Possibility of returning to school

LikeTheDeadSea, MSN, RN · Nov 9, 2020

Symptomatic kiddos go behind a tarp/shower curtain set up in the corner of the office. There are 2 of those in my office.

No Nebs.

Return to School Guidelines - is your DOH on the same page as the CDC? If not, your district needs to decide what page they want to be on.

Mavnurse17, BSN, RN · Nov 9, 2020

Oh man... I can't imagine navigating this with little to no guidance. I'm in TX and luckily we're basically having our hand held with protocol out the wazoo.

My area is in the red zone so any kid with any symptom at all gets sent home-- yes, even if you have just a runny nose. Seems extreme but I have caught a few covid cases that only presented as vague symptoms like that. I do put them in an iso room that's close to an exit in the building for easy pickup. Symptomatic kids go home for 10 days; they can come back sooner with a negative covid test or a provider's statement diagnosing them with something else instead. Close contacts of positive kids at school go home for 14 days from last contact and they can't come back until then even if they get tested and are negative.

Our district is strongly recommending against neb treatments and asking us to work with the providers to find an alternative. If the provider is adamant about nebs, we have to allow them but they're done outside of the clinic (likely in our iso room) with full PPE and then the room gets cleaned immediately after.

BrisketRN, BSN, RN · Nov 9, 2020

We're using the old art room as isolation because art is "art on a cart" this year (as well as music, library too).

No nebs for us, but that is in-line with state/city health dept guidance.

Does your health department have any guidelines? Most of our reopening plan is pulled from the state & city DOH.

I could only find NIOSH N95s, no fit test. I do a "seal check" when I put them on.

nursetlm, ADN · Nov 9, 2020

We have been in person since the beginning of September. I have an isolation room next to mine- I get to cover both. We require students to wear masks, socially distance (as much as possible) etc...

We are not allowing nebulizer treatments this year- a parent must pick up and take home to do a neb.

We have been very lucky at my K-3 school- no positive students on my side of the school. We have had quite a few staff test positive.

SchoolNurseK, BSN, RN · Nov 9, 2020

13 minutes ago, nursetlm said:

We have been in person since the beginning of September. I have an isolation room next to mine- I get to cover both. We require students to wear masks, socially distance (as much as possible) etc...

Similar setup for me. The isolation room is connected to my office so I can man both. I have HS so they don't require quite as much supervision. We've done well (no on-campus positives so far) with our mitigation efforts. It takes a lot of reminders, but they are getting it. I stand in the hall and hand sanitize between classes and I go to every lunch. During classes, I try to walk around and Lysol spray high touch surfaces. I don't always have time, but I try. Every little bit helps, I figure!

We are not doing nebs, though not too many in HS anyway.

I have a few N95's that have not been fit tested. I feel pretty confident of my fit though and I do try to limit my time with symptomatic students.

I highly recommend the Johns Hopkins contact tracing class. It is important to know what you're talking about when dealing with a parent. I feel like I've gotten my calls down to a script and overall it is going pretty well.

Good luck! Trust your nursing instincts. This is what tripped me up at first with all the decision trees and guidelines. Then I stopped and remembered I am an RN and I have 18 years worth of nursing judgment stored up. Time to use it! ?

JenTheSchoolRN, BSN, RN · Nov 10, 2020

I have N95s, but fit testing has been impossible. I am pretty confident of the fit, though, like @SchoolNurseK. I also have back-ups KN95s and surgical masks, along with goggles and shields. I will not assess a student with COVID-like symptoms without at least a surgical mask, eye protection, and goggles on. And will up the ante on PPE depending on which symptoms. I try and limit my time within less than 6 six of a symptomatic student. All symptomatic students also get their mask swapped out with a surgical mask upon entry to the isolation space.

I do have an isolation space and got to hire an extra LPN (which is a huge luxury I know many don't have). Which helps, since my isolation space in one floor above me. I actually like this as it keeps both spaces very separate. My LPN maintains and stays in the isolation space - her desk is there. I'm in my office, where all chronic care happens (diabetic checks, for example). Yes, I go back and forth between spaces, but not without proper PPE.

But I've also only had a period with high need students that lasted about 5 weeks prior to us going fully remote due to rising cases (in the community, not the school specifically). We are hoping to transition back with high needs students after Thanksgiving.

For those without guidance, here is a link to the MA guidance. It isn't perfect at all, but I'm come to realize it is actually a lot more than several states are offering:

https://www.doe.mass.edu/covid19/on-desktop.html

(This link takes you to a page with all the education guidance. One useful one is the Protocols for Responding to COVID-19 Scenarios.)

ruby_jane, BSN, RN · Nov 10, 2020

21 hours ago, SchoolNurse91 said:

I've read posts in here and feel a little better about the situation. I've tried buying N-95s, but cannot find any... We don't have a way to fit test either. So I'm not sure how that would go.

Fit testing may be overrated for us anyway (former TB nurse here and I never thought I would say it.) Check the dental supply places. They seem to be well-stocked.

Are you guys allowing neb treatments in school?

No and this has caused no end of trouble. But we're standing firm.

Best of luck.

Flare, ASN, BSN · Nov 10, 2020

I have an isolation room right next to my office. Actually, I had 2 - one for each school, but when I pointed out that I am still only one nurse for both schools, that room was quietly turned over into an extra prep and staging area for the cafeteria staff. The isolation room isn't routinely staffed. When I send a kid in, then the admins have to scramble unless it's the hours that I have my clerical aide, then she sits on the room.

No nebs here. The dept of health made the statement that if someone is that dependent on a nebulizer that an administration is expected, then they should be full virtual.