Many schools across the United States do not have a full-time school nurse, resulting in care being provided by unlicensed school employees when children are sick or injured at school. The purpose of this study was to determine if there was a difference in the number of students sent home when ill or injured based on who assessed the student in the school health office--a school nurse or an unlicensed school employee. Findings indicated that 5% of students seen by the school nurse were sent home and 18% of students seen by an unlicensed school employee were sent home. This study suggests that more students could be kept in school when school nurses provide assessment and interventions aimed at helping students who become ill or injured while at school, thus increasing school attendance and promoting academic success. These findings also support the need for a school nurse in every school. (Contains 2 tables and 1 figure.)