The Importance of School Nurses

The school nurse's work as a care provider, advocate, and educator has always played a large role in helping to ensure positive student outcomes. Now COVID-19 has created unfathomable difficulties that have put school nurses on the frontlines and made it challenging for them to do their jobs effectively.

The importance of school nurses cannot be understated, especially when the decision to not employ a full-time nurse can lead to staff with little to no medical training handling basic medical procedures and any medical emergencies. According to a survey conducted by the National Association of School Nurses (NASN), 25% of schools don't employ a school nurse at all, while just under 40% employ a full time nurse – and many of those nurses work at multiple schools in their district.

The fact that over 60% of schools don't have a full-time nurse is even more alarming now that many schools are returning to in-person education in the midst of the pandemic. On top of the incredible work already being done by school nurses, they're now frontline workers in the fight against COVID-19, and their job has expanded to include creating, implementing, and maintaining health and safety protocols to protect students and staff against the virus.

In their role as public health specialists, school nurses have been key players in helping schools and districts determine whether it's safe to reenter the classroom. According to another survey by NASN, over 60% of school nurses were included in district discussions regarding COVID-19. Their background and expertise makes them uniquely qualified to help determine:

If schools potentially have the resources for and ability to perform daily mass screenings
The amount of personal protective equipment (PPE) needed to protect students and staff
Policies and procedures for maintaining healthy practices in the school
The procedure for when a student or staff member is presumed to have or is diagnosed with COVID-19
Return-to-school policies and procedures for staff or students diagnosed with COVID-19
Best processes for managing existing health services

Back in the School

Planning teams have thoroughly considered the levels of community transmission and the school's capacity to implement proper mitigation measures, and it's been determined that students and staff will be returning to the classroom for this school year. What happens next? We've created recommendations and considerations based on information from NASN, CDC, and other leading organizations.

It's time to create a plan for how to bring students and staff back safely. School nurses and administrators should collaborate to create guidelines that address health and safety protocols for all areas of the school. Consider adopting the CDC's Readiness and Planning Tool, which provides checklists to help schools prepare for if someone gets sick and ensure general and daily/weekly readiness. Factors include:

General Readiness Assessment
- Develop a plan to conduct daily health checks of staff and students, as possible, and in accordance with any applicable privacy laws and regulations
- Develop a schedule for increased routine cleaning and disinfection in collaboration with maintenance staff
- Develop appropriate COVID-19 accommodations, modifications, and assistance for students with special healthcare needs or disabilities
Daily/Weekly Readiness Assessment
- Continue to provide or update messages about behaviors that prevent the spread of COVID-19 when communicating with staff and families
- Reinforce the use of cloth face coverings and reinforce and monitor handwashing with soap and water for 20 seconds
- Monitor and restock supplies including soap, hand sanitizer, and cleaning and disinfection supplies
Preparing for if Someone Gets Sick
- Make sure staff and families know they should not come to school, and that they should notify school officials if they have COVID-19 symptoms, are diagnosed with COVID-19, are waiting for test results, or have been exposed to someone with symptoms or a confirmed or suspected case
- Identify an isolation room or area to separate anyone who has COVID-19 symptoms or who has tested positive but does not have symptoms
- Close off areas used by a sick person, and do not use these areas until after cleaning and disinfecting them
- Advise those who have had close contact with a person diagnosed with COVID-19 to stay home, self-monitor for symptoms, and follow CDC guidance if symptoms develop

Once your plan is in place, it's essential to educate students, families, and staff on what's expected of them. According to NASN, in April 2020, nearly half of school nurses were answering phone calls from parents and the community. It's even more important now for nurses and administrators to develop a communications plan that involves students, parents, and staff and provides a centralized person and phone number, email, or website to address COVID-19 specific questions and concerns. Also, consider creating a parent handbook that outlines policies and procedures prior to the start of the school year.

When do staff and students need to stay home from school
What are the best practices for maintaining hygiene and respiratory etiquette (including handwashing and donning, removing, wearing, and caring for facemasks)
What changes should students expect in the classroom, lunchroom, and other communal areas around the school
What changes should parents expect in regard to transportation to school, health services, and scheduling
How will staff and families be notified of school closures, event cancellations, or communicable disease or illness (also consider potential language, cultural, and disability barriers associated with communicating information)

Consider how nurses are going to manage existing health services, including:

Medication administration
Performing aerosol generating procedures
Helping students manage chronic conditions
Immunization clinics
Working with students, families, and the communities to promote adequate access to essentials

Because of changes to the school's health and safety protocols, school nurses may also need to outfit their offices differently this year. Consider:

What supplies are needed to maintain the school's new policies and procedures (including PPE, disinfectant, hand sanitizer, soap, and paper towels)?
Is there an isolated space to screen and triage everyone entering the school nurse's office or facility? Is everyone in the office able to adhere to social distancing guidelines as much as possible? Is there seating that can be placed 6' apart or can partitions to separate individuals?
Are facemasks, tissues, hand sanitizer, and trashcans easily accessible?
Are resources up to date to assist students who may dealing with emotional management issues, bullying, or lack of basic needs including access to healthcare providers, adequate nutrition, and housing security?
Are there existing health services that can be managed virtually?
Does the space have enhanced ventilation?
Are there existing health services that can be managed virtually?
Are you working in a space with enhanced ventilation?

PPE and Hygiene

The CDC strongly encourages the use of masks to reduce the spread of COVID-19, and many states and cities now require mask usage when in public. Masks should be a requirement for all students, teachers, and staff, especially indoors and when social distancing is difficult to maintain or implement, they may need to consider alternatives and adaptions for:

Students in early elementary school who may find appropriate, consistent use of masks challenging
Students and staff with special educational or healthcare needs including intellectual and developmental disabilities, mental-health conditions, and sensory concerns
Students and staff who are deaf or hard of hearing
Students and staff with severe asthma or breathing difficulties

Alternative options include transparent facemasks and facemasks with clear-view patches or building schedules and routines around prioritized times for mask usage. The CDC does not currently recommend face shields as a substitute for masks, but if they're necessary, the CDC suggests face shields that wrap around the side of the wearer's face and extends below the chin and hooded face shields.

Hand hygiene should also be essential to any health and safety policies. Support proper hygiene with easy access to soap and water, paper towels, and hand sanitizer. School nurses should work with staff to educate students on and reinforce frequent, consistent handwashing with soap and water for 20 seconds and covering coughs and sneezes with tissues.

Staff and students should be instructed on the proper methods for donning, using, removing, and caring for facemasks and other PPE to minimize potential contamination risks. Easily accessible PPE and signage in highly visible locations will also encourage staff and students to follow health and hygiene protocols.

It's important, too, to consider how much PPE, disinfectant, soap, hand sanitizer, and other essentials will be needed. Think about:

Who needs access to PPE other than facemasks, including gloves, eye protection, surgical masks, and respirators
How much disinfectant is required to clean frequently touched objects either daily or in between use
Whether hand sanitizer is consistently accessible in every classroom and office and in areas where a sink can't be quickly accessed. When deciding how much hand sanitizer is needed, consider this – according to a study published in the American Journal of Infection Control, at least 3mL of hand sanitizer is required to sufficiently cover both the palms and backs of hands.

PPE Considerations

PPE Type	Low-Risk Situation	Moderate-Risk Situation	High-Risk Situation
	Students and staff are interacting, but physical distancing can't always be maintained	Tasks require close or direct contact with staff or students who are not known or suspected to have COVID-19	Tasks include physically assessing staff or students who are suspected of having COVID-19; performing aerosol-generating procedures
Cloth Face Covering (not PPE)	X
Gloves		X	X
Eye Protection		X	X
Surgical Facemask		X	X
Gown/Coveralls			X
Respirator/N95			X

Source NASN
Further Product Considerations

Product Type	Nurse's Office	Throughout the School
	Product should be available in the nurse's office	Product should be readily available throughout the school
Hand Sanitizer	X	X
Soap	X	X
Disinfectant	X	X
Paper Towel	X	X
Signage	X	X
Face Shields	X
Cloth Face Coverings	X	X
Gloves	X
Eye Protection	X
Surgical Facemasks	X
Gowns/Coveralls	X
Respirators/N95	X
Partitions/Barriers	X	X
Tissues	X	X
Social Distancing Floor Markers	X	X
No-Touch Foot Pedal Trashcans	X	X
No-Touch Soap/Hand Sanitizer Dispensers	X	X

How much PPE do you need to keep stocked? Download the CDC's Burn Rate Calculator

Virtual Schooling

The school has made the decision to start the year in a virtual environment before returning to the classroom or has chosen to do a mix of virtual and in-person learning. There may already be a system in place for delivering care to students via audio-visual technology because the school or district was virtual in the spring, but it's important to review the essentials of providing virtual care and ensure school nurses have the systems and support in place to provide high-quality care to students.

Most importantly, many states have modified requirements for telehealth, and it's imperative that school nurses and administrators stay up to date on current state laws and policies.

It's a smart idea to ensure schools and districts have implemented policies for sending and receiving resources between school and home. In the April 2020 survey conducted by NASN, 72% of school nurses were returning medication and equipment to families, and over 30% were assisting with deliveries to students – including medication and food. Administrators and school nurses may want to consider whether it's appropriate to create a pick-up site at the school, drop off resources at a student's home, or mail resources directly. It's also a smart idea to implement drop-off lanes and bins and schedule drop-off times for students and families who need to return materials back to the school.

Mental Wellbeing

It's important while determining new health and safety protocols to take into consideration the mental wellbeing of staff and students who may be facing heightened stress and anxiety because of COVID-19 and any associated challenges. Research suggests that schools may function as the de facto mental health system for children and adolescents, making the school nurse's role even more essential when it comes to supporting mental health. It's also important to provide stress-management resources for teachers and staff.

Trust FaciliSafety to Help Start the School Year Safely

The school nurse's role as a care provider, advocate, and educator has always been a demanding one, and they're now facing challenges they never could have imagined. School nurses are critical frontline workers for the 2020-2021 school year, and support and collaboration with school staff, administrators, and families is essential to ensuring success.

FaciliSafety is here to help. With nearly 50 years of unparalleled medical-industry expertise and a team of experts ranging from the medical field to consumer and workplace safety, we're uniquely qualified to help you get back to school safely. We also work hard to guarantee customized solutions, friendly, knowledgeable customer service, and thousands of products in stock and ready to ship same day.