In an effort to address the needs of the increasing number of children who are coming to school with physical and emotional health conditions that prevent them from learning to their full potential, school systems have begun to alter the scope and nature of their school health services. Given their direct access to children, families, and school personnel, school nurses are in a unique position and have the skills and knowledge to improve children's health and their ability to learn. In order to effectively meet our nation's challenges and to best safeguard the health of its students, school nurses must have an expanded scope of practice, manage diverse client needs as well as students with more complex health problems, and become key players in the integration of various health care delivery models into the school setting. This paper describes the challenges and issues being faced today by school nurses, examines their roles in new health service delivery models, and offers recommendations for improving and expanding school nursing services. Following an introduction on trends for the future of school nursing, the paper is divided into brief chapters: (1) history of school nursing; (2) school nursing practice today; (3) two models of health service delivery; (4) futures of school nursing; (5) recommendations; and (6) model programs. Contains 28 references. (TJQ)