Background: School nurses are rarely integrated into primary care teams to their full potential. We aimed to characterize school nurses' perceptions related to current and optimal collaboration with primary care providers (PCPs) and identify actionable solutions to improve efficiency, quality, and coordination of pediatric care. Methods: We conducted and qualitatively analyzed interviews with school nurses to characterize structures, processes, and perceived benefits of optimized school nurse-PCP collaboration. Results: School nurse interviewees (n = 23) identified factors important to school nurse-PCP collaboration within 2 domains: information sharing and relationship building. Information sharing themes included health information sharing laws, data sharing systems, and technology-based communication systems. Relationship building themes included health care sector understanding of the school nurse role, PCP knowledge of school health requirements, shared professional development opportunities, and time and personnel. Perceived benefits of optimized PCP-school nurse collaboration were identified for children, PCPs, school nurses, and parents. Implications for School Health Policy, Practice, and Equity: Needs assessments and action plans guided by the domains of information sharing and relationship building can inform local improvements to optimize school nurse-PCP collaboration. Conclusions: School nurses highlighted cross-sector solutions to enhance school nurse-PCP collaboration including integrated information sharing systems and intentional relationship building.