Background <p>Adolescents who experience gender dysphoria are exposed to harassment, discrimination, and violence in the school environment to a greater extent than other students. The school nurses play a key professional role in supporting the health of these vulnerable students.</p> Methods <p>A qualitative descriptive design. Semi-structured interviews were conducted with eight school nurses in Sweden and analysed via qualitative content analysis.</p> Results <p>School nurses perceived students with gender dysphoria to struggle with anxiety, depression, and self-harm. Some school nurses reported an open school climate, while others expressed the opposite. School nurses express it as vital to establish a relationship to instil courage, strengthen and provide support. They strive to be accessible, signal openness, show understanding, and listen. School nurses call for a collective effort from school staff to elevate competence. They believe that there is a lack of education and directives from management on how school staff should work with students with gender dysphoria.</p> Conclusions <p>The school nurses highlight a connection between gender dysphoria and ill health among students, which school nurses should be aware of to better identify these vulnerable students’ needs through the professional role of the school nurse. The health dialogue and the health forms are a key tool for initiating conversations and providing support. The school nurse plays a role in creating inclusion, such as adapting the school environment. The lack of self-reported competence described by school nurses, can be overcome by openness regarding the topic.</p> Clinical trial number <p>Not applicable.</p>