This article describes some of the special health and safety concerns that many lesbian, gay, bisexual, and questioning youth face in schools. Among these problems are increased drug and alcohol use, sexually transmitted infections and pregnancy risks, depression and suicidality, and increased likelihood of being a victim of harassment or assault. School nurses can play a unique role in the lives of these students. A needs assessment is reviewed that describes school nurses' perceived professional responsibility and their actual practice with regard to lesbian, gay, bisexual, and questioning youth. Five barriers to optimal health care for these students are discussed. Methods that encourage students to view the school nurse as an ally, as well as issues surrounding disclosure or "coming out," are discussed. Special considerations of confidentiality, community agency referral, and family disclosure are discussed. Appropriate interventions at school and ways to begin to change the school climate are also presented. (Contains 2 tables and 3 figures.)