School Nursing

The Relentless School Nurse: 182 Questions to Answer Before Schools Reopen

Superintendent Dr. David Aderhold

Dr. David Aderhold is back with another 91 Questions that must be answered before school re-opens. The original questions have prompted more even more questions.  There are now 182!

The Next 91: Questions 92 – 182

By Dr. David M. Aderhold, Superintendent of Schools, West Windsor – Plainsboro Regional  School District and President of the Garden State Coalition of Schools

The first 91 questions have only generated more questions for our school community.  Based upon received feedback, it is clear that the education community is craving guidance so that we can properly plan for re-entry.  Superintendents across the state do not anticipate a traditional school opening for the Fall of 2020.  Time, money, modifications, safety measures, and public health guidelines will all be required to ensure the safety of staff and students.  Critical to the success of any future re-entry will be ensuring staff training and support that will be a critical component of 2020-21 planning.  The specific focus must be on the following areas:

  • Staff and student health, wellness, safety measures, and procedural adjustments.
  • Additional staff training and support to further enhance best practices for online, distance-learning practices for synchronous instruction and virtual student engagement.
  • An increase in support for mental health, trauma-informed care, mindfulness, and social-emotional supports to assist students in readjusting to impacts from the public health-related school closure.
  • Physical modifications of our schools to ensure physical distancing requirements.

92. Will school districts be required to track health metrics of COVID positive or suspected cases and report them to a public health authority?

93. Will school districts be required to utilize containment strategies such as increased testing, isolation and quarantine, and contact tracing?

94. While school districts are required to provide daily or weekly health screenings on students and staff members:

               a. Will there be PPE supply inventory to conduct such                                             screenings?

                b. Will the Department of Education purchase the supply                                        inventories?

                c. Will purchasing cooperatives be established to ensure the bulk                        purchasing of equipment?

   95. Will additional medical personnel be needed to enact any such medical              plans that will be required?

  1. What medical tracking will be done over the summer to monitor the cases in each community before schools open?
  2. Will school districts continue to maintain food distribution to support our students throughout the summer? Who will fund this? Who will staff this as food service vendors do not currently work over the summer
  3. Will programs such as school based youth services, guidance counseling services, or other mental health services be available to students over the summer? Will there be funding?
  4. How do we address families that are asking to repeat a grade level?
  1. How will Speech Therapists deliver services if students cannot see their mouths? Will we need to provide clear masks to certain employees? If so, what other professionals will need such masks?  World Language?  ESL/ELL?
  2. How will Occupational Therapists provide socially distanced therapeutic services?
  3. How does an athletic trainer handle injuries, such as taping a student’s ankle, without violating social distancing requirements?
  4. If school districts must conduct capacity analysis of facilities, what is the square footage allowed for COVID-19 per child?
  5. Based upon a USA Today survey, 20% of teachers say they will not return in the Fall due to concerns over COVID-19.
    1. How will we staff our schools?
    2. With fewer teachers, what will be the impact on scheduling?
  6. Will school districts have difficulties finding substitutes upon return to school re-entry? Substitute teachers are part-time per diem employees. How do we ensure that they do not present a risk to the school community, especially since they work between schools and across school districts?
  7. How will we ensure a robust supply of substitute teachers to replace teachers either sick themselves, quarantining in place, or tending to sick family members?
  8. What accommodations will we need to make to support medically compromised staff and/or their family members?
  9. What legislative or regulatory changes are going to need to be made in advance so that we can ensure maximum flexibility in adjusting to remote learning or in-person environments for Fall 2020? If waived by Executive Order, the NJDOE will need to provide guidance for school districts as each change impacts BOE Policy/Regulation and may affect employee contracts.
    1. Class size
    2. Length of Day
    3. Fire Code
    4. Security and Safety
    5. Facility
    6. Transportation
    7. Special Education
    8. Medical Exclusion
    9. Attendance
    10. Registration
    11. Instructional
    12. Licensure
    13. Budget
    14. State Testing
    15. Teacher and Administrative Evaluation
    16. ESL/ELL
    17. Athletics
    18. Certification
    19. Graduation and high school credit requirements
  10. How is it possible that in 2020, New Jersey has over 75,000 students that do not have access to an internet connection? What is being done to address such inequities? Will legislative action be needed?
  11. Can parents opt their children into virtual learning?
  12. If a student enrolls in a virtual learning experience, will the student be eligible for co-curricular and athletic activities?
  13. If a hybrid instructional model is allowed, how will it be defined?
    1. Will we implement alternative day schedules (in-school, virtual) based on health department guidelines?
    2. Depending on social distancing requirements, will building plans need to serve students who require in-person instruction and supports?
  14. What happens to clubs and activities? Will they be virtual? 
  15. If athletic programs must be postponed or canceled, do we need to invest in e-sport leagues for our students? How do we fund them in a time of fiscal constraint?
  16. What happens to large ensemble gatherings such as band, orchestra, and choir?
  17. How will classroom music equipment be shared in the future?
  18. Will choir and general music teachers be allowed to have students utilize risers?
  19. Will students be required to sing with masks?
  20. How will socially distanced science labs work?
  21. Will we need to provide specialty masks for staff members and students with hearing aids and cochlear implants?
  22. Will specialty air filters be needed for HVAC systems?
  23. Will PTA/PTSA/PTO meetings be allowed to occur in person or will they be virtual?
  24. What happens to book fairs?
  25. What happens to AM/PM childcare?
  26. The National Federation of High School Sports Associations Sports Medicine Advisory Committee released a document entitled, “Guidance for Opening Up High School Athletics and Activities.” Based upon that guidance, how will sports return in the Fall 2020, when the Sports Medicine Advisory Committee that provides guidance to athletic associations across the nation state that there is to be no shared equipment, no more than 10 athletes on a field at any time, and no handing off/pitching/passing/catching a shared ball? 
  27. How are we assisting staff members that are experiencing “empathy fatigue”?
  28. What guidance do we need to provide for our librarians about the checkout and return procedures for books?
  29. What happens to library lessons in PK-5 classrooms?
  30. What does “circle time” or “morning meeting” look like in a socially distanced elementary classroom?
  31. Essentially, how do you create connections when you are forced to disconnect?
  32. How do we address the social and emotional impacts of promoting structures that force social isolation and social distancing?
  33. How can we leverage the voice of our classroom or instructional aides to provide greater supports to our students?
  34. Will additional technological resources and platforms be provided through state or federal departments of education that can serve as a digital learning resource for school districts and families?
  35. Will online e-books and e-libraries be made available for summer and fall reading programs?
  36. In secondary schools, would teachers move from class-to-class instead of the students? How would this work with the variety of elective and course sequences?
  37. What does physical restraint look like when there are physical altercations or aggressions?
  38. What does redirection in a socially distanced Pre-K autism classroom look like?
  39. How will school districts address concerns for young students that simply have “an accident” during the school day?
  40. Will we need to create non-classroom guidelines and procedures (e.g., restrooms, cafeteria, hallways, library, playground, bus, etc.)?
  41. What modifications to school safety protocols will need to be adjusted, such as locker or book bag searches?
  42. Will there be a need to alter protocols for drug testing?
  43. Many guidance counselor’s offices will not allow for meeting with students or families with proper social distancing guidelines due to space constraints. How will individual guidance services be met under social distancing requirements?
  44. Secretaries often are the first point of contact with members of the public. What modifications will need to be made to workspaces and main office locations?
  45. Administrative workspaces are often in high trafficked areas of school buildings. What measures will need to be put in place to protect these staff members from potential exposure?
  46. Do we have enough nursing staff to meet the needs of our school communities?
    1. If not, where will we find the additional staff and monies to increase the nursing shortages that we are already experiencing?
    2. Will certification guidelines be altered to increase the school nurse pipeline?
    3. Would this come at the expense of our greater health care system?
  47. Will nurses need higher medical-grade equipment?
  48. Currently, there is a two-month backorder on masks and hand sanitizers. How does the entire educational system acquire the PPE required to outfit the nation while medical facilities and hospitals have shortages?
  49. Since medical treatment cannot be socially distanced, how will we meet the medical needs of children with epilepsy or seizure disorder?
  50. Will high-risk students be medically excluded from school until there is a vaccine?
  51. At some point, there will be a vaccine. Will vaccines be required for staff members?  If they refuse to get vaccinated, will they be allowed work in the schools?
  52. Will vaccines be mandatory for students? This would require major changes to legal provisions and has broad societal ramifications regarding parental rights and choice. 
  53. How will schools clean and sanitize our schools? What guidelines and what industry standards?
  54. If we believe that proactive antibody and COVID testing is needed to ensure the public health, who is going to conduct such testing and on what frequency? Will this be mandatory?  If a staff member or student refuses testing, will they be excluded or suspended?  If someone tests positive, what are the next steps?  Will schools need to be shut down?  Will there be movement to online instruction and 14 day district wide quarantines? 
  55. Will districts need to invest in electrostatic sprayers, eye and face protection, and portable sinks?
  56. Will hallway water fountains need to be turned off to prevent the potential spread of the virus?
  57. Will districts be required to hire a third party vendor to check temperatures when employees return to work? If so, who will be checking the vendors? What will return to work clearance and guidelines look like?
  58. Will OSHA be issuing any industry specific standards?
  59. Will districts need to reduce the school week and stagger school start and break times?
  60. What specialized personal protective equipment will be needed for students and staff (Deaf and Hard of Hearing, Down’s Syndrome, William’s Syndrome, Auto-Immune disease, Autism, etc.)?
  61. What accommodations will be needed for audio enhancement equipment that may be affected by the use of masks?
  62. How will psychological assessments be conducted?
  63. What will the opening two-weeks of school look like? Will there be a series of assessments and remediation measures or will the opening of schools be focused on SEL and re-establishing school culture?
  64. What happens in any classroom that has shared equipment and supplies (arts, culinary, technology, athletics, food services, clothing, pre-K and kindergarten, physical education, robotics, etc.)?
  65. Teachers and administrators that are shared between buildings or departments move amongst school buildings daily and weekly. Will limitations and modifications be needed for shared staff schedules?
  66. Do school districts need to have an enhanced cleaning protocol for shared toys in PK and K classrooms?
  67. Disciplines such as CTE, Athletics, Pre-K and Kindergarten with shared  equipment and supplies will be disproportionately impacted by requirements for disinfecting and social distancing.  How will we ensure the success of such programs?
  68. Many nurses’ offices are limited in size. It seems obvious we will need a space for quarantining students or staff that may become ill and are suspected of being COVID positive.  What will the requirements of such space be?  What standards?  What physical requirements?  Do we need modifications of our facilities or just place a mask over the individual?
  69. Will districts be required to establish a student, employee, and visitor contract tracing protocol? If so, how?
  70. Will all district field trips be cancelled for the 2020 – 2021 school year?
  71. Since there was a shortage of bus drivers prior to the global health pandemic, what happens if there is insufficient busing due to inability to find bus drivers? What will happen with school districts’ obligation to transport students?
  72. As buses are used for multiple runs per day, what will be the cleaning protocols in between routes?
  73. Increased staffing and increasing the number of bus routes will be necessary to meet any schedule modification. How is this possible with limited drivers, buses, and finances?
  74. How will a bus aide whose sole responsibility is the monitoring and safety of special education students that have harnessing and restraints, socially distance from the students for whom they are responsible?
  75. How will transition times (hallways) be monitored? Will hallways need to be one-way?  If so, will this create a concern with fire code and door egress?
  76. Will cafeteria services be grab and go? Who will monitor the students?
  77. How will school districts address the loss of revenues from facility rentals, AM/PM care programs, and summer camps?
  78. Since many finger print facilities have been shut during the pandemic, will newly hired staff be able to receive finger print clearance in time to begin working?
  79. Will staff members whose certifications that may be expiring for first aid, lifeguard, or life safety be granted exemptions or extensions?
  80. How will students experience socially distanced Driver’s Education?
  81. How will kids walk up and down the stairs if they cannot hold a hand-railing?
  82. What happens to shared-time vocational education programs? Would students be asked to choose between programs?
  83. If nurses only work during the academic school day, who will monitor temperature checks of staff, visitors, and students in after hour programs and evening custodial shifts?






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