Background: With the increasing acuity of student health problems, growing rates of poverty among urban families, and widening racial/ethnic health disparities in child and adolescent health indicators, the contributions of school nurses are of increasing interest to policymakers. This study was conducted to evaluate the impact of school nurses on promoting a healthy school environment and healthy, resilient learners. Methods: A mixed-methods approach was used for this study. Using a cross-sectional design, surveys captured the level of satisfaction that school staff had with the nurse in their school, as well as their perceptions of the impact of the nurse on the efficient management of student health concerns. Using a quasi-experimental design, data from electronic school records were used to compare rates of immunization and completeness of health records in schools with nurses. Results: This study provides evidence that school nurses positively influenced immunization rates, the accuracy of student health records, and management of student health concerns. This research demonstrates that teachers and other staff consider nurse interventions vital to eliminating barriers to student learning and improving overall school health. A cost analysis revealed the estimated annual cost per school for the time staff spent managing health concerns. Conclusions: In an environment of scarce resources, school boards need quality evaluation data to justify hiring and retaining school nurses to support improved school health environments. (Contains 4 tables.)