The aim of this article is to explore how the development of the theoretical and strategic basis of school nursing offers a vehicle for the delivery of an effective public health strategy for children and adolescents. Through a critical examination of the status and scope of school nursing within the UK and US health care systems it is clear that a deficiency exists regarding the theoretical and strategic basis for the functioning of school nursing. Consideration is given to the concept of the school nurse as for the child along the trajectory of the school health journey. This novel approach to school nursing needs to be developed theoretically and evaluated for effectiveness. A rapid review of the evidence to support school nursing interventions has revealed that the evidence base for school nursing interventions/actions remains very weak, thereby challenging the ability of school nurses to deliver desired outcomes for the present ambitious public health agenda. We argue that a planned approach to developing the evidence for school nursing, based on the UK Medical Research Council (MRC, 2000) framework for the evaluation of complex interventions, could help to ensure a robust role for the school nurse. This acknowledgement and development of a novel approach to school nursing could contribute to policy implementation around public health goals for the school-aged population.