School Nursing

The Relentless School Nurse: Dear School Superintendent, Enough is Enough

This letter was sent to the Washington State School Superintendent by Liz Pray, President of the School Nurse Organization of Washington. Liz is a seasoned school nurse leader who is a fearless advocate for student and staff safety. You will see what prompted her to write, “enough is enough” to the Superintendent. Disturbingly, Liz’s story is only too familiar! School nurses who are covering multiple buildings cannot clone themselves to be onsight when that emergency call comes that a student or staff member is down. Thank you Liz for sharing your story and taking immediate action. You are demonstrating extraordinary leadership and using your agency to advocate for change. School nurses should no longer tolerate the intolerable. 


March 26, 2021

Superintendent Reykdal,

I know that when we talked on Monday there was one thing our organization was going to work on this week. Well, we all know plans change as evidenced by the past 15 months. Yesterday, while the majority of our state tuned in to hear what the Governor was saying and hoping we were adopting CDC Guidance, I was trying to do a sternal rub on an unresponsive 3-year-old.  
School Nurses have been tirelessly trying to advocate for a better funding model for the safety of our students and staff. Enough is enough! I was covering five buildings yesterday in a district that has been back to in-person learning since September. When I got the call about that 3-year-old student who went down in therapy where was I? Halfway across town at another school trying to figure out the fastest route to get to him while I prayed the ambulance crew was not held up. 
We were asked by our national organization to think about who our allies are as we continue to advocate for better staffing ratios. If the outcome had been different yesterday our biggest ally would have been the parents of that little boy.
I have reached out to our members across the state through multiple channels and attached is the list of what the School Nurses have been doing for the past 15 months. The next time everyone is waiting for the most recent announcement on changes to guidance please remember that unresponsive 3-year-old and his school nurse who was covering five buildings.

Thank you, 

Liz Pray MSN-Ed, RN, NCSN
Moses Lake SD School Nurse
President, School Nurse Organization of WA

  • COVID-19 Support
      • Contact Tracing and support of Public Health, sometimes this includes case investigation depending on the county
        • Student / Family education around quarantine
        • Follow up with families on needs during quarantine including meal/homework delivery
        • Follow up with families of absent students with an illness or failed attestation
        • Taking district calls for COVID-related issues after hours, weekends, and holidays.
        • Family and Community education around COVID
      • Return to Learn planning, includes building safety plans, updating plans when guidance changes, ensuring district compliance with State Laws
      • COVID Site Supervisors and or Support for COVID Site Supervisors
      • Isolation Room monitoring/support for symptomatic students
      • Interpreting COVID Guidance from DOH and Local Health Departments and disseminating information
      • Staff training around COVID (above and beyond the training for life-threatening health conditions and emergency medications)
        • Including use of an infrared thermometer, how to screen students
        • What mask for the task
        • Cleaning and disinfection of high touch areas and general areas of the schools
      • Selecting district PPE and training on use both in person and virtually
      • Participation in COVID Safety meetings for multiple buildings
      • Screening of staff and or students upon arrival to school
      • Liaison between Department of Health and or Local Health Jurisdictions 
      • Participating in testing pilot programs to test staff and students as directed 
      • Volunteering at vaccination sites
  • Virtual office hours continued after students made the transition to Spring 2020
      • Outreach to students at risk
      • Participating in virtual class with students/teachers
      • Virtual support groups on particular topics such as stress, chronic condition management, medication
  • Support for virtual students including 504 accommodations due to increased screen time, assisting teachers with class participation
  • Immunization Compliance (Required for school attendance)
  • Transitioning to the School Module during downtime or while students are back in person.
  • Exclusion letters and at times making arrangements for students to be seen by a physician or assist with finding places that families can take students for required immunizations
  • Participating in and preparing professional development
  • Assisting students and families with managing chronic health conditions
      • Virtual training for emergency medications
      • Emergency home visits to ensure student safety
      • Answering phone calls from parents and assisting with access to physicians 
      • Medication/ equipment return to families after buildings were closed and ensuring families had enough medication at home
  • Updating/developing outdated School Health Policies
  • Participating in conferences (telephone or virtual) with administration regarding current events
  • Working on student health care plans, and other school nurse specific duties
  • Reviewing your data
  • Developing or maintaining professional school nurse webpage
  • Employee Health
      • Monitoring attestations, answering questions around vaccine hesitancy, return to work preparations and training
      • Exposures, contact tracing for staff
      • Teaching or providing staff self-care
      • Educating/training staff on COVID-19, infection control measures, use of PPE, handwashing
      • Create Respiratory Protection Plans, Fit testing staff 
      • Vaccine hesitancy 
  • Several nurses have been asked to support their buildings when short-staffed by answering phones, covering recess duty, and taking students/classes to various locations within the school building.
  • Vision screening, referrals have been higher this school year than in the previous years
      • Ensuring that families have access to vision care and can schedule appointments
  • Child Protective Services referrals and interventions 
  • IEP medical assessments (medical/physical portion), higher number due to lack of progress after school closures Spring 2020

Marysville School District – 80% of their time has been spent on COVID but first time that they have felt respected and involved as a school nurse

Dieringer School District – 80% of the time being spent on COVID, working up to 2.5 hours past normal workday.  This does not include the pay for being on call nights and weekends

LWSD – no digital attestations and this is consuming their time, sometimes 4 hours per day is spent just doing phone calls.  Sub nurses have been brought in to work on WAIIS (School Module) transition.


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