Objective The purpose of our study was to characterise return-to-learn practices following concussion in primary and secondary schools, particularly with regard to prescribed cognitive rest.

Design Cross-sectional survey.

Setting Massachusetts.

Participants Nine hundred member of the Massachusetts School Nurse Research Network (MASNRN) employed full or part-time at a public, private, or charter school serving pre-school through the 12th grade.

Outcome measures Prescribed rest (actual) versus perceived benefit of rest.

Main results A majority of respondents expressed the opinion that more prolonged cognitive rest benefits recovery, with 53.6% endorsing 4–10 days as beneficial compared to 44.3% endorsing 3 days or less. Only 2.1% felt no benefit to cognitive rest following concussion. The average number of medically advised rest (actual) was equal for older and younger students (4.5 days). School nurses perceived less benefit to prolonged cognitive rest (>4 days) for high school students relative to students in elementary school [2 (4, n=97)=11.05, p<0.05], but provided academic accommodations to high school students for comparatively longer periods of time (10–14 days vs. 6–10 days) [F(2,89)=4.74, p=0.011].

Conclusions Counter to the practice of administering accommodations for fewer days in younger students, school nurses perceived greater benefit to shorter periods of cognitive rest (3 days or less) for older children (high school age) relative to elementary school and middle school children. In all settings, schools rest is overprescribed in light of recent finding indicating that prolonged rest (beyond two to three days) may delay recovery.

Competing interests None.