Overview
School nursing is essential healthcare for many school-aged children, and federal protections for parental rights already protect parents’ ability to make decisions about their child’s health and education. However, many states have recently introduced parental rights legislation in response to a perceived lack of parental authority in educational settings. Largely driven by politics, these laws are not created with implementation in mind, causing confusion and compromising the care provided by school nurses.
Many of these laws also require parental consent to any service provided at school and parental review of health and education records. Because they largely are driven by politics, these laws are not created with implementation in mind and have caused confusion for school districts, educators, school nurses, and parents as efforts to assert parental control undermine school policies to effectively teach and care for children. These laws also fail to consider the rights and wellbeing of students and naively assume that all children live in healthy, stable homes with caring parents.
Federal laws, such as the Family Educational Rights and Privacy Act (“FERPA”) and the Protection of Pupil Rights Amendment (“PPRA”), already provide strong protections for parents in the educational process. This year, in Mahmoud v. Taylor, the Supreme Court further bolstered federal protections for parents by reinforcing that parents be allowed to opt out of certain educational materials for religious reasons. These strong federal protections emphasize that state-level parental rights legislation is redundant.
In many states, the lack of careful consideration of how these state parental rights laws should be implemented has created widespread confusion and placed undue burden on day-to-day school operations. One troubling consequence of parental-rights legislation is its impact on school nursing. School nurses provide essential healthcare for children while they are at school, both in routine and emergency situations. Laws that unduly restrict the authority of school nurses result in delayed care, reduced access, and confusion about privacy requirements.
For example, when a nurse is talking to a student in a state with restrictive parental rights laws, they might have to consider what topics must be reported to parents, whether they must report any notes kept for nursing purposes, and whether they must encourage a student to stop discussing an issue at school and discuss it with their parent instead, even when the child has expressed fear about their situation at home. This is especially true of discussions about sexual health and gender identity, which are specifically addressed in some parental rights legislation as topics that cannot be discussed at school regardless of relevance to student healthcare.
There are currently 26 states with parental rights legislation that affect school nursing. These laws cover: (1) granting a fundamental right to control education and healthcare, (2) restricting reproductive and sexual health content taught in classrooms, (3) obtaining parental consent before administering healthcare, (4) names and pronouns used to address a child, regardless of the child’s wishes, and (5) parent access to child healthcare records. (The Network has developed a fact sheet that provides a detailed review of this issue and summaries of state parental rights laws.)
Requirements for parental consent are particularly confusing and difficult to implement, because state laws that require consent for school nursing care fail to define what actions do or do not require consent. Nursing is a medical discipline with its own terms of art. Instead of using these terms to facilitate understanding and implementation among medical professionals in a school setting, these laws use terms like “emergency care,” “routine care”, and “first aid” often without precise definitions.
For example, at the beginning of the school year, Texas updated their parental rights law in 2025 that required parental consent “before providing health care services, medication, or conducting a medical procedure” and consent for “routine care.” This new legislation led to confusion among Texas school nurses, who must comply with the letter of the law or risk losing their license. One Texas nurse was unsure how to administer care to a student who became ill at school when their parent had not completed a care consent form. Because a school policy prohibited giving the child a change of clothes and consent forms were required for any type of “routine” medical care, the nurse reasonably interpreted that they could not assist the child in any way without facing a disciplinary process.
In response, Texas legislators urged nurses to use “common sense,” which is not a definition that helps nurses who are facing disciplinary action. Texas since clarified that “general caretaking” (defined as “offering a change of clothing if necessary because of illness, assisting with cleaning up spills or other accidents, feeling a child’s forehead, checking for swollen throat, applying or handing out band aids, helping wipe a bloody nose, etc.”) does not require active consent on file because it is “not a health-care service.” This web of terms and definitions—created by parental rights legislation without consideration to what these terms mean in nursing practice—causes undue confusion for school nurses who are tasked with providing the best care possible to the students they serve.
Another trend in parental rights legislation is “given name” laws that require school employees to notify parents when a student requests to go by a different name or use a different pronoun. In South Carolina a school must notify parents if their child “asserts to any school employee that the minor’s gender is inconsistent with his or her sex or requests a school employee to address a minor using a pronoun or title that does not align with the minor’s sex.” This legislation impacts the ability of school nurses, and educators in general, to build trust with students who may only seek healthcare in a school setting. Additionally, the privacy provisions in parental rights laws may allow parents to access student health records, including notes taken in a nurse’s office.
In Washington, a 2025 update uses language that mirrors FERPA and specifically protects private nursing notes by including an exception to parental review of a student’s education record for records that are “kept in the sole possession of the maker, are used only as a personal memory aid, and are not accessible or revealed to any other person except a temporary substitute for the maker of the record.” Such efforts to safeguard the privacy of school nursing notes are important for protecting the privacy rights and wellbeing of students who need to seek care without parental knowledge, such as reproductive healthcare or mental health counseling.
This article was written by Katherine Schutes, Staff Attorney, Network for Public Health Law—Eastern Region, under the supervision of Kerri McGowan Lowrey, Deputy Director, Network for Public Health Law, Eastern Region.
The Network promotes public health and health equity through non-partisan educational resources and technical assistance. These materials provided are provided solely for educational purposes and do not constitute legal advice. The Network’s provision of these materials does not create an attorney-client relationship with you or any other person and is subject to the Network’s Disclaimer.
Support for the Network is provided by the Robert Wood Johnson Foundation (RWJF). The views expressed in this post do not represent the views of (and should not be attributed to) RWJF.
