OBJECTIVE:To describe the changing role of school nurses in eight New Zealand (NZ) secondary schools from low socio-economic areas with high Pacific Island and Māori rolls. METHODS:An evaluation of a pilot addressing under-achievement in low-decile schools in Auckland, NZ (2002-05). Annual semi-structured school nurse interviews and analysis of routinely collected school health service data were undertaken. RESULTS:Two patterns of school nurse operation were identified: an embracing pattern, where nurses embraced the concept of providing school-based health services; and a Band-Aid pattern, where only the basics for student health care were provided by school nurses. CONCLUSIONS AND IMPLICATIONS:School nurses with an embracing pattern of practice provided more effective school-based health services. School health services are better served by nurses with structured postgraduate education that fosters the development of a nurse-practitioner role. Co-ordination of school nurses either at a regional or national level is required.