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School nurses have key responsibility for children with diabetes either directly when on-site or indirectly when delegating health care services to other school personnel. Few studies describe how nurses plan for and manage school children with diabetes. The purpose of this exploratory study was to describe the scope of school nursing practice related to children with complex special health care needs. Specific aims related to this pediatric population were to determine the educational preparation and continuing education needs of school nurses; identify sources of information, and support; and explore challenges in providing nursing care. A mixed-methods community-based participatory research design included a survey (n=50) and observations with in-depth interviews in a subset of the sample (n=12). Follow-up focus group interviews will be conducted to assist in data verification and interpretation. This is a secondary analysis of survey data from nurses who indicated they provided care to children with diabetes at school. The sample consisted of 47 nurses (8 LPN and 39 RN) assigned to public schools in five counties in Northeast Florida. The questionnaire containing 30 structured and open-ended items was returned by mail. Nurses reported 174 events dealing with hypoglycemia or hyperglycemia with 15 severe hypoglycemic incidents in the past year. All respondents felt "very competent" with blood glucose monitoring. While 86% felt ''very competent" administering glucagon, only half of the respondents felt ''very competent" managing insulin and infusion pumps. Diabetes was identified more than any other topic as a need or area of interest for continuing education. The majority of respondents preferred written or web-based self-study or a mailed newsletter as a source of continuing education rather than attending an in-person continuing education program. Results may be used by community-based stakeholders when designing interventions to support school nurses toward ultimately improving health outcomes for children with diabetes. [ABSTRACT FROM AUTHOR]