School nurses experienced increased workloads and changes to practice during the COVID-19 pandemic, leading to emotional stressors. A national survey was distributed through the National Association of School Nurses from December 2021 to February 2022. Participants' (n = 1,479) levels of moral distress were measured and analyzed for possible associations with demographics and moral dilemmas. Results showed that higher moral distress was significantly associated with full-time equivalent workload and school nurse certification. All 12 moral dilemmas were significantly associated with higher moral distress, the largest percentages for not having enough time to provide chronic disease and preventative care, workloads, and pressure from the administration. Moral distress levels were higher when compared to pre-pandemic and earlier-pandemic levels. These results highlight the importance of clear guidelines for the scope of school nursing practice and to inform future policies supporting school nurses, especially during public health emergencies like pandemics.