The chaos and the quiet: Navigating 2020 as a school nurse

Allison Moses was running a COVID-19 unit at the beginning of the year at MercyOne Medical Center in Des Moines.

When the first COVID patient arrived at the hospital, Moses, a Huxley resident, volunteered to have her unit become the primary COVID unit at the hospital.

"We had a patient suspected a couple weeks earlier in March and it went really, really well and smooth, so we decided to put them on our (cardiopulmonary) unit," Moses said. "I was excited about it — that's kind of the person I am. I like being able to take charge and being able to feel like we can accomplish the goal."

Within the next 48 hours, another nine-bed-unit was opened, in addition to Moses' 38-bed unit, she said.

"It just was constant and things changed on the daily," Moses said. "COVID is very exhausting to frontline nursing and health-care workers."

For six years, Moses served as the director of nursing at Mercy and, in total, had spent 17 years at the hospital. As a mother of two young children and the wife of a police officer, she found herself exhausted and burnt out as she clocked in 50-, 60- and 70-hour work weeks.

She looked to a new avenue, one that allowed her to use her medical background, and also provide somewhat of a sense of steadiness.

Today, she serves as the sole nurse at Ames' Edwards Elementary.

"I really thought about what the school districts were getting ready to face, going back with the unknown of facing COVID this year," Moses said. "I feel like I can bring a lot to the table with my past experience and knowledge, working in a hospital setting, because there's just a lot of unknowns as we go into this school year."

Life before March

Kim Mortale, the nurse at Ames' Kate Mitchell Elementary, typically saw up to 70 students a day for issues ranging from ear to stomach aches, or even aches attributed to anxiety, she said.

Before joining the district in 2016, Mortale spent 22 years working as a nurse in Des Moines. While it was hard to leave, she wanted to be able to spend more time at home, with her family.

In March — the month where schools were first instructed to close for two weeks and, later, for the remainder of the school year — school nurses hit the books, diving into research articles that picked apart the disease and detailed its impact.

Often the only health-care professionals in their buildings, they felt the weight of that responsibilty.

"It was hard to be the only health person in the building because you feel like you know more about the health concern, but education is more concerned about education," Mortale said.

Over the summer, the district's nurses were tasked with developing new protocols in light of COVID-19. Nurses split the research up, Mortale said.

She looked into the area of temperature screening, focusing on the benefits of screening temperatures of students prior to allowing them in the building — some schools had invested tens of thousands of dollars into screening equipment, she said. 

"I determined that really wasn't accurate," Mortale said. "You're going to have kids running and jumping and being on a bus — their temperatures are going to be all over the place."

In July, nurses began to meet with district staff, which helped, Mortale added.

"Being able to share our point of view on where this year might go was helpful," she said.

Eric Smidt, the district's director of communications, said that, following the summer's research, adjustments were made to the way nurses would handle certain incidents and where they treat students.

"They also established a new system for treating minor issues in their own classrooms, rather than sending them to the nurse's room," he said. "This helps eliminate exposure to students displaying symptoms of an illness."

Buildings also expanded the health office space by establishing a separate "sick room," Smidt said, "with the sole purpose of isolating students with COVID symptoms."

The district's nurses also partnered with Story County Public Health to get fellow nurses fit-tested for N95 masks and contracted for gowns and other PPE, Smidt said.

Knowing "there would be a great deal of demand for our nursing staff," two additional nurses were hired in the lead-up to the school year, Smidt said.

"We work closely with and rely on them to monitor our student and staff health," he added.

The district later announced a new position from within the district — one that would complete the research, focus on statistics and also have a health and medical background.

"We began to realize that we needed a health-care expert who was also trained in emergency management to coordinate our district's effort," Smidt said. "The amount of procedures that have to be created, implemented and have a continuous review of is simply not possible without this position."

Dr. Kathi Arnold, an Ames resident with a Master of Science and Ph.D. in nursing from Florida Atlantic University and a Master of Arts degree in health psychology from Northern Arizona University, fit the bill and was brought on board to join the team.

A new role for an uncertain time 

Prior to beginning in her new role, Arnold was teaching online courses for the University of Missouri-St. Louis when her classes were cut due to the pandemic.

Searching for new work, she stumbled across the emergency management post at the Ames district and discovered the job's requirements matched her career completely.

"I saw the posting and went, 'This is me'," Arnold said. "I love logistics, I love policies and procedures, I love data — I'm one of those really weird people that loves those things."

As a parent in the district, she was impressed with the Ames schools and felt the position was right for her.

Upon starting, Arnold took a load off of school nurses' shoulders in diving into the research, noting at the time that national research wasn't readily available from the CDC, yet.

One of the first critical responses she looked into was what happens if a student tests positive for COVID-19 and what follow-up communication would look like.

"She's been a huge help to us," Mortale said. "It was very overwhelming."

Each week, Arnold meets with a group that includes representatives from Mary Greeley, Ames' police and fire departments and city management, Iowa State and other partners.

As part of Arnold's role, she worked alongside the school district in researching how area districts would later report COVID-19 cases to the public.

Today, daily updates are reported on the district's "COVID-19 dashboard" on the district's website, which lists current quarantine and positive case information, as well as community indicators.

Arnold also shares current district and community COVID-19 reports with the school board its meetings, as well as answering any questions board members might have.

"We want to make sure that we're being as transparent as we can be," she said.

Arnold's role has been helpful for the district, Smidt noted.

"It is helpful to have an employee that can solely focus on COVID," Smidt said. "She is able to keep (Ames Community School District) up to date on CDC and (Iowa Department of Public Health) policy changes, assist with student and staff contact-tracing, manage PPE sourcing and inventory, and analyze (and) report all the COVID-19 associated data."

Smidt added that Arnold "spearheaded the student absence reporting form," which gives families the opportunity to report a student absence online, and is also available in multiple languages.

If staff have questions about a potential COVID-19 exposure, testing or other general questions related to COVID-19, Arnold is the go-to source.

A world of new

This year has brought new challenges to everyone and completely restructured the way schools operate — including with options to teach fully online.

Since the start of the school year, Ames has yet to have students back in its buildings, fully in-person, though students and staff have partially operated in-person via a hybrid model.

Although only a few students visit Mortale's door each day, she's enjoyed the opportunity to help them in her office or while she's working around the building.

"You would be surprised at how much a school nurse does," Mortale said. "The paperwork is pretty crazy."

In addition to fielding COVID-19-related questions and concerns, Mortale said school nurses check immunization records on each and every student who is attending the district and, if records aren't up to date, they begin making calls.

There's also phone calls to parents about students who may be sick, said Moses, who has had to call parents this year when students are simply coughing.

"On a normal year, you wouldn't do that."

Alongside Arnold, nurses also assist in tracking COVID-19 cases within their school building, where the quarantine and COVID-19 positive information is later published on the district's website by Arnold.

"That's tough," Mortale said. "People say, 'Well, I just have a cold.' This year, we assume COVID unless proven otherwise."

Mortale added that, "luckily, parents have been good" if a student has to stay out of school for 10 days to quarantine.

Outside of looking after students, Mortale has been keeping an eye on staff, whom she noted have worked harder than ever this year. To help, Mortale, alongside the school's counselor and student and family advocate, started "The Mitchell Self-Care Team."

"I knew self-care was going to be important this year," Mortale said. "Every week, we send out a self-care quote (and) we gave out journals to everybody at the beginning of the year. (Self-care) is really needed this year; it's really hard to do it because they're so busy, but it's super important."

For Moses, who is still navigating the new role during a pandemic, the work is just as important. She feels proud to be a school nurse, she said.

"I feel what I haven't felt in a long time, and that's making a huge difference in kids' lives."