Due to under-identification of student mental health problems and limited specialty mental health providers in schools, school nurses are often faced with identifying and addressing student mental health needs. This exploratory study assessed prevalence and types of student mental health problems encountered by school nurses, as well as their prior training, perceived competence and levels of comfort addressing such problems. Data collected at a 2010 National Association of School Nurses conference from 78 school nurses suggest that in their view, 31% of students present with mental health concerns as their "primary" presenting issue. School nurses reported moderate levels of comfort identifying specific problem areas, but limited comfort in mental health intervention and pre-service training to identify, assess, make referrals and/or intervene. Perceived competence identifying mental health concerns overall was predictive of perceived competence to make referrals. Implications and recommendations for professional development are presented.