The Relentless School Nurse: Can We Save the School Nursing Workforce?

 

We have reached a tipping point, my friends. School nurses are taking stock of the extreme circumstances we find ourselves mired in and are having brave conversations about self-preservation. This includes resignations, early retirements, or medical leaves, all of which are understandable but leave schools scrambling to fill unfillable open positions. COVID laid bare what we all knew was always below the surface of our profession, a stark lack of infrastructure that could easily come crashing down like a game of Jenga. 

School nursing is an independent practice. We often work in isolation as the only healthcare providers in an educational system that refuses to prioritize the importance of health services. Student wellness services can no longer be on the shoulders of lone school nurses with impossible caseloads. It was never sustainable and in the midst of a seemingly unending pandemic, we have reached our breaking point. 

Over the past 14 months, I have held more than 95 hours of support groups with hundreds of school nurses. These peer-to-peer support groups reveal a snapshot of a beleaguered workforce that is questioning our fortitude to remain in practice. For privacy, no names, locations, or school districts are documented.  I collect themes and have anonymous quotes that illustrate the depth of the distress. Here are some examples:

“I have been a nurse for 24 years and I have never felt more demoralized, questioned, or made to feel incompetent.”

“I feel put in the middle of everything, between parents, administration, teachers, and pediatricians.”

“I am done with people fitting the guidelines for their own narrative. I have been a nurse for 17 years and it might be my last.”

“Why do I have to prove my worth to the administration?”

“Worry is the word of this pandemic.”

“I have little hope. My cousin died this week of COVID, we buried him yesterday. That’s why I am here.”

“This is a bittersweet day. I resigned from my school nurse position. This year took its toll on me. I’m feeling lost.”

So how can we save ourselves, our workforce, our beloved profession? The first step may be for superintendents and school leadership to listen to us. School nurses have the answers to save ourselves and in turn, our school communities. Here are some solutions garnered from the many hours of deeply revealing community conversations with school nurses:

• We need to work as a health services team, with staffing that meets the enormity of the challenge at hand. School nurses cannot work in isolation anymore, it was never sustainable.
• We cannot be the de facto health department. There needs to be a team of contact tracers embedded in school districts/buildings. School nurses are not the only staff members that can perform contact tracing. In fact, it is such an overwhelming and time-consuming job that it takes us away from every other important responsibility that we have.
• Districts need to partner with vendors to implement testing for staff and students. Stop adding layer after layer of expectations on the shoulders of a beleaguered workforce with no support to share the load. 
• Support your staff, do not allow or excuse abusive language or behavior directed towards school nurses who are attempting to implement the public health mitigation strategies that keep students and staff safe. Stand up for us and protect our wellbeing and safety.
• Pay school nurses who are working outside of school hours, including nights, weekends, and holidays to perform tasks we cannot complete during the day. Understand that one positive case of COVID in school can take hours to conclude correctly.
• Recognize that we have COVID reporting responsibilities that include, school level, district level, county level, and state level. These reports take time and space to complete correctly, the level of data collection is enormous, it does not happen in a vacuum or with endless interruptions. 
• School nurses need to be supervised by school nurses. We need leadership that has an intimate understanding of the full scope of school nursing practice. Create Health Services Departments at the district level, with opportunities for school nurses to have upward mobility and grow their leadership skills. 
• Say thank you, it goes a long way to give us fuel to keep going. Recognize and include school nurses in school activities and celebrations. 
• Value our educational preparation, leadership skills, and consensus-building, we are a trusted member of the school community. Include school nurses on committees, but give us uninterrupted release time to participate. 
• Pay a wage commensurate with our professional expertise and education. Create a salary scale that recognizes our work experience prior to entering school nursing. 

I welcome more community-based solutions from our school nursing workforce and will update this list with your feedback.