In Pennsylvania, certified school nurses were governed by the same educational rules and administrative directives as teachers. School nurses were supervised and evaluated by non-nurse managers who had no knowledge of the scope of school nurse practice. A focus of the study was to examine the efficacy of management for school health programs. The quantitative study involved a survey distributed to 351 school nurses, which resulted in 113 responses. Survey data were analyzed for descriptive and inferential statistics, which included examining relationships between demographic variables, self-reported variables of perceived efficacy and empowerment, and a dichotomous variable indicating whether or not there was a dedicated nurse manager. Logistic regression results indicated significant relationships (p less than 0.05) between the presence of nurse managers and years worked in the district, and dummy variables representing categories of type of community, grade level responsibility, and the region of Pennsylvania worked in. Results of multiple linear regression analysis indicated that the suburban versus rural category of the type of community worked in was a significant (p less than 0.05) predictor for empowerment. Implications were that school nurses working in rural areas reported increased empowerment. Extending the study to a larger sample, particularly school nurses in rural areas, and expanding the survey to include a greater number of questions, may have a more measurable impact directly linking the presence of nurse managers to perceived efficacy and empowerment. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://www.proquest.com/en-US/products/dissertations/individuals.shtml.]