Lisa Kern is at the center of her Florida county school district’s response to COVID19. In this guest blog, she generously shares her recommendations for school nurses to create an informed response to meeting the needs of their students, staff, and school communities during distance learning. We are physically separated but socially connected. Lisa’s well-designed plan maps out actionable steps for a productive virtual health office based on several of the principles of the National Association of School Nurse’s (NASN) Framework for 21st Century School Nursing Practice™. (pictured below)
Thank you, Lisa, for your leadership, generosity, and always being an edge runner in school nursing practice. You use your expertise, skills, and talents to amplify the best of school nursing and I am honored to call you a friend.
Before COVID-19 became a pandemic and schools closed their brick and mortar buildings across the state of Florida in mid-March, educators began to develop their new virtual reality. Our district recognized that students and families would still need support from Specialized Instructional Support Personnel but what would this support look like? I’m sure you are familiar with the expression “building the plane as you fly”? This phrase captures a feeling of risk associated with developing innovative practices and testing them in real-time while still functioning. That’s what we do!
Being a member of NASN, a past Director and a Supervisor with some experience (lived through H1N1), I turned to the NASN Framework for some guidance. Two days before we closed our doors for spring break, I traveled to another part of the state for required training. I left the initial task of fleshing out the school nurses’ role in a pandemic, to two school nurses that I have great respect for – Kelley Huelle mental health liaison and Amy Ponce, district support. They developed the original document from a task-oriented standpoint and over Spring break and the following week, after input from our School Nurse Leadership team we launched our School Nurse Roles and Procedures during Distance Learning (DL).
Care Coordination Role: This role focuses on the coordination of services, advocacy, planning, and monitoring of students and families through acute and/or chronic health problems. These activities involve the assessment of the nursing/health care needs of all students, the development/implementation/evaluation of outcomes of Individualized Healthcare Plans (IHP) and Emergency Care Plans (ECP). School nurses will partner with students, family members, faculty and staff members, and health care providers to provide assistance with issues that hinder the student’s ability to engage in DL.
The school nurse will continue support to families of students with Chronic Health Conditions (CHC) by providing continuity of care during this time of transition to DL in the following manner:
Create a Google Voice account and share this number with teachers, district, administration, and other student services colleagues so it can be shared with families who need support.
- Set up a schedule to check in with high- or at-risk students/families on a regular basis
- Convene or participate in collaborative meetings with families and school teams remotely (we use Zoom) on a regular basis to determine the best approach to meet students’ needs in the DL environment. Provide appropriate resources and guidance for families, school staff, administration regarding health or medical needs/concerns.
- Consider setting up school nurse office hours virtually for students or staff (also using ZOOM).
- Consider the impact of Social Determinants of Health (SDoH) and identify resources that will support the whole child; do not focus solely on the medical needs of student/family. Behavioral health and family/social supports will have a huge impact on student’s physical health so focus on access to care, insurance, transportation, housing, food sources. Consult with the social worker as needed to supplement appropriate resources. Although working remotely, be aware of domestic violence and child welfare concerns and follow appropriate procedures (keep numbers handy).
- Collaborate with student/family and healthcare providers of medically fragile students to ensure medical needs are being met at home while schools are closed and provide guidance in preparation for re-entry to school. Be sure to contact regularly for updates.
- Document interventions daily in Electronic Health Record (EHR). This system can now be accessed from home.
- Review existing IHP, ECP, and Special Needs Reports. Contact parents and providers to update as necessary.
- Review records of students with CHCs who may need 504 protections or accommodations and address outstanding concerns.
Interdisciplinary Teams: School teams will work remotely and collaboratively through Zoom. The ability to use videoconferencing software to schedule meetings may be the best option for some parents — as long as the technology works on both ends and everyone has an opportunity to meaningfully participate. Alternate options will be to connect with parents by phone.
- Refer to detailed DL 504, IEP and Hospital Homebound procedures
- Participate in conference calls on a regular basis
- Weekly ZOOM calls with school teams, discipline-specific groups (school nurses meet every Wednesday afternoon!) and new school nurses (intended to provide an additional layer of support).
Community/Public Health Role: The school nurse assists school districts with infectious disease prevention programs by focusing on the promotion of vaccines, emphasizing the use of nonpharmacological intervention (NPI) measures such as staying home when sick, hand hygiene, etc. and educating school staff, parents, and the community on how to contain, manage and prevent further spread of communicable diseases.
Disease prevention/Risk reduction: Remotely monitor students/families with suspect or confirmed COVID-19, including assisting the Florida Department of Health (FDOH) with contact tracing requests.
- Coordinate and collaborate with FDOH liaison regularly to report concerns.
- Maintain careful records in preparation for schools reopening.
- Provide testing and vaccine information as it becomes available.
- Provide parents with accurate information about COVID-19 prevention and home management measures. Examples of resources:
- CDC – Talking with Children
- Hesperian Health Guides – Coronavirus (English); Coronavirus (Spanish)
- NASP/NASN handout – Talking with Children
- How to isolate and quarantine in close quarters: https://hub.jhu.edu/2020/03/23/how-to-self-quarantine-self-isolate/
- Support for families during long days of COVID: Action for Healthy Kids Resources
Collaborate with the school team, especially school social worker and counselor to monitor for student absence on a weekly basis; especially those with CHC, special needs, etc. Consider the impact of SDoH on attendance concerns (lack of access to health care, housing, food, etc.) and provide support as appropriate. Provide guidance to teachers, staff, students, and families on prevention measures related to pandemic. Some ideas: offer to be a guest speaker in the learning setting. Use your imagination to generate other ideas and share them with peers.
- Consider using this NASN resource if you are intending to teach students or families about COVID19. Provide accurate information, appropriate to developmental level, presented so as to not increase levels of stress or anxiety.
- Add school nurse wellness messages to be shared via your school’s social media platforms.
- Work on the development of mini training for school staff intended to prepare them for safe health actions to take when school reopens.
- Stay up to date on all CDC recommendations and information regularly.
- Dispel rumors and myths as soon as possible.
Leadership Role: School nurses are front line health care providers, serving as the bridge between the health care and education systems. School nurses engage school communities, parents, and healthcare providers to promote wellness and improve health outcomes for children. For many children living in or near poverty, the school nurse may be the only health care professional they have access to. School nurses will need to maintain their professional/ethical practice during DL by:
- Participating in professional development as available and as appropriate– online webinars, conferences, and chats.
- Checking and responding to all emails and Zoom invites daily.
- When participating in virtual meetings, being sure to adhere to acceptable work attire guidelines especially when parents or community partners are in attendance for these meetings. Consider keeping a shirt with a school logo handy and be sure to think about factors such as background noise and location when determining appropriate workspace from home.
- Collaborating with Administration on preparation/ procedures for reopening of schools should/when this occurs utilizing district guidelines (Under development!).
- Volunteering to participate in school nurse workgroups focused on updating manuals, forms, etc.
To-Do List:
- Set up daily/weekly checklists to follow while working from home
- Create daily office hours when you can be available for remote consultation with students, staff, families
- Complete end-of-year checklist including data reporting to the best of your ability
- When access to providers becomes more accessible to families, begin follow up work on outstanding vision, hearing, BMI and scoliosis referrals
- Document, document, document! You are able to access EHR from home now!
- Review/update condition lists, health records
- Complete immunization review for the remainder of the year and next school year, including 7th-grade Tdap requirement and incoming KG students
- Collaborate with the Mental Health Team as necessary. Work collaboratively with School-Based Student Services Team to follow protocols for safety plan development, threat to self/others, bullying, and other student/family mental health needs.
Bio: Lisa Kern, MSN, RN, NCSN, Currently the Supervisor for Health Services for Pasco County Schools, Lisa serves 75,000+ students across 84 schools. School nurses in Pasco have 2 – 3 schools with full-time clinic assistants in each school as well as LPNs that provide care for medically fragile students at several locations.
Lisa has been in the Florida education system for close to 30 years, working as a school nurse for 15 years, and has retained national school nurse certification (NCSN) since 2002. She has been a member of the NASN and the Florida affiliate for approximately 10 years. She served as FASN secretary and is just completed her 4-year terms as Florida’s NASN Director.
Lisa participates in state-level committees and coalitions to support an integrated student services model which includes school nursing as a significant partner in the collaborative problem-solving process. She has presented at state health conferences and has been a SETT program trainer for NASN.
Lisa has been a registered nurse since 1984. She is a proud graduate of Fordham University, the College of New Rochelle, NY and Walden University. Previous nursing experience included practical nursing and CNA instructor, and oncology/medical-surgical nursing.
