School nurses have a critical role to play as schools grapple with responding to coronavirus.
They can advise district leaders on how best to communicate key information from health authorities to their school communities. They can oversee their school’s tactics for limiting the spread of the virus, through handwashing demonstrations and talking to parents. And their health expertise can help administrators make important decisions about limiting large group gatherings or ramping up cleaning schedules.
But not every school has a full time nurse—or any type of dedicated health professional—to lean on. Almost 25 percent of schools have no nurse all, according to a 2016 workforce study by the National Association of School Nurses. Nearly 40 percent of schools employed full-time nurses, while 35 percent had part-time nurses, the study found.
In a separate analysis of 2015-16 federal data, the American Civil Liberties Union found that there is one full-time nurse for every 936 students nationally—exceeding the recommended ratio of one nurse for every 750 students.
“I have confidence that some school systems have the nursing capacity to provide factual information to help reduce stigma, to assess students for illness, to educate school communities about those nonprescription interventions that are so essential to health that we should be doing all the time—like washing your hands for 20 seconds, covering coughs and sneezes, cleaning high-touch surfaces,” said Laurie G. Combe, president of the National Association of School Nurses.
“But that’s not the case for every school community.”
By playing the essential public health role, school nurses can free up administrators to make other important policy decisions about how to respond to a coronavirus case or outbreak in their communities, Combe said.
The nurse’s role can range from small to large, said Rachel Orscheln, an associate professor of pediatrics and infectious diseases at Washington University School of Medicine in St. Louis.
“They can include a variety of strategies such as making sure something simple as handwashing is performed routinely in the schools; making sure there is access to alcohol-based hand sanitizers for the children; providing education regarding handwashing.”
They can also review health records to ensure that students are up-to-date on their routine childhood vaccinations, including for influenza.
“Promoting childhood vaccination as a way to keep kids healthy overall—it’s something really important for school nurses to do,” Orscheln said.
And, of course, school nurses should be paying close attention to the symptoms students exhibit when the visit the nurse’s office and to student absences.
So if your school does have a nurse, here are some best practices for how to deploy them right now, as well as practices nurses should avoid.
What School Nurses Should Do During the Coronavirus Outbreak
• Use your nurses or other health professionals to keep current on developments from reputable sources like the Centers for Disease Control and Prevention and state and county health agencies: With the situation changing rapidly—including the number of local cases and states where the coronavirus is present—it’s important for districts to have a designated individual or team keeping track of that information. School nurses are well positioned to do so.
“School nurses are going to be a key player in helping to fill that information [role] for their own schools,” Orscheln said. “They can seek out the most appropriate resources, like ...the Centers for Disease Control, which often provides information for the public. They can be a venue by which that information can be passed on both to the rest of the school and to families. It’s probably likely that people can find information from a variety of different sources, so steering them to the most accurate and up-to-date information is really critical. And health professionals within schools can really serve that role.”
• Establish a relationship with local health departments: Many local and state health agencies have a liaison who works with school districts. School nurses should already be in contact with that individual, but it becomes even more important to do so as the coronavirus spreads in the United States.
In the nearly 54,000-student Klein Independent School District near Houston, Yvonne Clarke, the district’s health services coordinator, is in constant contact with Harris County health officials.
“I am that go-between to get information for our district,” Clarke said. “Then I can translate that into everyday language and share that with other team members.”
Information from the CDC or the county, for example, can be used to help district administrators create educational campaigns, informational letters to parents and guardians, make adjustments to district cleaning schedules, or in some cases, make the decision to close one or more schools.
• Review your district’s and school’s communicable disease plan: School nurses should be part of helping to develop their district’s communicable and infectious disease plans, and while they are commonly reviewed annually, this is a good opportunity to dust them off and make changes to ensure they are applicable to this current unfolding health crisis.
Clarke sits on Klein ISD’s safety and security committee, which is not often the case in many school districts.
She’s also responsible for providing input and updating the sections of the district’s emergency management plan on pandemics and biological incidents, districtwide first-aid requirements, and on managing shelters and mass-care facilities. Nurses are also part of the emergency planning teams at individual schools, she said.
Unlike many districts, Klein ISD has, at minimum, one registered nurse and one clinic assistant at each of its 41 elementary and middle schools. Each of the six high schools has at least two registered nurses and a clinic assistant, Clarke said. The staffing level can increase, depending on enrollment and other conditions, including the number of health incidents at a school.
Melinda Vose, a retired school nurse who will be filling in at Arrowhead Union High School in Hartland, Wis., said while the coronavirus may be a new and evolving situation, nurses have past experiences that set them up well to help schools manage what’s happening now.
“This is a unique situation that we’re in,” Vose said. “But we’re always dealing with outbreaks of influenza, pertussis, or other potentially infectious diseases, monitoring immunization records. So this is just standard nursing practices for nurses.”
• Translate medical information for staff and school community: Every industry has its industry-specific lingo that can be confusing or hard to understand for those on the outside. Nurses can help translate medical jargon and other directives into easy-to-understand language for administrators, principals, students, and parents. And they can collaborate with physical education and homeroom teachers, who both cover health in their classes, on how best to make that information grade-level appropriate. “Having someone with a nursing certification who can interpret that” for people who don’t have the expertise is vital, Clarke said.
Vose and her colleague, Kristi Kirk, also a nurse at Arrowhead Union High, worked in schools during the H1N1 flu pandemic in 2009. They said there is far more demand for information about the coronavirus. As a result, they have been proactively looking for educational materials to share with the superintendent or post around the high school.
• Act as a liaison to answer health-related questions from parents and staff: Parents may need help understanding the information the district sends home. Nurses can play a key role in explaining what that means for individual children in the school, based on their medical histories.
• Model good prevention techniques: Schools have been asking students to wash their hands properly, cough into their elbows, and take other steps to prevent the spread of respiratory illnesses and the coronavirus.
School nurses can run demonstrations, particularly for younger students to show them the correct way to do so.
“It’s probably true that children aren’t always necessarily informed about the best ways to wash their hands and certainly about the amount of time it takes to properly wash your hands,” Orscheln said. “I think demonstrations could be effective.”
What School Nurses Shouldn’t Do Amid the Coronavirus Outbreak
• Don’t wing it: Rely on legitimate health sources, like the CDC and local health departments to get the latest information and make informed decisions.
“The landscape keeps changing and those entities have the most up-to-date information,” Orscheln said. “Any of us trying to make it up as we go along is going to be ineffective.”
• Don’t do random temperature checks: First of all, it would be hard to do. But it would also be ineffective, as it captures a child’s temperature at just that one moment in time, Orscheln said.
But school nurses can check temperatures—as they would have done anyway—if the student comes to the nurse’s office with other symptoms.
“It would be hard to implement a widespread temperature screening, and again, you’re really just getting one data point,” she said. “You check the temperature now, [the student’s temperature] can spike a temperature in three hours. ... Most children who have fever also have other symptoms. They appear unwell; so I think it is unlikely you’ll find significant numbers of ill children merely by screening with temperature alone.”
That’s the policy that Arrowhead Union High is using. The school got a new infrared thermometer, which can measure temperatures from a distance, after concerns about the spread of coronavirus spiked. “It’s just a much easier way to take a temperature, according to Kirk. But temperature checks are only used when a student enters the office and he is not feeling well.
Kirk said she will not be “taking the temperature of a kid who is coming in to get a medication.”