School Nursing

The Relentless School Nurse: 91 Questions for Reopening Schools

This compelling letter is reprinted with permission by NJ School Superintendent Dr. David Aderhold.  He has posed 91 questions that must be answered to safely prepare for schools to reopen in the fall.  Dr. Aderhold shared his open letter in a Tweet to NJ Governor Phil Murphy. Here is the Tweet:

We Cannot Look in the Rearview Mirror: Preparing Our School Districts for Fall 2020

By Dr. David M. Aderhold

Superintendent of Schools, West Windsor – Plainsboro Regional School District & President of the Garden State Coalition of Schools


There are over 580 school districts, more than 2500 schools, and over 115,000 teachers serving more than 1.4 million students in New Jersey. Without clear guidance on how to prepare for the fall semester, public health will be compromised. The planning for September happens now. We cannot wait. We need clear and definitive guidance on re-entry, remaining virtual, or creating a hybrid model now. We need guidance on the amount of state aid that school districts can anticipate. The state aid numbers released in February 2020 are a fallacy based upon a different time, a pre-global pandemic time.

The public health and the health of our staff and students are paramount. If budgetary reductions are coming, we cannot wait until the end of August 2020 to make adjustments with just a week before we open schools. School Districts cannot wait until the Governor’s August 25th budget report. Actions must be taken now. Contracts are appointed now. Staff renewals have already happened.

Summer is coming. Schedules are being built and class rosters created. New student orientations and Fall athletics are upon us. While many are worried about ending the year, we cannot forget that next year’s planning happens now. There are literally hundreds of questions that must be answered in order to ensure the safety of our school communities. Without such guidance, we cannot safely reopen our schools.

Here is a list of 91 Questions to get us started:

1. Who gets to determine the acceptable risk of foreseeable harm, illness, and potentially death in our public schools should we return from virtual instruction to in-person instruction?

2. What will be the criteria and parameters to reopen schools? When will we receive a re-entry plan?

3. What will be the COVID-19 testing protocols for students, staff, visitors, etc.?

4. What will be the budgetary impacts for school districts based upon the economic challenges realized due to the public health crisis?

5. If someone in the school community tests positive for COVID-19, what will be the next required steps? Will schools need to be closed for deep cleaning? What will the requirements be for contact tracing and testing? How long will staff or students need to be quarantined?

6. If a school building or school district has a COVID-19 positive case, how long will a closure be to ensure there’s no super-spread to the community?

7. Will students and staff members be required to wear masks?

8. If schools return in the Fall 2020, will modifications be made to teaching schedules for staff members that have pressing medical needs?

9. Will accommodations be made to allow families who wish to keep their children home in the fall? Will those children be allowed to participate in virtual instruction or will they be required to withdraw their children to be homeschooled by their parents?

10. Will hybrid schedules be allowed for students and staff members?

11. Will there be modifications to our school day?

a. Virtual school days?

b. Staggered start times?

c. Class size restrictions?

d. Half-day classes?

e. One-day-on, one-day-off schedules?

f. Smaller class sizes?

g. A hybrid model, that allows parents to opt to virtual instruction while maintaining in-person instruction?

12. If modified schedules are a requirement for social distancing to be implemented, will such schedules provide parents the ability to return to work?

13. What are the contractual impacts to the myriad of possible scheduling solutions?

14. What are the financial impacts in order to implement social distancing requirements?

a. Additional busing as we will need to transport fewer students per bus?

b. Additional teachers needed for social distance classrooms?

c. Additional nursing staff?

15. Will school districts continue to offer extended daycare programs (before school and after school programs)?

16. Do school districts have the infrastructure to meet the social distancing requirements?

17. Will school districts have the funding to meet the physical modifications and additional Personal Protective Equipment (PPE) needed?

18. Will districts need to provide PPE to nurses and support staff such as gloves, masks, face shields, etc.?

19. Will districts receive funding for PPE for students, staff members, and visitors?

20. Can the supply chain accommodate the massive amounts of PPE that school districts are going to be required?

a. Ex. If required to provide one mask per day for students and staff members, my district alone will need 60,000 masks per week or 250,000 masks per month. This does not include masks for visitors or the potential need of multiple masks per student (especially at the elementary level).

b. Ex. In NJ there are 1.5 million students and teachers. If each student and teacher needs one mask a day, then NJ school districts will need to have access to 30 million masks per month or 300 million masks per school year. (If three masks are needed per day per student, then 900 million masks will be needed).

21. What equipment and supplies will be required to make schools safe? (Hand sanitizer, face masks, Personal Protective Equipment (PPE), cleaning supplies, gloves, etc.)

22. For schools and school districts without air conditioning how can you have students and staff members wear masks with certain temperature conditions?

23. What happens when students sneeze repeatedly due to allergies and sniffles when wearing masks? Do they get a new mask for each time they sneeze?

24. Since students need to eat and drink during lunch, won’t all safety protocols be violated during that time when masks must be removed for all students?

25. Will isolation rooms be needed in nursing offices for students or staff with fevers? If so, what are the specifications needed and how long will the physical modifications of these spaces take?

26. What requirements will need to be implemented for the protection of medically vulnerable students and staff?

27. Is the expectation that students and teachers will be wearing masks reasonable? Many students have sensory issues, asthma, or special needs that would make wearing a mask for extended periods of time very difficult.

28. Will modifications be needed for nebulizer treatments? Will nebulizers be allowed in schools?

29. Will there be standard health care equipment needed in schools? (Such as No Touch Thermometers)

30. Based on the new CDC guidelines, what does it mean to screen students?

31. Must we do a temperature scan prior to students boarding a school bus? If so, who is going to do this?

32. Will there be standardized screening protocols for staff and students entering school buildings? If so, who will do that?

33. Should we require a COVID-19 test for any student or staff member exhibiting symptoms?

34. Will the NJDOH establish clear protocols for the disposition of students/staff demonstrating COVD-19 symptoms? Will policies and regulations follow from the NJDOE?

35. Will we need to limit the number of students in health offices at one time? Will we need separate areas for first aid? If so, who will cover those stations, and with what certificate?

36. How do we socially distance students on our buses? Will buses run ½ empty to increase social distancing? What will the cleaning protocols on buses look like? How frequently will this need to occur?

37. How do you socially distance a bus stop?

38. Based upon the average age and the persistent shortage of bus drivers, will there be enough bus drivers available to transport all students in the fall?

39. How will school arrival look in the future?

a. Will students be permitted to enter the building to mass holding areas as currently done prior to the pandemic in most schools?

b. Will schools need to conduct temperature checks at school entrance ways?

● How many staff members will be needed to accomplish this?

40. What will music classrooms look like in the Fall 2020?

a. Spit valves on brass instruments?

b. Choir classrooms with vapor particles? 

c. What does band class look like?

d. What about concerts?

41. How do you socially distance physical education classes?

a. How do you socially distance locker rooms for gym classrooms?

42. Based upon the guidance of the National Federation of State High School Associations’ guidance from the Sports Medical Council, how can we safely open athletics in the Fall 2020?

43. What does socially distanced contact sports (such as football, wrestling, boy’s lacrosse, competitive cheer, or dance) look like?

44. How will school districts assess education gaps and remediate learning needs?

45. What are the building facility cleaning protocols that need to be followed?

46. Will students have recess in the future? How frequently will schools need to clean the recess equipment?

47. What protocols will be required for athletic facilities to be maintained and cleaned due to the coronavirus (including surface areas, turf fields, sports equipment, etc.)?

48. How frequently will school equipment need to be sterilized? What guidelines will be utilized? What industry standards will be used?

49. Will there be enhanced cleaning protocols for school buses? If so, based upon what criteria and to what specifications?

50. Will limitations be placed on the number of students that can use bathroom facilities at one time? Will enhanced cleaning protocols be required?

51. Will COVID-19 increase the needs for additional custodial staffing, nursing, security staff, etc.?

52. How will fire drills work in a time of social distancing?

53. Will any changes be required as we implement school district lockdown or evacuation plans?

54. What revisions will be necessary to modify emergency plans, shelter in place, evacuation, etc.?

55. What will cafeterias look like in the Fall 2020? How will students pick up and receive meals? Will lunch lines need to be socially distanced? If cafeterias are not used, will meals be served in classroom desks? If in classrooms, there will be coverage concerns as there are not enough lunch aides to cover all classrooms.

56. What changes will be required for food preparation locations to ensure health and safety?

57. What will the socially distancing guidelines look like in schools? How many feet between students will be required?

58. How will we socially distance during passing periods (in hallways)?

59. How will middle school and high school students report to lockers with social distancing requirements?

60. Will school districts allow or be allowed to offer extra-curricular activities that require mass gatherings to occur during the 2020 – 2021 school year (indoor track tournaments, robotic tournaments, school musicals/plays, field trips, basketball tournaments)?

61. Will guest speakers be allowed in the future?

62. What protocols will visitors need to go through? Will school nurses be responsible to take the temperature of every visitor to a school? If so, how is that even remotely possible without a massive increase in medical personnel in schools?

63. How will schools govern the entrance and exiting of buildings and the movement throughout school buildings?

64. What physical modifications will be needed to reopen schools? When will those guidelines be released? Will funding follow?

65. Will there be staffing reductions as a result of changes in state aid payments?

66. What liability will school districts have should students, staff, or visitors become ill due to COVID-19 outbreak that is traced back to a school district? What will be the impact on liability insurance? Ultimately, such decisions will come at taxpayer expense.

67. As the fall brings illnesses such as the flu, respiratory infections, and whooping cough, will modifications be required to medical exclusion policies?

68. Will there be a standard return to school policies and procedures for students and staff who are presumed positive or diagnosed with COVID-19?

69. How will the implementation of IEP’s for Special Education students be met in a virtual, hybrid, or partial day academic program? a. What is the state’s guidance for Extended School Year programs for students who receive Special Education services?

70. Many special needs students, students that need assistance with toileting, or wheelchair-bound students require hands-on assistance. How can a staff member safely assist these students without creating mutual risk?

71. Will union/association contracts need to be reopened to seek modifications to provide for flexibility in implementation for varied school schedules?

72. With decreasing funding, school districts will need to prioritize equitable access to resources for all students. What will school districts’ responsibilities be for providing internet access and devices? Will legislative actions be taken to ensure that all students are connected?

73. How will districts provide for mental health supports that may be needed for both students and staff that have experienced trauma due to the loss of family members, isolation, suicidal ideations, food insecurity, loss of income, loss of housing, etc.?

74. What professional development needs will school districts have in order to assist their teacher’s enhancement of virtual instructional practices?

75. How will we meet the needs of our rising seniors with their post-secondary planning? How will the college application process change?

76. What protocols will be required for construction projects during the continued pandemic?

77. Will school facilities be reopened to public use on evenings and weekends? If so, what safety requirements will need to be put in place?

78. With the purchase of mass amounts of technology during the 2019 – 2020 school year, how will the future replacement of devices be handled without huge infusions of funding? (Operation systems go unsupported on four-year cycles which render Chromebooks virtually useless.)

79. The utilization of devices is only one component of technological costs. Increased servers, cloud storage, security, technological staff, web monitoring security, web-based instructional programs, and hot spots have all been needed. Will school districts be allowed to exceed the 2% budgetary cap for the infusion of technology purchases in subsequent budgets?

80. How will we assess which students need academic support and remediation?

81. How will school districts address the digital divide that still exists months into the pandemic?

82. Will education look fundamentally different post-pandemic or will school systems revert to prior structures?

83. We can safely assume that there will be some parents that will refuse to send their students to school in the fall. As such, will districts be allowed by the state to run both in-school and remote programs? If so, there are budgetary, contractual, legal, policy, and staffing considerations that demand time and attention to think through now.

84. What legislative and regulatory changes will occur that impact the transition from 2019 – 2020 school year to 2020 – 2021?

85. What strategies will need to be employed for the fall to assist teachers in building culture and classroom routines in a virtual environment with students they have not met?

86. Will modifications for evaluations of certificated staff members continue into the 2020 – 2021 school year?

87. How will school districts assess, grade, and provide feedback to students during an extended closure?

88. What will virtual professional development look like for new teacher orientation?

89. Will there be antibody testing available for staff members and students? If so, who will administer such testing? What are the implications for HIPAA and confidentiality rights?

90. How will we teach programs that require hands-on interactions in close proximity, such as Robotics, Woodworking, Culinary Arts, and Fashion Design?

91. New Jersey’s guidelines state a “substantial increase in testing capacity” is needed before reopening measures move further. What does this mean in relation to schools?

Bio: Dr. David Aderhold is the chief school administrator of West Windsor-Plainsboro School District in New Jersey and was named the 2019 Mercer County Superintendent of the Year in June by the Mercer County Association of School Administrators (MCASA).

Dr. Aderhold serves as president of the Garden State Coalition of Schools and the New Jersey Network of Superintendents and serves on several other task forces and committees throughout New Jersey.

7 thoughts on “The Relentless School Nurse: 91 Questions for Reopening Schools”

  1. Thank you for sharing these valuable questions with us. These questions were essential to contributing to a return to school plan in my district. Thank you, Robin and Thank you, Dr. Aderhold.

  2. I appreciate the attention to students with special needs. One group of students with special needs, those with life threatening food allergies, have parents accustomed to making life or death decisions with respect to group participation, including food service. Moving cafeteria dining to classrooms presents issues for students who move from class to class. As a parent, one of the reasons I felt we had no choice, but to leave our top 150 public high school (nationally) is that warm chocolate chip cookies with nuts were served as a morning snack at the desk. I did not want my child to be known as the one who took away the chocolate chip cookies. Please consult this group of uniquely qualified parents when changing food service. The protections for kids in all categories of special needs are hard won in the last few decades and more; now that every parent has joined this club, we want to again be part of the solution and not be perceived as part of the problem, or an after thought. Our children may be unable to attend school in person. For years. Disability law applies And we will be at the front of the line for equal on line instruction. But let us be involved from the beginning in how to make schools safe. Even if our own kids won’t be walking through the doors this fall.

  3. I have 30yrs of nursing experience (eighteen of those as a school nurse) and this is likely one of the most difficult challenges I have had to face. Thank you for helping us to heighten public awareness for the tremendous amount of challenges we are facing. The extreme degree of responsibility & liability that will be thrust upon us in schools due to the degree of ambiguity that still surrounds this virus, makes it virtually impossible to return safely. Maintaining the most optimal level of health and safety for our students has always been our number one priority. The expectation that we should be able to adhere to all of the CDC directives and continue the same standard of care is laughable. After working day and night on a school plan for one week, I have only just started page 10! I have to continually revisit information and revise protocol according to whatever incident it is that pops into my head causing me to change whatever I “thought” might work ennitially. The CDC recommendations for return are numerous and amount to nothing more than a collection of great ideas with no method for implementation. They explode with ambiguity and do not take into account the school incidents that occur within minutes or even seconds yet may impact an individual’s health forever. I want us all to return as soon as possible but they just can’t have it both ways. If the element of risk remains heightened to the degree that so many directives are necessary, It seems incredibly unfair that school staff members should be forced into accepting this level of responsibility along with the guilt that will follow if failing to protect a child.
    Eileen Cosenzo BA, RN, CSN

    1. Thank you for this important message, Eileen! You have captured what many of us are experiencing and I appreciate you sharing your reflections.

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