The purpose of this comparative review was to examine the legislative evolution of school guidance and school nursing over the past century, in hopes of identifying reasons why guidance counselors have been more successful in compliance to recommended ratios than school nurses. A literature review was conducted including CINAHL, MEDLINE, ERIC and other EBSCO databases. The results from this review indicate school guidance programs have been included in more federal legislation, mandating funding, education and certification requirements, which gives counselors a uniformly recognizable credential understood by educators. An extensive effort to develop a national model of school guidance has assisted counselors to uniformly show how they impact student academic success. School nurses can learn how to further integrate the school nursing role into education from the example of guidance counselors. (Contains 2 tables.)