Background: Studies have shown that the absence of skin color representation in health science education leads to diminished patient outcomes for these populations. As awareness of this issue grows, literature has emerged to analyze these discrepancies. Expanding teaching images to include a diverse range of all skin types is crucial for promoting equal representation in education. Objective: This study aims to assess skin color representation in pediatric nursing practitioner (PNP) education through a systematic analysis of eight commonly used nursing textbooks. Methods: Eight commonly referenced nursing textbooks were analyzed, given their established use in PNP education. Textbooks were coded for skin color representation by two investigators trained in skin phototyping. Coders used the widely accepted phototyping scale, the Fitzpatrick Scale (range I-VI). Teaching photographs were defined as all photos, including human skin, that provided insight into a disease, diagnostic technique, or concept. Two individual coders coded and documented data, ensuring each coder was blinded to the overall results. Results: Textbooks were included based on the presence of teaching images involving human skin that were not black and white. Of the eight textbooks selected, five were considered given these criteria. A significant proportion of chapters demonstrated skin color underrepresentation. However, chapters addressing conditions of abuse, neglect, and stigmatized social issues displayed a disproportionate representation of skin of color. Conclusion: These findings highlight the importance of enhancing equitable representation in nursing educational resources while collaborating with health science institutions to establish clear, standardized metrics for future implementation. Including skin tone diversity in health science education materials is necessary to ensure clinicians have the knowledge and training to provide all patients with the highest level of care.