It is the position of the National Association of School Nurses (NASN) that, to provide culturally competent care, school staff and communities should institute affirming policies that support lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) youth. These include bullying, health risk behaviors, and rejection from family and friends. Such challenges can cause adverse mental and physical health effects such as depression and suicidal ideation. Registered professional nurses (hereinafter referred to as school nurses) are uniquely positioned to help LGBTQ youth by creating LGBTQ-affirming spaces, guiding youth towards resources, advocating for school-wide protections, and assuring youth that their identities and feelings are normal and appropriate. This document provides the background and rationale for NASN's position. [This position statement was initially adopted in 1994 and was revised in June 2003, January 2012, January 2016, and January 2021. For the January 2012 version, "Sexual Orientation and Gender Identity/Expression (Sexual Minority Students): School Nurse Practice. Position Statement. Revised," see ED539206.]