May 11 is National School Nurse day which I’m sure is noted on your calendar. As April is quickly on its way to becoming May, what is on my mind as a school nurse? Yes, of course – how many more days until the last day of school? I believe that faculty and staff are more eager for that last day to arrive than the average student. Please, prove me wrong.
But, as the end of the year approaches, what is on my mind? Unfortunately, it’s Covid. It’s always Covid. Can we get away from Covid and onto a more pleasant topic? School nursing has traditionally been comprised of equal-parts nurse, counselor, case manager, wellness advocate, health educator, and some days, a “school-mom” among others. Public health nurse has always been the unspoken part of the role, but Covid has greatly expanded that aspect of school nursing, at times, to the detriment of the other roles. How has Covid changed school nursing?
Returning to school for the 2020-2021 school year, after lockdown, was fraught with unknowns and uncertainties. I work with four school nurses in my district (we are fortunate to have one certified school nurse in each building) and we were tasked that summer with developing the re-entry plan for the district. As none of us had previously experienced a pandemic, we were grateful to have an influenza pandemic plan to use as a model to get us started. We collaborated that summer to develop the plan – would hallways be one-way, where will students eat their lunch, will temperatures be taken prior to entry into the buildings – were a few of the issues we needed to address. Never in my nursing career did it occur to me that I would have conversations to address such concerns. We worked diligently to keep up with the ever-changing best practices and hoped for the best.
Our district was “hybrid” for three quarters of that school year with all students returning to in-person learning in March of 2021. Students who chose to attend in-person that year were divided such that half of the students were in the buildings on Monday/Tuesday and the other half were in the building on Thursday/Friday. The buildings were closed on Wednesdays for “deep cleanings”. Class sizes were small with the hybrid schedule so we had maybe ten (or fewer) students in the classroom and we were able to keep the students at least six feet apart to accommodate social distancing. Athletics continued and as cases in the classrooms increased, so went athletic teams. We learned, on the fly, about contact tracing and how the state wanted positive cases reported. We were, unofficially, a branch of the health department. We were told to tell parents that the health department would follow up with them after we gave them return to school dates and gathered the requisite information. If the department of health contacted the families, they gave the same information we did. Families frequently reported that they never heard from the health department.
The amount of time spent on state reporting, and in particular with contact tracing, caused the greatest disruptions to school nursing. Students had to be quarantined for vague symptoms and had to be isolated in the school setting which was very challenging. One positive student could cause an athletic team to be quarantined as well as multiple students in their classroom and on the bus. The cafeteria was another area we had to consider when quarantining. Students who had been in close contact with the positive case had to be pulled from the classroom for immediate dismissal in the hopes that the parents would come quickly to free up a space in a holding area for another student. Teachers had to stop what they were doing to recall what happened in their classroom 3-5 days prior and consider who was where and for how long. Parents who were gracious when they were called to collect their student for the first quarantine were not so much with subsequent calls.
Parents were frustrated that their student was being quarantined for the second (or more) time, perhaps, when s/he was not even having symptoms. I understood their frustration. My son was quarantined four times that school year (ten days at a time) and his building was closed twice due to excessive positive cases. It was the new normal and we were on a ride that we all wanted to get off. Parents vented their frustration to the school nurses because we were contact tracing and the point of contact. Some recognized that we were just the messenger and we were trying to keep all students as safe as possible.
Parents notified us of positive cases at all times of the day, so we were on call at home as well. There were no boundaries. If we didn’t call the parent back from home, they would send the student to school further exposing more students. Parents called for advice. Faculty and staff texted for advice or to report their own positive cases. Again, there were no boundaries – calls, texts, and emails were received without regard for my personal time. There was no down-time.
Dealing with Covid quickly overwhelmed the school nurse’s office leaving little time for routine sick/injury visits and daily meds. It was difficult to maintain confidentiality while calling parents to quarantine their student if ill students were in the health room. Students were sent home for just about any ailment, per health department guidelines, so it truly became all Covid, all day. It was impossible for the school nurse to make 20-50 calls a day to parents (just for pick-ups), so the main office needed to help. It was not sustainable. Somehow, we school nurses prevailed, because that’s what we do.
The availability of testing and vaccines changed the course of Covid-19 in the school setting. School districts re-opened for the 2021-2022 with a mask mandate in PA and a variety of district-specific protocols. Covid this school year is very different from last year. Masks are not required in my district, but there are students who choose to wear a mask. We are not contact tracing. We are not sending students home for vague symptoms. Cases decreased. As was reported in South Africa, positive cases in my building decreased precipitously in mid-February and I’ve had 3 reported cases since then.
My school nursing practice today resembles what it was prior to the pandemic. My folder of Covid papers/procedures is still on my desk, on stand-by. I hope I won’t need to use it in the next 20 days. I do feel as though Covid is still standing behind me, skulking. I don’t know what Covid will look like in the school setting in the future, but I am still standing. School nurses are resilient – it’s what we do.
