What will school nursing look like after this pandemic?

[MHDNURSE]

Had a zoom school nursing meeting this morning and we were talking about many things that might change when we are finally back in school- from new fever protocols, isolation rooms for kids, not allowing teachers to randomly send kids down to us if they think they might have a fever, etc. Curious what your thoughts are and also what protocols have already changed.

[KeeperOfTheIceRN, ADN]

No changes as of yet, but I am anticipating a very busy Summer to establish just that. New protocols. New policies. New screening of sick kids. All of it. I think we're about to become very popular and it wouldn't surprise me to see an increase in the number of school nurses in schools because of this. Like OldDude use to say, we're not valued until something major happens. Well, it doesn't get much more major than what we have now.

But this is just my opinion ?

[tining, BSN, RN]

Hopefully the parents that we have told to not send their students to school with fever really get it now. I have told one parent 4 (FOUR) times in 2 years, after catching student with fever, to not send to school because of this very thing.

THIS IS A PEDIATRICIAN I TOLD THIS TOO & HER DENTIST HUSBAND.

[k1p1ssk, BSN, RN]

17 hours ago, tining said:

Hopefully the parents that we have told to not send their students to school with fever really get it now. I have told one parent 4 (FOUR) times in 2 years, after catching student with fever, to not send to school because of this very thing.

THIS IS A PEDIATRICIAN I TOLD THIS TOO & HER DENTIST HUSBAND.

Doesn't it always seem to be the parents with the most demanding jobs? Like, don't have kids if it is going to be too inconvenient for you to take a few days off of work to care for them AS THEIR PARENTS. On top of that, they MUST make enough money to have an on-call caretaker. I mean, c'mon... They must be making close to 300-500k or more per year collectively.

[Flare, ASN, BSN]

so a few thoughts occur to me as I put my mind into the gear of planning reopening. Maybe some of these talking points can help us all. Feel free to add yours: (bear with me - this is a bit of a stream of consciousness list)

• Students should not present if they've had a fever, sob, cough, other s/s consistent with covid.
  • Concerns: student being sent in medicated or told not to report.
  • "no thermometer" available at student homes. (Apply for Kinsa? Will that even be available...)
  • Students being sent home and reporting the next day anyhow.
    • This becomes a game of chase and yet another dimension of added duty. Granted, yes this has happened before all of this, but given the financial strain people are feeling, I anticipate this will happen more
  • PArents should update emergency pickup contacts AND also medical info to most current, recent.
• Student / staff presenting in office with s/s consistent while in school.
  • Isolation would have to be instituted
    • Nurse and office become unavailable
      • Students coming down for routine temp checks, no s/s a concern
      • Students coming into office for simple discomfort measures (dry skin, invisible cuts, headache they've had for a week, stuffy nose...etc.)
  • Positive case??
    • Nurse has to be out for 14 day??
      • other contacts too??
• Students being sent down - call the office first?
  • Pro - ensures that office is available for vists
  • Con - nearly constant phone calls detracting from student care
• Resurgence in fall?
  • s/s being confused with s/s of flu, bronchitis, allergies, etc.
• Masks??
  • NJ Gov mentioned he's considering having students wear masks
    • compliance issues
    • taking off to eat, drink
    • pre-k and sped kids in masks
  • limited supply of surgical masks in health office if intention is to mask symptomatic individuals
    • Getting more supplies is difficult, takes a long time to deliver, expensive.
  • School nurse will most likely need to wear masks throughout the day. n-95??
• Testing for covid in schools:
  • availability
  • feasibility
  • MD order
  • training
    • If not testing in house, should notifying school nurse be done when health dept receives pos test report.
• Communication with local health dept and OEM ongoing to report cases.

This NPR article is interesting:

https://www.npr.org/2020/04/24/842528906/what-it-might-look-like-to-safely-reopen-schools

I am wondering about setting up mobile hand washing stations (like they have at outdoor festivals for example) at the entrances to every school.

I think about my school district which is a large, urban district and there just is no way to decrease class sizes- there just are not enough classrooms. I guess if they get rid of all common areas and put up walls to make classrooms maybe, but even then I just do not think we can do it.

[kellbell23, BSN, MSN]

I started working as a school nurse at an international school in Thailand in January?. Before campus closed, we were checking temperatures and sanitizing hands of all staff and students each morning. We may start doing this before lunch when we reopen. We're also looking into spreading out desks & changing up lunch procedures. Administration is looking to me for ways to safely reopen but I don't know how to keep kindergartners 6 feet apart!

[BooBooCrew, BSN, RN]

I just read this article and thought they had some really good points.

https://www.npr.org/2020/04/24/842528906/what-it-might-look-like-to-safely-reopen-schools

One more...

https://www.usnews.com/news/education-news/articles/2020-05-08/how-school-will-change-when-kids-return-to-classrooms

[ruby_jane, BSN, RN]

The majority of students will be asymptomatic (per my local Children's Hospital).

The majority won't be febrile when they arrive at school (and we know this is true because we survive flu season every year).

We need to decide if the student is febrile, whether we'll require a 72-hour stay home versus 24, or will require a doctor's note.

Finally - the trach suctioning and nebulizing that's been routinely done in clinics and even classrooms - those are now a high risk procedure. How do we do those? Do we have to offer students who need these procedures homebound education for this year or part of this year because we do not have a negative pressure room or even enough PPE to do this safely?

That last one keeps me up at night.

[Flare, ASN, BSN]

18 hours ago, ruby_jane said:

The majority of students will be asymptomatic (per my local Children's Hospital).

The majority won't be febrile when they arrive at school (and we know this is true because we survive flu season every year).

We need to decide if the student is febrile, whether we'll require a 72-hour stay home versus 24, or will require a doctor's note.

Finally - the trach suctioning and nebulizing that's been routinely done in clinics and even classrooms - those are now a high risk procedure. How do we do those? Do we have to offer students who need these procedures homebound education for this year or part of this year because we do not have a negative pressure room or even enough PPE to do this safely?

That last one keeps me up at night.

Oh lord! I didn't even think about those procedures yet! Thank god for my virtual co-workers!! I'm going to update the list (posted above, but expounded upon) that I shared with the "re-opening team"

[ruby_jane, BSN, RN]

2 hours ago, Flare said:

Oh lord! I didn't even think about those procedures yet! Thank god for my virtual co-workers!! I'm going to update the list (posted above, but expounded upon) that I shared with the "re-opening team"

I didn't think about the consequences of a nurse having to stay out for 14 days post-exposure either so YAY for the HIVE BRAIN.

[Flare, ASN, BSN]

Here's the updated version of my growing list of concerns and thoughts:

(hope this works)

https://docs.Google.com/document/d/1vhvZTY9uChnUTfm2jNDXIFDLk3UwkRf25yv-AMZLD48/edit?usp=sharing