School Nursing

The Relentless School Nurse: Status Surge Capacity Depletion

We have reached public health surge capacity depletion and it is clear we are unable to meet the demands of this endless moment. Standing on the threshold of pandemic year number three, with the omicron variant swirling all around us, has created an impossible situation for school nurses to manage safely.  Running on surge capacity can only last so long until you are depleted. Here we are…

Health journalist Tara Halle captured surge capacity depletion perfectly in an article written in August of 2020, way back at the beginning of this long nightmare:

In those early months, I, along with most of the rest of the country, was using “surge capacity” to operate, as Ann Masten, PhD, a psychologist and professor of child development at the University of Minnesota, calls it. Surge capacity is a collection of adaptive systems — mental and physical — that humans draw on for short-term survival in acutely stressful situations, such as natural disasters. But natural disasters occur over a short period, even if recovery is long. Pandemics are different — the disaster itself stretches out indefinitely.

“The pandemic has demonstrated both what we can do with surge capacity and the limits of surge capacity,” says Masten. When it’s depleted, it has to be renewed. But what happens when you struggle to renew it because the emergency phase has now become chronic? – Tara Haelle (2020)

School nurses have spent almost twenty-four months navigating inconsistent recommendations and guidelines. We have been under fire from parents, staff, and administration for implementing the fluid guidance. Incivility has grown ever-present and it has taken a toll on our school nursing workforce.

Health office volume and demands have never been higher or more consequential.  We are juggling sick visits, common complaints, medication administration, emergencies, first aid, mental health crises, care coordination and health education, plus so much more. There is absolutely no time to complete state-mandated screenings, new student registrations, vaccination compliance because there is no one to help. In most cases, our request for assistance falls on deaf ears. 

While the majority of school nurses support in school COVID testing, we do not have the time or the capacity to run a test to stay program. There are not enough hours in the day, it is that simple and that complicated.  School nurses are working well into the evening to “catch up” on those things we cannot get done during the school day. 

One nurse said it best:

I feel like I’m hanging onto a lifeboat with one hand while waves continue to pummel the boat and there is no land in sight! And, in my attempt to hang on, I am going to miss something important!

We are well beyond our tipping point. School nurses are leaving the profession as they are overwhelmed, burnt out, and lack the required support. School nurses work in an educational system that does not understand the scope of our role or the intricacies of our practice, especially during the pandemic.

COVID has brought the need and importance of school nursing front and center, but we are often not in positions of decision making when it comes to surge capacity staffing or other necessary resources. This wears away our sense of agency and disempowers even the most seasoned school nurse. Many are or have already left, retiring early or choosing to resign for self-preservation. These decisions are not made lightly or on the fly, they come after being worn down from almost twenty-four months of pandemic school nursing with no reprieve and little support.

There is a stunning lack of decision-making from local health departments. While we are tasked with reporting to them, the direction for temporarily moving to remote learning, for example, is solely at the discretion of school administration. Last year, there had been a coordinated approach with our local health departments, but now districts are formulating their own protocols which may or may not align with the ever-changing CDC, local, and state guidance. 

Even more alarming is the abject lack of intervention by Departments of Education across the country. Why are they silent about health issues and only focused on learning loss? Do they not see that health and learning are inextricably linked? Where do we go from here? I am at a loss for next steps.


Haelle, T. (2020, September 10). Your ‘surge capacity’ is depleted - it’s why you feel awful. Medium. Retrieved January 6, 2022, from











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