Aims To develop a theory describing the processes and actions involved with school nurse case management for school‐aged children with chronic conditions in the K12 system. Design Case management is an essential practice for the school nurse. Little is known about actual case management practice in real‐world settings. Grounded theory methodology following a literature‐based conceptual model of school nurse case management. Methods A purposive maximum variation sampling was used for data collection and analysis. Semi‐structured interviews conducted in‐person and via conferencing software from January to March 2017 with school nurses practicing in Washington State until data saturation was achieved. A condition lasting at least 6 months was also used to define a chronic condition. Results In all, 14 school nurses with an average of 12 years of experience were interviewed. Analysis revealed that the core strategy used by participating nurses for case management involved navigating through ambiguity; balancing multiple roles; seeking guidance and training; acknowledging imperfect functioning and navigating poor system supports. Conclusion The findings suggest that actual school nurse case management practice differs from best practice recommendations. Participants did not discuss health promotion or environmental management and did not act to set goals or prioritize care as suggested in the literature. Impact This article informs nursing leadership of the real‐world challenges faced by nurses performing case management in the school setting. These findings indicate that improvements in system supports and training, together with tolerance for the challenges nurses face in providing such care, might improve case management practice in the schools.

The Framework for 21st Century School Nursing Practice™, created by the National Association of School Nurses (NASN), explains school nursing practice, providing guidance, organization, prioritization, and meaning. This is the second article in a series for The Framework for 21st Century School Nursing Practice. This article focuses on case management, one of the practice components in the principle of care coordination. Case management focuses on school nurse support of individual at-risk students and collaborative actions to reduce barriers to their academic success. This article will clarify how the terms care coordination and case management are used in context of the Framework and provide an example to help the reader apply the concept to practice. Washington’s School Nurse Case Management Program will serve as a model. The program outlines evidence for effective practice and shares practical examples of how school nurses can implement case management into their daily work. Any school nurse, no matter how large or small their workload, can provide case management.

Managing asthma in the schools is complex and requires careful planning. This article highlights key steps in implementing guideline-based care for children with asthma in Washington State schools: assessing students, establishing acuity, communicating with parents, and training staff. Advance planning can improve outcomes for students, parents, and school staff in managing this complex and prevalent disease. NASN recently developed asthma management guidelines. Developing state-specific guidelines provides an opportunity to speak specifically to state laws and nurse practice acts while also reinforcing the importance of specialized practice to school nurses, school administrators and teachers, parents, and students.

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