School nurses often provide direct health care to school-age children, and thus need a range of knowledge and skills to meet the needs of less healthy children, as well as healthy children. To meet this challenge in South Carolina, a statewide continuing education program with didactic and school-based clinical instruction was implemented to enhance the scope of school nurse practice. The physical, psychosocial, and environmental health dimensions of the school nurse's role improved significantly when the program ended at nine months and were maintained at 18 months follow-up. However, program management skills did not improve. Practice guidelines indicate continuing education can improve practice in areas under direct control of the school nurse. Focus on development of program management skills is called for in continuing education. Redefinition of this aspect is crucial to full development of the school nurse role and improved health for school-age children.