes, and consequent obscurity in the school nurse's role in suicide intervention. This is a notable and somewhat uncomfortable finding for a field that has long assumed school nurses are central to youth mental health safety nets. It suggests that despite face-valid positioning, the profession has not yet generated (or at least published) an outcome-linked evidence base specific to suicide prevention actions taken by school nurses.

For teaching purposes, this article works well as a case study in appraising review-level evidence and in distinguishing between role plausibility and role validation. Students should be pushed to consider: what would it take to move from 'nurses are positioned to help' to 'nurses demonstrably improve outcomes'? This is also a strong vehicle for discussing the limits of integrative reviews as a design, since the abstract and available metadata do not specify the number of included studies, inclusion/exclusion criteria, databases searched, or date range, an important critique point for a class exercise on critical appraisal of review methodology.

The authors' practical recommendations, centered on building school nursing capacity in this domain, should be discussed as capacity-building at the level of role clarity, training, and documentation practices, rather than as clinical protocols, since the abstract does not detail specific interventions endorsed by the review. Instructors may pair this 2021 review with the same author group's later empirical work, including their 2025 study of school nurse suicide-prevention practice in rural North Carolina (the direct companion to this review), a 2025 national survey, and a piece on moral distress. For Canadian programs, NASN is a US framework; the transferable lesson is role clarity, which in Canada falls to provincial scope of practice (e.g., CNO) and RNAO guidance rather than a national school-nursing body. Full text was not accessible through open channels at the time of this summary (SAGE journal page returned a paywall); analysis here is grounded in the ERIC and PubMed abstract records and publication metadata, and faculty wanting protocol-level or study-count detail should consult the full SAGE article via institutional access.