# School nursing in Germany - a developing field: results of a mixed methods study

## TL;DR

This study explores the current state of school nursing in Germany, highlighting its multifaceted role in promoting health and the need for further development.

## Contribution

The study provides a comprehensive mixed-methods analysis of school nursing in Germany, identifying three distinct approaches and the need for standardized frameworks.

## Key findings

- School nurses in Germany work across various school types and focus on health promotion, prevention, and counseling.
- Three distinct approaches to school nursing were identified, with limited use of existing models or frameworks.
- School nurses collaborate with multiple stakeholders and are recognized as health experts within schools.

## Abstract

School nursing is a well-established part of school health services globally. In Germany, school nursing is limited to a few model projects. Little is known about the school nurses’ role, its related tasks and goals, and the collaboration with interest-holders. The aim of the study is to explore to what extent and how school nursing is currently implemented in Germany, to provide a basis for further development.

We conducted a context analysis, guided by the UK Medical Research Council’s framework from December 2022 to June 2023. A convergent mixed-methods design was used to gain a comprehensive understanding on the role, needs, working environment, and goals of school nurses. Quantitative data were collected via an online-survey and analysed descriptively. Semi-structured, guided focus group interviews, non-participatory observation of school nurses and expert interviews with interest-holders were conducted and analysed via content analysis for qualitative data, and typology formation was carried out. The findings were subsequently triangulated.

We analysed 65 survey datasets, qualitative data from five participatory observations, two focus group interviews, and ten expert interviews. School nurses work across various school types, caring for students of all ages. Of the respondents, 97% are registered nurses, with 34% holding a Bachelor’s degree. Their tasks, employment relationship and funding vary across federal states. Health promotion, prevention, and counselling are performed by 92%, addressing diverse topics depending on needs, 85% aim to strengthen health literacy among students, parents, and teaching staff. School nurses collaborate widely with internal and external interest-holders, are recognised as health experts and their work is valued supportive and accepted. Three different approaches for school nursing in Germany were identified. Using models and frameworks to inform school nursing was rarely reported.

School nurses in Germany aim to contribute to students and their communities by health promotion, prevention and inclusion. Their role is multifaceted, combining nursing, education, and counselling with different emphases across schools and supporting broader public health efforts. When implemented, they reach students, school staff, parents and partly their community. Given its development stage, established international concepts could serve as a foundation and orientation for further implementation.

The online version contains supplementary material available at 10.1186/s12889-025-25493-z.