In her nearly 40 years as a school nurse, Patricia Gunter has had to prepare for diseases like swine flu, H1N1, West Nile Virus, SARS, and even HIV, all while dealing with the usual school illness like head lice and chicken pox.
“We’ve put a plan in place every time we’ve had something happen,” said Gunter, a nurse with the Cleveland Metropolitan School District.
But none of those illnesses caused the closure of a school district, let alone an entire state.
With the COVID-19 pandemic, Gunter said plans have to be in place to recognize that a school is an educational facility, not a health facility.
School districts and the state should also acknowledge the lack of resources (and in some cases lack of nurses) facing the districts.
“I don’t think this is going to get any better for a while,” Gunter said. “I do believe that they would be putting all of us in danger to bring us back to school.”
The role of school nurses has grown through the decades, increasingly making them part of the school community and giving them further motivation to find a plan to bring the kids back safely.
If/how to come back
School nurses across the state have had to come up with medical plans that protect the many students and staff who regularly visit the schools, but especially emphasize the needs of students who have intensive medical needs and require daily visits from school medical professionals.
Chelsi Fry, licensed school nurse at New Lebanon Schools, said the two part-time medical assistants that usually work one-on-one with students for four-hour shifts per day have been pulled in for COVID-19-related tasks. The district will be leaving temperature checks up to parents.
As the only licensed school nurse in the district, Fry splits her time between the three buildings, 156 staff members and 1,200 students. This includes some students needing diabetic care, and other daily monitoring.
Still, Fry supports bringing students back to school, because she’s confident in the plans she and her district have put together to keep the facilities safe.
“The face shields that I purchased are very kid-friendly,” Fry said. “They have animals and emojis which are really popular. It something that says I understand wearing a mask is hard, but we can make it a little easier.”
The district has given parents until Aug. 7 to decide whether they want to send their kids to school or continue virtual learning. A hybrid option is also available.
Cleveland Metro Schools have decided to close for the first semester, giving Gunter and other staff a 9-week extension to hone plans for reopening. Union members and district administration formed committees to discuss recommendations and best practices.
The Cleveland school district has 102 school buildings, and full-time nursing services in 25 of them, according to Gunter. School nurses have to attend to students with feeding tubes and tracheostomies, along with other students considered “medically fragile.”
Now the nurses will also have to take temperatures and staff an isolation room in every building, where those exhibiting symptoms can be taken until they leave the school grounds.
“We are going to be very busy,” Gunter said.
Forming a plan
In Gunter’s role on the reopening committees, she focused on getting the school access to PPE, and advising the district on sanitation and air filtration measures that need to be in place.
“We have 102 school buildings, and 10 of them are without air conditioning,” Gunter said. “Really there’s no way you should be putting anyone in a building with no ventilation right now.”
Teachers are allowed to go into their classrooms to remotely teach the students if they choose, and district administration are working to provide Chromebooks and internet packages, according to Gunter.
The first three weeks of the 9-week delay will be professional development for teachers, bus drivers, and school nurses. Whatever plan is put in place, however, won’t work without more money in the school coffers, and Gunter said federal funding is the key to their success.
“(State and federal officials) are saying open, open, open, but we have no money to put this plan in place,” Gunter said.
As the only licensed nurse at New Lebanon schools, Fry already had to balance her work between the school buildings, and now has to put that balance into a COVID-19 plan.
“We don’t have the funds to supply a person to each building,” Fry said.
The school has received grants for personal protective equipment (PPE) and other things, but have tried to save costs by, for example, having night-shift custodians build plastic shields for school offices.
As New Lebanon opens up, Fry plans to make clinics in the schools, and install one-way patterns within the clinics to control spread as much as possible. Isolation areas will be created and the face shields, masks and goggles will be available and utilized. The biggest thing schools will need, according to Fry, is open communication.
“We need to be putting as much work in as we can and parents need to be putting in as much work,” Fry said. “There has to be that communication about if a student is sick, if they have symptoms, and how we go forward.”
Nurses? What nurses?
The Ohio Association of School Nurses (OASN) was already concerned about the lack of school nurses in some districts. But with COVID-19 now pushing the limits of school medical professionals, the problem has been spotlighted.
“This pandemic is highlighting that we need a nurse in every building,” said Heidi Shaw, president-elect of the OASN, and school nurse in the Athens City School District.
A special license is required through the state to be considered an official school nurse, beyond the Bachelor’s degree required to be a Registered Nurse.
School nurses act as a medical contact for students and personnel, but also act as educators and trainers for health promotion and disease prevention, according to the state.
Officials at the OASN said licensed school nurses were hired in 50.3% of school districts in the state as of summer 2019.
“A lot of nursing tasks fall on secretaries and paraprofessionals,” Shaw said. “Since there’s no one else in the building, they do it.”
The National Association of School Nurses pushed for 10,000 more school nurses to be hired in the country. School nurses in Ohio are sharing information from one district to the other, seeking best practices and more specific protocols than the Ohio Department of Education gave in Reset and Restart guidelines.
Recommendations gathered by The Big 8 Plus Health and Safety Coalition, school nurses and practitioners from some of the state’s biggest school districts, combines CDC guidelines with protocols on everything from transportation to eating meals to help districts create their own plan.
The virtual school nurse
Even if schools go to a virtual model temporarily, school nurses are still getting creative with their role, especially in areas where poverty and lack of access to health care affect the lives of their students.
Fry has already formulated a plan outside the realm of school days, preparing for an at-least partially virtual school experience. With a district made up of 60% low-income students, community outreach is something Fry sees as a need.
“Some of our kids, the only health care our kids receive is from the school nurse,” Fry said.
She is considering creating a mobile clinic for her district, and offering telehealth opportunities. She also wants to increase her social media presence to bring back positive updates.
“I just would be reminding parents that this is a hard time, and there are things we can do to just give them a sense of normalcy,” Fry said.
Gunter said on top of their normal duties, the school nurses at Cleveland schools will be volunteering to staff a COVID hotline, to be open for faculty, students and parents with questions.
Fry, Gunter and Shaw —in her capacity as an Athens schools nurse — all said emotional support will be significant as the students continue their new concept of school, and as they come back to in-person instruction.
“It’s not going to be the same environment, and the sterileness of that environment is going to cause some unease for kids,” Shaw said.
Mental health will need to be part of the reopening plan, and the nurses have pushed for counselor intervention along with other medical recommendations.
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