The Relentless School Nurse: ‘Test To Stay’ in Schools Cannot Land Solely on the Shoulders of School Nurses

There is a wide gap between theory and practice when it comes to implementing COVID testing in schools. Just ask a school nurse! It is great news that the CDC and the White House are promoting ‘Test to Stay’ in schools as an alternative to quarantining close contacts. But, let’s be sure that the implementation is equitable and appropriately resourced to be successful. School districts that have staffing and resources to seamlessly implement this important strategy to save school days are very fortunate. I don’t happen to work in one of these districts. We are struggling to fill positions which adds an additional burden to those of us who cover for our missing colleagues. There are no substitute school nurses in my school district, and many others as well.

When you read about hospitals not having enough beds for acute care patients, what they are really saying is that they don’t have enough nursing staff. Hospitals have plenty of furniture, like beds, but who is staffing those ‘beds’? This is also happening in schools, where remember 25% of schools have no school nurse at all and 35% may have a part-time school nurse. Forty percent of schools have full-time school nurses, but what does that really mean in terms of school nurse-to-student ratios? It could mean one school nurse to several thousand students or minimally hundreds and hundreds. 

I have been speaking with school nurses across the country who have testing programs in their schools. The issue comes down to staffing. Who shoulders the responsibility of this program? Who coordinates the actual testing protocol? Who reports the results to parents? Will parents be available each morning we are testing so that if their child tests positive, they can promptly return home? Who is reporting the results to county and state departments of health? This goes far beyond having rapid tests available in a school nurse’s office. Will school districts provide testing teams so that the building school nurse (if there is one) can resume their non-COVID responsibilities? Pandemic school nursing is more than a full time job and does not allow time or capacity for anything else.

Twitter lit up with the news of ‘Test to Stay’ after it was announced. Here are two examples of discussions I had about the issue from a school nurse’s perspective. The first is with NBC reporter Heidi Pryzbyla:

Thank you, Heidi, I appreciate your response. We can make this work, no one wants to quarantine all of these students. Districts would be better served including school nurses in the design, planning, implementation & evaluation of #testing

— Robin Cogan (@RobinCogan) December 17, 2021

I appreciated this second example of a Twitter discussion with Dr. Taison Bell about ‘Test to Stay.’ There is no school nurse in this country who finds quarantining dozens and dozens of students at a time because of exposure at school helpful. It has been the cause of much friction between parents and those of us who have to break the unwelcome disruptions. But as Dr. Bell so aptly responded to my caveat that we can do this and want to do this, but we need resources, help, time, space, and staff, he said, “Great point, it’s not like turning on a light switch.”

I have high regard for you Dr. Bell & agree with you, but this will only work if we are supported in school with proper staffing, resources, release time, supplies, proper facilities & cooperation from parents & school staff. We can't do this alone.

Respectfully, a school nurse

— Robin Cogan (@RobinCogan) December 17, 2021

TY for responding & understanding. Collaborative Implementation with robust resources are keys to success. I work in an under-resourced district, hard-hit by COVID. 1/3 of my students are in quarantine which impacts families who often do not have the luxury of sick days. #Equity

— Robin Cogan (@RobinCogan) December 18, 2021

This sums up the entire issue in a nutshell; it is not like turning on a light switch. It is much more nuanced and complicated. School nurses want to support students being in school, but how many ways do we need to ask for HELP to make that happen? We have shouldered the responsibility of being the de facto health department in schools for more than 20 months. This is not only unsustainable, it has driven our colleagues to resign and retire. Our tipping point has come and gone, we are beyond surge capacity just as the Omicron variant rears its unwelcome head. 

Here is the latest Morbidity and Mortality Weekly Report (MMWR) report from the CDC that supports Test to Stay:

MMWR- Evaluation of Test to Stay Strategy on Secondary and Tertiary Transmission of SARS-CoV-2 in K–12 Schools