Laureen Murray’s work day still looks much like what you’d expect for a school nurse: caring for children with chronic conditions like diabetes and asthma, administering medicine, talking to parents.
But Murray, who works in a Colorado school district of around 400 students, has seen her duties expand as her district, like others across the country, prepares to deal with the new coronavirus, or COVID-19.
She’s ordered extra gloves and face masks. She’s studied up on the virus and sent a letter to parents offering advice. And she’s attended a meeting with emergency medical workers in her area to learn about their own plans.
“It changes the focus a little bit,” she said of the coronavirus’ effect on her job in the Cripple Creek-Victor district. “I’ve spent a lot of time to make sure I’m informed.”
As more Americans are diagnosed with illness caused by the new coronavirus, and schools weigh the possibility of closing their doors to help stop its spread, more attention is being paid to school nurses — and how they can both contribute to keeping school communities healthy and keeping them calm and informed when there’s a disease outbreak.
In New York City, officials have pledged a nurse for every school in response to coronavirus concerns. But many districts across the country do not employ full-time nurses or have the ability to quickly add staff — a situation experts say doesn’t necessarily mean schools will be unprepared, but does make responding to fast-changing public health guidance more difficult.
“I don’t know if I would want people to be worried,” said Donna Mazyck, the executive director of the National Association of School Nurses, “but I think that they need to look at the bigger picture. And the absence of school nurses to help in this moment that we’re dealing with COVID-19 means that there is a gap.”
In situations like this one, school nurses can play an important role in keeping school staff, parents, and students informed.
Anne Sheetz served as the director of school health services for the Massachusetts Department of Public Health for 23 years, including during the 2009 outbreak of the H1N1 virus. During that outbreak, she held regular conference calls with school nurses across the state, who in turn kept families up to date — which did a lot to calm parent anxiety.
“Families need to know there’s somebody there they can go to or call,” said Sheetz, who wrote about the leadership role school nurses played during the H1N1 pandemic. “People get scared if they hear different information one week to the next,” she said, but a consistent messenger can help.
As more test positive for the virus, school nurses across the country are doing just that: keeping parents, students, and school staffers informed. In Logansport, Indiana, about an hour and a half north of Indianapolis, principal Christine Hess has encouraged her school nurse to meet regularly with the entire school staff to answer questions and debunk misconceptions.
“There’s a lot of fear right now, and we need accurate information,” Hess said. “Our nurse has been a gatekeeper to our staff and parents, helping them to feel at ease.”
They’re also playing a key role in broader planning. In Chicago, for example, school nurses were told to collaborate with principals to come up with action plans and to closely monitor students who have returned from high-risk countries.
There’s evidence that it makes sense to ask nurses to do so. A call from a school nurse in New York City, for example, helped identify an H1N1 outbreak in 2009. And a survey conducted by researchers at Saint Louis University of nearly 2,000 school nurses in the wake of that outbreak found when school nurses were involved in planning for a disaster or a pandemic, schools ended up with higher-rated response plans.
School nurses also know how to assess whether a staff member or student may need to be tested for the virus — though so far, it appears children with confirmed cases have had milder symptoms than adults. A school nurse knows to ask if the person has a fever or respiratory symptoms, or whether they’ve recently traveled to a country with a higher risk for the spread of the disease, Mazyck said. And as part of the school’s emergency plan, the nurse knows when to call the local health department for further guidance.
“That kind of conversation is very important,” Mazyck said. “You don’t want to waste time.”
But not all schools have a full-time nurse, or a nurse at all, to offer that support.
Across the country, more than a third of school nurses work in three or more schools, according to a 2018 study by researchers at the University of Washington and the National Association of School Nurses. In Western states and rural communities, more than half of school nurses cover three or more schools.
About one in five public schools has no paid nursing support at all, it found.
Some places are taking steps to add nursing staff in response to coronavirus concerns. In New York City, where 137 of about 1,800 schools don’t have permanent full-time nurses or school-based health clinics, officials have promised to fill those gaps in some form.
For Jaye Horvath, an elementary school nurse in Denver, the lack of full-time nurses at many Denver schools is her biggest concern. She’s employed at her school five days a week, but is an exception in the district, where nurses often rotate to several schools each week.
“This concerns me about the safety of our students every single school day,” Horvath said, “and an epidemic like COVID-19 simply highlights what a crisis this is.”
At schools without nurses, many of those tasks fall to other staff, who typically don’t have the same training. In New York City, for example, the city’s education department sent a letter to principals saying if they didn’t have a nurse, another adult would be responsible for asking students who arrive at school with a fever and cough to wear a face mask. If the student had respiratory symptoms, he or she would have to wait in a room with an adult away from other students — while that adult also wore a mask.
Still, school nurses are just one piece of the puzzle. Mazyck points out that nurses typically work on larger teams — including school social workers, counselors and psychologists — to address the health needs of students, and this situation is no different.
School leaders will play a key role in deciding whether to keep buildings open, custodial staff will help make decisions about keeping buildings clean, and teachers will have to decide how to educate students if schools are closed for an extended time.
“I think it’s important that everyone does their part,” Mazyck said.
Chalkbeat reporters Caroline Bauman in Memphis; Melanie Asmar in Denver; Samantha Smylie in Chicago; and Amy Zimmer in New York City contributed to this report.