Published research concerning health promotion in Greek schools is limited. The aim of the study was to evaluate special education school nurses' involvement in health promotion activities, examine their attitudes toward it, and to explore the factors influencing their practices. A cross-sectional survey was carried out in 2005 by mailed questionnaires to all 45 Greek school nurses. Descriptive statistics and nonparametric tests were used. The results indicate that 37 (82%) school nurses have had moderate involvement in health promotion programs due to the existing health policies set mainly by the school personnel and the state services. Their attitude toward health promotion was positive and depended on personal health promotion practices and activities and on health policies. Pupils' participation in health promotion programs changed according to their special health needs. The lack of legislated duties and absence of a specific health promotion programming prevented school nurses from being involved. Children's special needs inhibited or promoted health promotion activities. (Contains 5 tables.)