This study examined school nurses' communication with community physicians and its relationship to school nurse satisfaction with school health services. A stratified random sample of school nurses in Pennsylvania (N = 615) were surveyed about communication effectiveness with community physicians, satisfaction with school health services for students, perception of leadership, and students' health care needs. Additional information from national/state education data on student poverty, nurse-to-student ratio, and rural/urban location was included. Findings indicate that having a leadership role in influencing school health policy is related to school nurses' communication with community physicians and satisfaction with school health services. Effective communication with physicians was found to be a salient issue influencing satisfaction with school health services, suggesting the importance of stressing communication as well as leadership skills in school nurse education. (Contains 3 tables.)