Abstract
Firearm injury prevention efforts play a critical role in addressing both morbidity and mortality associated with firearms among children and adolescents. School nurses, through their clinical expertise and trusted relationships with students and families, are uniquely positioned to contribute to and influence these prevention efforts. Nurses can engage in meaningful, respectful conversations during initial or brief encounters and through ongoing communication. This article provides an overview of firearm violence among youth and offers practical tools and resources for school nurses. These resources empower school nurses as trusted messengers, strengthening their ability to lead courageous, life-saving conversations around sensitive health and safety issues, including firearm injury prevention.
Keywords
Why This Matters: How Firearm Violence Impacts Youth
Youth violence is a significant public health issue in the United States, with firearms playing a major role in this crisis. Children and adolescents are disproportionately impacted, as firearm injury is the leading cause of death among youth in this country (Centers for Disease Control and Prevention [CDC], 2023). According to the Gun Violence Archive (2026), youth ages 0 to 17 account for a substantial share of firearm-related injuries each year, representing 17% of such injuries in 2025. Thousands of young people are injured annually, and many of these incidents result in deaths that are preventable with effective secure storage strategies. These injuries stem from a range of circumstances, including interpersonal violence, self-inflicted harm, and unintentional shootings.
Patterns of firearm injury among youth also vary by community context: in many urban areas, deaths more often involve homicide, frequently linked to community violence exposure and neighborhood disadvantage, while rural areas experience higher rates of youth firearm suicide, often associated with access to firearms during periods of emotional distress (CDC, 2023). Together, these patterns underscore the importance of prevention strategies that focus on reducing access to firearms during moments of crisis. Secure storage is an evidence-based strategy shown to reduce the risk of injury.
The Importance of Secure Storage
Secure storage is the easiest and simplest step one can take to keep children safe. Secure firearm storage means keeping firearms locked, unloaded, and stored separately from ammunition. Keeping children from having easy access to firearms is a proven way to reduce injuries and deaths among youth (CDC, 2023).
Recently, the American Academy of Pediatrics (AAP) emphasized that securely storing firearms can make a meaningful difference in preventing firearm-related harms (American Academy of Pediatrics [AAP], 2022). Secure storage helps decrease various instances of gun violence, such as school shootings. Research shows that approximately 76% of school shooters obtain firearms from the home of a parent, relative, or friend (Everytown for Gun Safety, 2020; National Threat Assessment Center, 2019). This research highlights that access is often at home and, therefore, secure storage is a preventative step firearm owners can take to ensure their firearms are not used by unauthorized users.
Firearm owners possess firearms for different reasons, which is why secure storage may look different from one household to another, but the goal is the same: prevent youth and unauthorized access to all firearms in the home. Firearm owners can take an additional step toward safety by using storage devices such as cable locks, trigger locks, lock boxes, or gun safes. These tools create a barrier that prevents access while still allowing firearm owners to maintain access to their firearms.
Securely storing firearms helps prevent unintentional injuries, especially when children find unsecured guns out of curiosity (CDC, 2023). While some families believe hiding a firearm or teaching children not to touch it is enough, the aforementioned research shows otherwise; many children know where firearms are stored, and some have handled them. Secure storage devices are the most reliable way to prevent access. Secure storage also reduces the risk of suicide by creating time and distance during moments of distress and limits access during conflict or impulsive decisions. Overall, secure storage limits access to firearms and protects those we love from unauthorized use.
When it comes to having conversations about secure storage, there is a need for a trusted messenger due to the stigma around owning guns and the concern that safety conversations may lead to firearms being taken away from lawful owners. School nurses can play a pivotal role in destigmatizing these conversations by sharing firearm injury prevention resources along with broader secure storage information to caregivers and the larger school community.
The Role of School Nurses in Firearm Injury Prevention
School nurses are consistently recognized as trusted professionals, reflecting the sustained public trust in nursing, which has ranked as the most honest and ethical profession in the United States for more than two decades (Brenan, 2026). This trust, built through continuity of care and relationship-centered practice, positions school nurses as effective messengers for sensitive health and safety topics, including firearm injury prevention. Framing these conversations through the lens of youth well-being aligns with the core principles of school nursing: protecting students, supporting families, and promoting safe environments (Combe & Cogan, 2023).
School nurses routinely address risks such as medication safety, concussion management, and environmental hazards. Discussing secure firearm storage extends this work through a public health approach focused on reducing risk. School nurses are often the first point of contact for students experiencing emotional distress or crisis. In many cases, these concerns surface in the health office before they are recognized elsewhere in the school setting. Their ability to assess risk, provide support, and collaborate with mental health professionals places them in a key position to recognize when access to lethal means may increase the risk of harm. Addressing secure storage as part of safety planning aligns with evidence-based suicide prevention strategies that emphasize reducing access during periods of acute risk (CDC, 2023).
Framing firearm safety alongside other routine safety topics helps reduce stigma and reinforces that the goal is injury prevention. Integrating these discussions into routine care can increase awareness and support safer practices among families (Combe & Cogan, 2023). Health education settings, parent communication, and individualized care discussions provide opportunities to share clear, actionable information about secure storage. Simple, consistent messaging, such as emphasizing that firearms should be locked, unloaded, and stored separately from ammunition, makes these conversations practical for families (AAP, 2022).
The National Association of School Nurses (NASN, 2024) School Nursing Practice Framework further supports this work by identifying Leadership and Community/Public Health as core principles of school nursing practice. Through leadership and a public health lens, school nurses influence policy, support interdisciplinary collaboration, and implement prevention strategies that extend beyond the individual student. Firearm injury prevention aligns directly with these principles, positioning school nurses as key contributors to holistically safer school communities.
Practical Ways School Nurses Can Act (the “How To”)
School nurses can meaningfully contribute to firearm injury prevention by integrating relationship-centered strategies into everyday practice. This work does not require new programs; it builds on what nurses already do. Conversations can begin during routine interactions with students and caregivers, using neutral, open-ended questions that frame firearm safety alongside other household safety practices (Brady United Against Gun Violence, n.d.). With students, discussions should be developmentally appropriate and focused on safety, particularly when concerns about emotional distress or risk behaviors arise (Zhivotovsky et al., 2025).
Firearm injury prevention strategies can be embedded into existing health education and parent communications as a standard component of injury prevention (AAP, 2022). Maintaining a nonjudgmental, respectful approach is essential. Focusing on secure storage and risk reduction builds trust across diverse perspectives. Partnerships with community organizations extend this work through consistent messaging and resources. These actions reflect the leadership and public health roles outlined in the NASN School Nursing Practice Framework (Combe & Cogan, 2023; NASN, 2024).
A secure firearm storage initiative and education campaign lead by Strengthening Chicago’s Youth at Ann & Robert H. Lurie Children’s Hospital of Chicago provided firearm storage education to approximately 1,000 parents, caregivers, and providers through both in-person and virtual trainings in 2025. Among 155 participants surveyed, 96% reported increased knowledge of secure firearm storage practices around children, 90% indicated they were more likely to engage in firearm safety conversations with children, and 50% reported confidence in their ability to securely store a firearm according to recommended guidelines. Additionally, the initiative distributed 500 firearm locks and 321 firearm lockboxes, supporting community-based efforts to prevent firearm-related injuries and deaths (Strengthening Chicago’s Youth, 2025).
Tools and Resources for School Nurses
Integrating Resources Into Practice
These tools are most impactful when incorporated into everyday school nursing practice rather than used independently. Through brief conversations, educational outreach, and coordinated care efforts, school nurses can turn evidence-based strategies into meaningful action. Collectively, these resources enhance prevention initiatives, promote safer environments, and reinforce the vital role of school nurses as trusted health professionals within both school and community settings. Please refer to the end of this article for a tear-off one-page flyer that can be displayed, distributed, or kept alongside other important resources.
Risk Recognition, Referral, and Prevention
When discussing the topic of firearm safety, the school nurse may identify students at significant risk for harm. School nurses play a critical role in recognizing when added support is needed and facilitating prompt referrals.
Referrals should be considered when a student shows:
Suicidal ideation or self-harm behaviors
Significant or sudden changes in mood or behavior
Exposure to violence or trauma
Concerns about access to unsecured firearms, particularly during periods of emotional distress
Effective referral includes clear communication with families, coordination with interdisciplinary teams, and follow-up to ensure continuity of care.
Access to practical, evidence-based resources supports school nurses in confidently addressing firearm injury prevention with students and families. The following tools provide guidance, educational materials, and communication strategies that can be integrated into school nursing practice to support prevention, family engagement, and prompt intervention.
Trusted Public Health and Clinical Resources
School nurses benefit from access to reliable, evidence-informed sources that support both clinical decision-making and population health approaches to prevention.
The Centers for Disease Control and Prevention provides firearm injury data and prevention tools through its Web-based Injury Statistics Query and Reporting System (WISQARS), which can be used to understand patterns of youth firearm injury and inform prevention efforts.
The Johns Hopkins Bloomberg School of Public Health Center for Gun Violence Solutions (2025) offers evidence-based reports and policy recommendations focused on reducing firearm-related harm, including youth suicide prevention strategies.
The NASN provides position statements and practice resources that align firearm injury prevention with school nursing roles in leadership and community/public health accessible on their website.
Resources from the Substance Abuse and Mental Health Services Administration (2023) support integration of mental health and suicide prevention into school-based care, including crisis response and referral guidance.
Conversation Guides and Communication Tools
Practical language is essential for starting and sustaining conversations about firearm injury prevention in ways that preserve trust and reduce defensiveness. The tools below support school nurses in normalizing conversations and promoting a safety-focused, nonjudgmental approach (Brady United Against Gun Violence, n.d.).
Be SMART Secure Storage Resources
Brady United Against Gun Violence’s This Is Our Lane initiative
Firearm and Injury Prevention in Pediatric Care tear-off page can be found at the end of this issue.
These resources provide structured guidance, sample language, case scenarios, and communication tools that support firearm safety discussions as part of routine care.
Secure Storage Guidance for Families
The materials below can be shared directly with families to reinforce consistent, evidence-based safety messaging:
End Family Fire Secure Storage https://assets.endfamilyfire.org/production/spread-the-word/EndFamilyFire_FactSheet.pdf?dm=1758814817&dl=1
American Academy of Pediatrics firearm injury prevention https://illinoisaap.org/firearmviolence/
HealthyChildren.org caregiver resources https://www.healthychildren.org/English/safety-prevention/at-home/Pages/Handguns-in-the-Home.aspx
These resources provide practical, accessible guidance for reducing youth access to firearms in the home.
Suicide Prevention and Crisis Resources
Mental health support is an essential part of firearm injury prevention, particularly given the strong association between access to lethal means and increased suicide risk. The 988 Suicide & Crisis Lifeline and 741741 crisis text line provide immediate, confidential support via call, text, or chat for individuals experiencing emotional distress or crisis. Secure storage and reducing access to lethal means are key suicide prevention strategies, as most firearm suicide attempts are fatal and often occur during short periods of crisis.
Conclusion
School nurses are uniquely positioned to support firearm injury prevention through their daily practice, trusted relationships, and commitment to student well-being. This work extends what they already do in assessing risk, supporting students and families, and helping create safe environments for children to learn and thrive.
Prevention is relational and built through consistent, respectful interactions that center trust and safety. Through both brief encounters and ongoing communication with families and school teams, school nurses have opportunities to address sensitive topics like secure firearm storage and firearm prevention strategies in a way that is grounded in care rather than judgment. Framing secure firearm storage within the broader context of injury prevention allows these conversations to align naturally with routine health guidance and keeps the focus on protecting youth and communities.
School nurses also play a critical role in moments of vulnerability by recognizing emotional distress, assessing risk, and connecting students and families to appropriate resources. In these situations, conversations about access to lethal means can be lifesaving, as even brief discussions can create awareness and support safer decisions. By continuing to engage, stay informed, and collaborate with healthcare providers, public health organizations, and community partners, school nurses strengthen their impact. Leading with safety, respect, and evidence helps reinforce trust while contributing to the prevention of avoidable harm and the promotion of healthier, safer school communities.
Footnotes
Acknowledgements
Prior to this article reaching publication, co-author, voice, mentor, advocate, and relentless school nurse, Robin Cogan passed away after a short illness. Robin was a fierce advocate for firearm injury prevention as a way to keep our children, their families, and our wider communities safe. This article is dedcated to her and all those who work to ensure our collective safety. We will continue to advocate relentlessly for firearm injury prevention in her honor.
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The authors received no financial support for the research, authorship, and/or publication of this article.
Ethics Approval Statement
This article adheres to NASN’s established ethical standards. Ethical approval was not required as the work did not involve human participants, animal subjects, or sensitive data.
Karma E. Wilson has over 10 years of experience in public health, specializing in behavioral health, trauma-informed care, and violence prevention in underserved communities. She currently serves as Manager of Violence Prevention at Ann & Robert H. Lurie Children’s Hospital of Chicago, where she leads gun violence prevention initiatives, communications, and strategic partnerships. Karma holds a Master of Public Health from Benedictine University and is currently pursuing a Master of Nursing at Marquette University.
Kelitah Armstrong is the senior program manager of Brady’s End Family Fire program, supporting the organization’s efforts to promote safe firearm storage and engage firearm owners in ways they can be part of the solution to ending gun violence in America. The End Family Fire program focuses on using safe storage as a means to reduce unintentional shootings, firearm suicide, and firearm misuse. Her background includes extensive experience in Diversity, Equity, and Inclusion (DEI), higher education, public education, and nonprofit work.
Robin Cogan is a Nationally Certified School Nurse (NCSN) in her 25th year as a New Jersey school nurse in the Camden City School District. Robin is the New Jersey Director for the National Association of School Nurses, representing the New Jersey State School Nurses Association. She also serves as faculty in the School Nurse Certificate Program at Rutgers University-Camden School of Nursing. Robin writes a weekly blog called The Relentless School Nurse.
Leslie Helmcamp is the executive director of Strengthening Chicago’s Youth and Director of Violence Prevention Initiatives at Lurie Children’s. She leads policy and systems-change efforts to prevent violence and expand opportunities for youth. Her background includes advocacy on economic mobility, workforce development, and immigration legal services.
Amy Park is an MPH student at Southern Illinois University. She interned at Violence Prevention Initiatives at Lurie Children’s, building upon her background in harm reduction research and community engagement.
Dr. Samaa Kemal is a pediatric emergency medicine clinician investigator at Lurie Children’s Hospital. Her work focuses on violence, health equity, and improving care for children affected by trauma. She serves as associate medical director of Brave Voices, helping lead trauma-informed, culturally responsive support for youth recovering from violence.
Dr. Karen Sheehan is a professor of pediatrics, medical education, and preventive medicine at Northwestern University Feinberg School of Medicine and medical director of the Patrick M. Magoon Institute for Healthy Communities. Her work centers on youth development and the prevention of injury and violence.