School nurses facing a pandemic head-on

allnurses recently spoke with a school nurses as she prepared for the 2020-21 school year. Along with concerns are messages of hope and encouragement from a sometimes overlooked healthcare professional.

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School nurses facing a pandemic head-on

With schools across the country already open or opening soon, there has been plenty of hand-wringing regarding what is safest for students. Educators, school leadership, and school boards are all weighing in on what they feel will work best in the middle of a global pandemic. What many forget, though, is that school districts have medical professionals on staff. Yes, the often overlooked school nurses. I recently took some time to visit in a socially distanced format with a school nurse who was willing to give us some insights and advice for the 2020-21 school year. In my conversation with Emme, she shared her past challenges and future concerns in the midst of a pandemic. Here’s what she had to say...

Let’s get started getting to know you, Emme. Tell our readers a bit about yourself, how long you have been a nurse, why you chose to become a school nurse, and how many students are in your building or buildings?

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EMME: Sounds good!

I have been an RN for about 8 years now. I started out as a medical assistant in pediatrics for about 10 years then once I was an RN I worked in emergency trauma at a level 2 trauma center. I also changed to labor & delivery nursing for about two years overlapping the school nursing. I have been a school nurse for going into my 4th year now - I was attracted to the day shift hours, the pediatric angle and found that it was definitely my calling as a nurse! I am currently working for a large district with 214 schools and around 300 school nurses. I work in a K-5 elementary with approximately 600 kids.

allnurses: With four years of experience as a school nurse and eight years as a RN, I’m sure that you have experienced plenty. How did the closure of schools earlier this year affect both you and the students you interact with on a daily basis?

E: Interestingly, my school had a rough year this past year - we had construction in the building to update classrooms and asbestos turned up. My school ended up closed for two weeks at the end of February and then we were relocated to another building for a few days before we were allowed back in. The kids missed almost 2 full weeks of instruction, then we were back to normal for about 2 weeks then we closed again.

While we were off school before they made the decision to close indefinitely I had no interaction with the students and no instructions. I felt terrible about that and kind of useless so I went ahead and made my own Google Classroom to communicate and began using ClassDojo to communicate with the parents. I started making videos (only made two) to share with them about safety, such as how to wear masks and a little germs experiment, just so they could see my face. The big kids seemed to like it!

I posted to my Google Classroom daily with things like yoga classes From Youtube, meditation for kids from Youtube just to help them take a breather and relax, and I found a great fitness coach who posted PE class every day! Plus I found lots of health education stuff online that I posted. None of the K-2 kids logged on to my stuff but the 3-5 kids did!

I also had “office hours” that the students and parents could contact me if they needed to but no one did. During that time I also attempted to contact all my parents of kids with health issues or any concerns on my part to check in and make sure they were OK and didn’t have any questions. Most I was not able to get in contact with, sadly.

AN: WOW! That definitely sounds like you and your school had more than their fair share of challenges even before COVID-19 struck. How have you, as a school nurse, been preparing for the upcoming school year? If your school district has announced adjustments for the 2020-21 school year, what type of adjustments have been made?

E: At the moment my preparation has been mostly educating myself and trying to keep up with the changing rules and news, trying to organize and plan out how I will change my practice for the coming year, and collect questions that I have for my supervisors. I’ve attended several webinars, and started collecting or making flow sheets and info sheets to share with staff to keep everyone informed.

We are still awaiting directives from the district as far as in person vs virtual opening, and awaiting a zoom meeting with the nursing supervisors to go over details and further info. Unfortunately at this point we are getting very close to starting the new year and very few decisions have been made (or at least communicated with the nurses and staff).

Presently, the plan on the table is a hybrid 2 days in school and 3 days virtual divided into two groups. This plan is being contested by the union and the parents and staff network and awaiting a second board meeting to approve or decline it. Other adjustments include masks for everyone all day in school, desks 6 feet apart, lunches in the classrooms, ramped up cleaning protocols, and temp checks at home before coming to school - no temps at the door of the building as it isn’t a feasible procedure or a realistic measure of COVID specifically. Specifics of all of these things are unknown at this time to me.

AN: It seems that many of the decisions regarding in-person vs. virtual or distance learning or a hybrid model of the two are still very much up in the air in many school districts. Have you or your fellow school nurses been attempting to procure PPE? If so, what types of PPE are you and your peers planning on using, and is it being provided by the school district or by other means?

E: PPE is to be provided by the district at this time. I am providing my own cloth face masks, face shields, and N95 masks just to be safe and ensure that I have it, and also I will wear a lab coat over scrubs. The district has stated that they will provide disposable face masks and face shields for the students and staff or they are welcome to provide their own if desired. As far as other PPE like disposable gowns or N95’s for mon medical staff I am not sure yet. I will have to order my gloves and other supplies not provided for me once we start back to the buildings and have our budgets prepared to order supplies.

AN: With PPE seemingly in place for the upcoming school year, what are your areas of concern both for school nurses, other school staff, and students?

E: Oh boy, that’s a big one. I’ll try to narrow it down.

1. Special needs kids, autism support kids, and medically disabled kids will have a very hard time if we reopen schools but also if we don’t reopen. If we do reopen these children are mostly unable to manage wearing masks, distancing, or even basic hygiene this putting staff and each other at risk.

2. Many of our buildings are not physically upgraded enough to manage the requirements for adequate ventilation, cleaning, or distancing. Mine personally has no air conditioning and many windows that do not open. We are supposed to have a separate isolation area for students and staff but mine and many others do not have an adequate room available. Mine and many others are currently under construction for upgrades but not the ones needed.

3. Unfortunately, we have many families that will not comply with the rules put forth such as checking temperatures at home, keeping kids at home if they are sick or honestly reporting. School nurses everywhere share the issue of parents who don’t answer the phone when you call them or not picking the kids up or giving them Motrin and sending them to school.

4. On the flip side, if we don’t open and do all virtual we have the issue of special needs students suffering from not having face to face education, students who may come from abusive or neglectful homes not being seen or helped, many many without adequate internet to do virtual learning, and many parents that have to go to work and can’t leave little ones home. Many children will suffer.

5. There is plenty of staff (and students and families) who are older and more at risk or have family members who have risk factors. Going into the buildings for them is potentially a death sentence for their families.

6. We nurses specifically are all quite anxious as we are still waiting for directives from our supervisors. It seems like it’s going to be a very big job and we are not ready! Plus many are also at risk for illness or death as well if they have to go into the buildings and are exposed.

AN: Do you have any words of advice for school nurses, parents, or school-age children who may be reading this?

E: For the nurses: be flexible, be patient, and do the best you can in the situation we are stuck in. It’s confusing and different but we’ve been through worse (if you got through nursing school you’ll get through this too!)

For the parents: we are here for you and your families. No matter how this craziness plays out the primary goal is safety for your kids and getting them the safest education possible. Don’t be afraid to ask for help or ask questions.

For the students: do the work!! If you’re all virtual or hybrid or even going back full time you still have to put in the work. Listen to the rules, wear your masks, wash your hands, pay attention to the distancing rules and things will be normal eventually. This is all temporary. If you feel anxious or worried or feel like you need to reach out then don’t be afraid to say something.

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Brian S.

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Thank you to the school nurses out there! As a nurse myself, I appreciate nurses who can fulfill the nursing positions that aren't the greatest fit for myself -- we all have our strengths and weaknesses. Everyone has their role.

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