Texas' new parental consent law leaves school nurses confused about which services they can provide to students

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A new state law requiring schools to obtain parental consent before administering health care services to students has triggered confusion among campus nurses who worry they could face punishment for routine acts like offering bandages or handing out ice packs.

The confusion is in response to Senate Bill 12, a sweeping law banning diversity, equity and inclusion practices; instruction on sexual orientation or gender identity; and LGBTQ+ student clubs. SB 12 comes as part of a larger effort by Texas Republicans to shape how public schools engage with students and their families on topics like race, racism, gender and sex.

Incorporated into the law are what Republican lawmakers call “parental rights” provisions, which include a requirement for Texas schools to get written approval from parents before offering routine health assistance and medication or conducting medical procedures. School districts are required to take disciplinary action against any employees who provide such services without consent.

In response, enforcement of the legislation has varied widely across the state's more than 1,200 school districts. Some have interpreted the law as still allowing for regular care, like first-aid treatment and injury evaluation. Others have indicated they will not assess or treat a student except in life-threatening emergencies.

“When you write such a strict enforcement mechanism into a law, people are going to take notice,” said Becca Harkleroad, executive director of the Texas School Nurses Organization and certified school nurse. “Now you've got nurses who are questioning if they can put a basket of Band-Aids on their countertop.”

Rep. Jeff Leach, R-Allen, and Sen. Brandon Creighton, the Conroe Republican chair of the Senate education committee, the authors of SB 12, sent a letter on Thursday to Texas Education Commissioner Mike Morath, calling on his agency to “provide clear and consistent guidance” to schools across the state.

“While we expect our educators to comply with the clear provisions of the bill, we also expect them not to suspend common sense when it comes to providing basic care for the children at their schools,” Leach wrote in a social media post.

Neither Leach nor Creighton responded to requests for comment from The Texas Tribune. The Texas Education Agency said in a statement that it is revising its guidance to ensure schools receive clear direction. Updated information will go out early next week, said Jake Kobersky, the agency’s spokesperson.

As SB 12 made its way through the legislative process earlier this year, nurses warned lawmakers that without more specificity, the bill could have unintended consequences. Harkleroad, the school nurse organization’s executive director, said she recommended the law require consent for only the activities the Legislature found most “questionable or objectionable.” But lawmakers’ response over the course of this year’s regular legislative session was that parents have the right to know exactly what’s happening to their kids in school.

After the law passed and as the 2025-26 school year got closer, some districts began preparing their consent policies. Others awaited guidance from the Texas Association of School Boards and state education officials, the latter of which did not arrive in their inboxes until four days before the law took effect on Sept. 1.

The education agency’s guidance noted that parents retain the right to make medical decisions for their children and that consent was necessary prior to schools providing medical or health assistance, unless it is for life-saving care.

Implementation has been inconsistent. Some district officials provided robust consent forms to families, detailing the various services school nurses may provide students and giving them the option to opt in or out of each one.

Others, school nurses told the Tribune, took an all-or-nothing approach.

“When you choose ‘no’ at that point, then we have to explain to the parent, ‘you now know that anytime I see your child, I will have to call you,’ then further making parents more upset, because they don't understand why you can do this but you can't do that,” said Diana Rios-Rodriguez, board president of the Texas School Nurses Organization and director of health and wellness for the Manor Independent School District, near Austin.

Nurses told the Tribune the confusion can be attributed to state lawmakers not listening to the school professionals who know exactly how their campuses function. And the solution may not be as simple as people think.

“They want us to use common sense. Of course, we’re happy to use common sense,” said Hollie Smith, president-elect of the nurses organization and director of health services at North Texas’ Eagle Mountain-Saginaw ISD. “But the question always is, is my license in jeopardy? And that's where a lot of, I think, our nurses are trying to practice from right now and feeling really uneasy.”

Disclosure: Texas Association of School Boards has been financial supporters of The Texas Tribune, a nonprofit, nonpartisan news organization that is funded in part by donations from members, foundations and corporate sponsors. Financial supporters play no role in the Tribune's journalism. Find a complete list of them here.

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