School Nursing

The Relentless School Nurse: Do You Want to Know Keeps School Nurses Up at Night?

Story telling is one way that I have shared the work of school nurses throughout the country. But the story of school nursing through this pandemic is not an easy one to tell, nor is there a happy ending in sight. Perhaps that is what makes telling our stories even more urgent. This will be the third school year impacted by COVID-19. That should stop all of us in our tracks. We must do whatever we need to do to stop the spread, which includes vaccinating and masking regardless of vaccine status.

Here is a glimpse into some of the conversations happening in the world of school nursing. There are no names, states or any identifying information shared to honor confidentiality and anonymity. But each of these messages came from first hand discussions with colleagues across the country, who like me, are about to return to school and are equally sleep deprived thinking about what is about to happen:

  • I don’t understand the decisions that are being made around masking. The very least we can do is still being fought.
  • I wish our governor would take charge and make universal requirements. Leaving it up to the school districts creates chaos and confusion, especially if adjacent towns are doing totally different protocols or none at all.
  • Groups of parents are protesting our board of education meetings. They are holding up signs that say “Follow the science; unmask the kids.” To make it worse, they are having the kids holding up signs too. What kind of messaging are we giving our children with all of the infighting?
  • The trauma of the pandemic is on-going, a persistent toxic stress that has no end in sight.
  • I am falling off the cliff with no safety net under me.
  • I submitted my letter of resignation today, feeling heartbroken and defeated but last year did me in and I can’t do it again.

You can get a flavor for the concerns from these snippets of conversations. My big ask is to please remember that to keep students safe, and in school, we need cooperation from everyone.

We need parents to stand with us, please ask questions about vaccinations, we are here to give evidence-based information. The goal post has never moved, we want to be back for face-to-face learning, but we have to be safe. Universal masking is a strategy that can help us meet that important goal. Getting vaccinated will bring us closer to a sense of safety, which at this moment is very hard to find. Most urgently, having your children vaccinated when it becomes available for them, will slow the spread and mutation of this deadly virus.

To our teaching staff, please understand that, like you, we are doing our very best under extreme circumstances. Over the past 18 months, school nurses have gotten pushback from teachers and school staff that may believe we are not doing enough. Keeping students in school is our priority but keeping the school community safe is also our priority. These are not competing goals by any means. We are following protocols that have been put into place, and hopefully will continue this year, that enable us to meet the needs of students and the school community at large. There may be protected medical information that we cannot share, we are not keeping secrets, we are protecting patient confidentiality, which we afford to anyone we care for in school. 

To the school boards, administrators, principals and superintendents, please know that if you are fortunate enough to have a full-time school nurse in your building, we are stretched beyond capacity and have been for more than 18 months. Here are some health services requests that would make our jobs sustainable:

#1-Now is the time to address inequities that have persisted in our schools 

  • Invest in professional school nurses. Our practice is grounded in an evidence-based model of care. The National Association of School Nurse Framework for 21st Century School Nursing Practice™ includes the Whole School, Whole Community, Whole Child model components. There are school nurses who also hold national certification, NCSN, a mark of excellence. 
  • Hire professional school nurses – specially trained to support student’s physical and emotional/mental health at all ages and stages.

#2-Addressing the “school nurse shortage”.  

  • Recognize their professional experience with appropriate compensation. Most school nurses come to the specialty field after years of professional nursing practice, but this is often not recognized in public education systems. 
  • Encouraging districts to hire professional school nurses at a salary commensurate with experience.  Schools are known to start nurses at step 1 because they have no experience as school nurses, but come with a wealth of pediatric, ER, and professional nursing experience.  This includes paying substitute nurses a fair wage.  Guidance/support from the State Department of Education or Department of Health would have weight.  
  • Encourage the State Board of Education to become more involved with assisting counties in developing recruitment strategies for full-time, part-time, and substitute nurses.  There are many open positions and after the year we just experienced, there will be a lot more vacancies. Having professional school nursing staff in place to work at recruitment fairs would be advantageous to fill open positions with qualified candidates.
  • Encourage districts to hire staff based on student health acuity AND numbers.  Many schools hire one nurse to deal with over 1,000 students with no assistance, but yet expect covid screening, contact tracing, mandatory screenings, mental health assistance, referrals, and chronic health management.  
  • School nurses are the Chief Well-Being Officers in schools. Support an infrastructure for school nurse staffing to allow release time for school nurses to actively participate in school committees that focus on student well-being. Cross-sector teams led by school nurses will be instrumental in addressing the challenges of school re-entry this fall. 

#3-Update antiquated health screening equipment and invest in electronic health records

  • There has been much advancement in the health office equipment – audio and vision machines that would expedite the screening process which would assist in limiting the amount of missed class time to have screening performed.  It’s time to make a one-time investment in high-tech health office screening devices and electronic health records.  

Long before the pandemic, budget lines for school health services were painfully small.  This remains true today.  Yet, the school health office and its staff care for EVERY student in the school district.  It should not take a pandemic for school districts to recognize that keeping students physically and mentally ready to learn should be a priority not an aside to education.  To paraphrase former United States Surgeon General Joycelyn Elders, “You can’t educate a child who is not healthy or keep a child healthy who is not educated.” 

This is OUR TIME to ask for what we need, what our students and families need. Remember, if we don’t ask, the answer is always NO! You can ask from your health office as an individual school nurse, through your district as a team of colleagues, or from your state school nurse organization. The point is to raise your concerns, the funding is flowing and now is our chance to get the necessary support we need to do the best job we can for our school communities. 

I am not sure if this will help any of us sleep better, but it’s a start. 


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