School Nursing

The Relentless School Nurse: A Moral Dilemma in School Nursing

School district after school district are lifting mask mandates, ending contact tracing, quarantining, and other public health safety protocols. Short-sightedness and the lack of public will beat out the principles of public health this go-round. The future remains unclear, but we will have to be ready to pivot, as we have done for the past two years.

It is painful to watch states and school districts ending protective measures so abruptly without clear metrics to know that we can still keep our students and staff safe. There is a narcissism infused in the message that “parental choice” will inform decisions moving forward. Schools are communities, they are not built for one family. We are responsible for other people’s children.

Moral dilemma and moral injury has become a significant unintended consequence of school nurses on the front lines of COVID-19 in schools. The rush to unmask and pretend that COVID is already in our rear view mirrors has created additional challenges that we are just beginning to see. For example, a school nurse reached out to me to present this real-time scenario that many of us may be tasked to do. Here is the thread to our discussion:

me: Wow…what an ask! Talk about a moral dilemma. Do you have a union? I think this is an inappropriate ask. This is much more about human behavior! The bullying is going to be real.

school nurse: I totally agree. Our social worker is the one that reached out because she’ll be the primary person managing the bullying. I didn’t even think of asking the union! Or even the thought that I’m allowed to say “no”. 

me: Stay strong, this is tough stuff and I am sorry they are asking you to do something that you do not agree with. I would never break your confidence, but can I share the ask from your school in a blog post. I feel like there are many other school nurses who may be asked to do similar presentations and are struggling.

school nurse: Absolutely! Anonymous is great with me and, I 100% agree—I think it could be helpful for other school nurses going through similar situations! 

What would you do? School nurses can say “no” when asked to do something that we know is inherently unsafe. 


Online Journal in Nursing – Ethical Issues in School Nursing by Teresa A. Savage, PhD, RN


4 thoughts on “The Relentless School Nurse: A Moral Dilemma in School Nursing”

  1. Just say no. MUCH easier said than done but I’m afraid it’s your best starting point. If they’re following the science that they’re asking you to employ, they wouldn’t be asking you. We’re venturing into the ultra looney realm. I just watched a board meeting where a member asked what’s the point of pooled testing now since it was only used so kids could play sports and now they can play no matter what and it wasn’t really ever so much for surveillance and another member agreed noting that kids were more likely to die from an MVA so……..I wrote a letter, followed my own advice to sleep on it. Haven’t slept for two nights. Letter going out today. Back to your dilemma. Stay strong and respectfully decline.

    1. Thank you Judy, I passed your very helpful comment onto the school nurse. You know I would LOVE to see that letter! We need to document all of this!

  2. That request is totally insane! For the school board to declare ‘ mask optional’ then ask a medical professional to, in a scientific way, outline the decision.

    What ??!!!

    There is no science behind ‘mask optional.’ Let’s start there.

    I’d have a hard time not being facetious and saying ” So, you essentially want me to tell these kids that some of them are are genetically superior per reports from their parents and so don’t need to wear a mask.”

    Please keep us updated to the outcome if possible!

    1. Thank you for your comments Susan. I shared them with the school nurse, who feels so supported, even if she has to remain anonymous.

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