The Importance of School Nurses
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:
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:
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.
Consider how nurses are going to manage existing health services, including:
Because of changes to the school's health and safety protocols, school nurses may also need to outfit their offices differently this year. Consider:
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:
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:
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) | |||
Gloves | |||
Eye Protection | |||
Surgical Facemask | |||
Gown/Coveralls | |||
Respirator/N95 |
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 | ||
Soap | ||
Disinfectant | ||
Paper Towel | ||
Signage | ||
Face Shields | ||
Cloth Face Coverings | ||
Gloves | ||
Eye Protection | ||
Surgical Facemasks | ||
Gowns/Coveralls | ||
Respirators/N95 | ||
Partitions/Barriers | ||
Tissues | ||
Social Distancing Floor Markers |
||
No-Touch Foot Pedal Trashcans |
||
No-Touch Soap/Hand Sanitizer Dispensers |
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.
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.
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.
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