School nurses are all too often the forgotten element of the school health services, lacking in central guidance and with a great variety of duties and functions which have grown up in an ad hoc and unstructured way. At a time when many districts are reviewing their approach to these services in the light of current policy changes, it would be helpful to step back and consider the issues from a historical perspective in order to understand the great variability in the role of school nurses today. Changing management structures demand improved understanding and acceptance of review and evaluation mechanisms, but where basic information is lacking, overall considerations of need and effectiveness may be severely limited.