ABSTRACTThe purpose of this descriptive pilot study was to begin an exploration of the role determinants that facilitate or cause barriers to the implementation of the school nurse practitioner (SNP) role. Utilizing a two‐step design, 16 SNPs from different school districts were surveyed to determine if their assignment included doing school physical exams. Thirteen indicated that they were functioning as SNPs. The three “no” districts were matched with three of the “yes” districts. An SNP, a school health administrator and a school physician from each district were interviewed individually using a structured questionnaire. The focus of the questions was on organizational structure of the school health services, indicators of administrative support for SNPs and the assigned function of the SNP. Responses were matched for the “yes” and “no” districts and for the three types of professionals. The major facilitator of SNP role implementation was if the idea had originated with the administrator or physician decision maker. Role change and boundary encroachment were the main ba