The Relentless School Nurse: Where Have All the School Nurses Gone?

 

The impact of COVID on school nursing is not yet fully realized, but what we do know is there are many open positions. The fall of 2022 looks rather bleak for some school districts. I have been on the faculty of Rutgers University – Camden School of Nursing for more than a decade. One of my roles is clinical coordinator, placing our students in practicum experiences with certified school nurses across the state. In the summer, our students who are already working in schools, but not yet certified, have a practicum experience in the Extended School Year programs. This summer, for the first time, I had school districts using agency nurses to fill summer positions. That was one sign of trouble ahead. The other red flag was a discussion I had with a school nursing supervisor who shared that they had TEN vacant positions in their district. More than half of their school nursing staff had either resigned or retired. 

School nurses have taken stock of the extreme circumstances we find ourselves mired in and are having brave conversations about self-preservation. This includes resignations, and early retirements, 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. Welcome to the school year 2022-2023, the fourth one impacted by COVID. No wonder we are in this predicament. 

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. Even summertime does not solve this workforce emergency, it only delays the reality of what is coming when schools reopen. 

Here is a map of the 41 states that have a State School Nurse Consultant. My state of New Jersey is one of the many without state-level leadership. A law was passed and signed by our Governor two years ago, but the position sits empty, meant to be housed in the NJ Department of Education. We have a dearth of school nursing leadership on the state and local levels. School nurses have limited growth potential in our own school districts because, in many states, there is little infrastructure to support school health services. 

How do we recover? That is the big question. We need a healthy, refreshed, and rejuvenated workforce. From what I can see, that may be short-lived once school resumes. I am looking forward to reviewing the most recent school nursing workforce study that NASN should be releasing in the coming months.

We are facing many challenges this coming school year. COVID is still impacting our practice, now we can add Monkeypox and the ever-present threat of violence in schools and communities. Joining NASN, your state and county school nursing organizations are protective factors for our own well-being. Request your school district to pay for your membership, if we don’t ask, the answer is always no. There is nothing more powerful and supportive than being with school nursing colleagues, especially now. 

For the past twenty-two months, I have held weekly Zoom peer support groups for school nurses across the country. This summer we are meeting two Sunday evenings a month.  It has been a lifeline for those school nurses who have joined together during the pandemic, seeking support, and a safe space to share the collective trauma of COVID personally and professionally. The impact is still not fully realized because we are not beyond the trauma yet. While I am not sure what the fall will bring, I know that support from colleagues helps me process the challenges at hand. If you are interested in joining one of our Sunday evenings, email me at relentlessschoolnurse@gmail.com and I will share the Zoom link.