Over the nearly 20 years Marnie McKercher has been in school nursing, she’s seen the profession change — but perhaps never as quickly as it has this year, when a global pandemic put infectious disease mitigation at the top of her priorities list.
School nurses are no strangers to disease prevention and intervention, as they’re tasked with ensuring students are immunized against preventable illnesses such as the measles and tracking cases or outbreaks of other diseases identified by public health experts. It’s normally a small part of the job, said McKercher, the lead school nurse consultant for Aurora Public Schools.
But as COVID-19 took center stage in 2020, so too did more intense disease mitigation efforts. Over the summer, for example, nursing staff played a crucial role in providing and contextualizing relevant epidemiological data to help administrators decide how — or whether — they could safely reopen schools.
“That 5% to 10% of what we did is now probably closer to 95% or greater of what school nurses are doing,” said McKercher. “We were watching (the coronavirus) like everybody else. We, just like everyone else, were surprised at how fast things transpired in March.”
Even during a typical school year the job of the school nurse goes well beyond “Band-Aids and sore throats,” she said. The short list of duties includes screening students for vision or hearing impairments, teaching health education, administering medications to kids with chronic conditions, addressing the needs of students with individualized education programs and 504 plans, assessing suicide risks, and providing first aid to sick or injured children.
“There’s one overarching goal for school nurses, and that is to remove health-related barriers to learning,” McKercher said. In Aurora Public Schools, specifically, that also includes connecting families to needed resources such as housing and meals. “If you don’t have access to basic necessities, it’s hard to be available to learn.”
Adopting telehealth and other new duties
The COVID-19 era has brought new practices to help ensure students and staff members are healthy even before they enter the building. Every weekday morning when DPS has in-person learning, nurse Rebecca Sposato posts up at one of two Denver Public Schools facilities to which she is assigned, ready to support teachers as they welcome students with infrared thermometers.
Anyone who comes to Sposato’s office feeling unwell during the school day is evaluated based on their potential COVID-19 risk. Her office at Whittier Elementary School has been expanded to include two rest areas: one for students experiencing “minor” or general cold symptoms, and one for students experiencing “major” symptoms or those most commonly associated with COVID-19.
No symptom, no matter how mundane, should be taken lightly and students are usually sent home, especially if they have a fever or respiratory issues.
“I have had a couple kids come in with low-level symptoms, like you know booger noses and cough, which typically I would say the student is fine, just be good hygiene-wise,” Sposato said. “This year, we’re a little bit more guarded even about those.”
How long a child’s symptoms last determines when they may return to school, and Sposato works with each family on that timeline. When a student receives a positive test result, she collects preliminary contact tracing information, such as the last day they attended school and a list of their classmates, before engaging DPS’s COVID-19 response team to further investigate. She uses the same protocol when students call in sick.
That system worked for schools hosting in-person learning. However, as more districts opt to move classes online, nurses have to increasingly rely on telehealth.
That’s been an adjustment for Lexi Barrere, an instructor at the University of Colorado’s College of Nursing and nurse practitioner at a school-based health clinic serving families in Sheridan School District No. 2. Barrere and her colleagues would traditionally go into schools to provide services such as sports physicals and mental, dental or behavioral health care, but now they rely on connecting with patients virtually, which is limiting families’ access to care, she said.
“That has changed our ability to interact with the kids in their space, which is really the essence of school-based health care,” Barrere said. “It’s changed the way that we practice as a pediatric team, both at our school-based health center and at our primary care clinic.”
Telehealth has also exposed glaring technological inequities in the regional community. Some households don’t have a reliable wifi connection, adding yet another barrier to receiving the services they may need.
“That’s where I see a huge need is treating broadband internet just like water, like sewer, like electricity. It should be a basic necessity, especially during a time like this,” Barrere said.
Doing more with less
For as much as has changed for school nurses during the pandemic, one thing hasn’t: They’re still woefully understaffed. McKercher, Sposato and Barrere all listed an increased workload among the biggest challenges they’re facing right now.
In a recent meeting with the Douglas County School District board, interim Superintendent Corey Wise said the nursing staff was “at a tipping point,” overwhelmed by having to conduct contact tracing daily on dozens of cases in addition to other school-based duties. The district has 45 nurses total, he said, which is not enough for each Dougco school to have its own.
That’s not uncommon. According to the Colorado Association of School Nurses, there were 756 part-time and full-time school nurses in Colorado during the 2019-20 school year. With 913,223 students in Colorado’s 1,914 public schools, the organization said there was one full-time school nurse for every 1,331 students in the state.
About 89% of Colorado schools said they had access to a licensed school nurse during class hours last school year, according to the Department of Education. In 2018, about 25% of schools nationwide did not have a nurse, according to the National Association of School Nurses.
Barrere was an advocate for having a nurse in every school prior to the pandemic and believes having medical professionals to support individual schools during this health crisis would be invaluable. Not only would they minimize the spread and impact of COVID-19, but they also would decrease stress and anxiety within the community.
Sposato agrees. The more individualized attention students can get during this time, the better, she said, especially since educators’ workloads are also swelling.
“All those students who we were concerned about falling through cracks academically, I feel like the crack got so much wider,” Sposato said. “Teachers, they’re trained in teaching. And to have them take on nursing duties is giving them more tasks at hand.”
