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Expert Viewpoint: School nurses at the forefront

After the COVID-19 pandemic forced schools to shut down in March 2020, school nurses were thrust into a pivotal and uncharted role: ensuring that millions of students, teachers and staff could return to and stay in school safely. Eileen Moss, DNP, RN, PEL-CSN, NCSN, an adjunct instructor in the UIC School Nurse Certificate Program and lead nurse in New Lenox (Illinois) District 122, says the pandemic brought both historic challenges and opportunities to lead.

“This is my 20th year in school nursing, and I’ve never experienced anything like this before. As school nurses, we do public health all day long. We’re experts in infection control among children in the school setting, but I don’t think we were prepared for the magnitude of the pandemic – the continuousness and seriousness of it.

The job itself changed. School nurses are used to a school-day schedule: 8 a.m. to 3:30 p.m, Monday through Friday. That job turned into a 7 a.m. to 9 p.m. work day, seven days a week.

We had to keep up with the ever-changing guidance from the CDC and state public health departments. We assessed students with a different lens, assuming any student with symptoms could have COVID-19. We were making decisions about whether students needed a test, or if, perhaps, they had allergies or somatic complaints, such as headache, stomachache or fatigue. If a COVID-19 case was identified after school hours, we had to contact trace and notify parents before the next day, so we didn’t have large-scale potential exposure.

This was in addition to the usual tasks of ensuring compliance with health exams and immunizations, obtaining and administering medications, and developing individualized healthcare and emergency plans.

Now in the second year of the pandemic, school nurses are poised to play a critical role in multiple ways, including identifying mental health and social/emotional support needs of both students and staff. Considering the trauma of the pandemic, somatic symptoms should not be overlooked as they may be associated with anxiety, depression, and school stress. As the health expert in school, the school nurse is in the perfect position to begin a conversation with parents or guardians and initiate referrals to behavioral healthcare providers if indicated.

The CDC recommends that viral testing in schools should be part of a comprehensive approach to all levels of community transmission. That means the school nurse can and should be helping to facilitate testing in schools as well as educating and facilitating vaccination of the school community.

In many districts, school nurses bore a vital role in creating a layered, COVID-19 prevention and mitigation strategy. But not all. The pandemic exposed how much local school administrators value nurses. Districts that did not utilize their school nurses to create their strategies missed out on an opportunity to gain improvements from an expert source.

The alignment of public health and education has never been more important. We, at all costs, must avoid going back to remote learning. Student recovery depends on the return to in-person learning with robust social/emotional support. School nurses are in position to make that happen.

This article was compiled from an interview with Moss and excerpts from her paper, “Roadmap to Recovery: Year 2 of the COVID-19 Pandemic,” which was published in NASN School Nurse, a peer-reviewed clinical resource journal of the National Association of School Nurses.