The purpose of this qualitative study was to determine how ratios influenced relationships between school nurses and the educators and parents with whom they work; and how the relationships influenced the understanding and value of the school nurse. A purposeful sampling of 33 participants from four states (New Hampshire, Vermont, Michigan, and Utah) was included in the study. The results indicate both educators and parents perceived the primary role of the school nurse to be medication administration and first aid. The value and understanding of the role of the nurse was not based on the school nurse-to-student ratio. It was influenced by the quality of interactions with school nurses; and the extent to which the nurse was a member of the school team. School nurses must understand the culture of education in order to build professional relationships with administrators and be seen as valuable members of the school team. (Contains 3 tables.)