Schools are uniquely positioned to impact student health and academic outcomes through health and wellness policies. The purpose of this study was to describe factors influencing implementation of school health and wellness policies, specifically those focused on physical activity and nutrition. In-depth, stakeholder interviews were conducted with key informants at eight Chicago Public Schools (K-eighth grade). Data were analyzed using summative content analysis. Two themes were identified, facilitators and challenges to policy implementation. Facilitators included district support and motivation (internal and external). Challenges included limited school nurse availability, breaking tradition and budget. The external community and wellness team composition fell within both themes. Specific strategies are suggested to build upon policy implementation facilitators and overcome challenges. While school nurses play an integral role in student health and wellness, further research is needed to understand school nurse impact on student health and academic outcomes through school health policy.