Six months ago, Kathy and I described in this blog how school nurses were juggling teaching, tracing, and testing responsibilities in schools.  We shared links to resources from our colleagues, including blog posts by NJ School Nurse Robin Cogan in NJ and a NASN School Nurse article by MA School Nurse Liz Flaherty.  We encouraged you to learn with us about how to manage this pandemic in schools in our NEUSHA live and recorded educational programs.

Recently, I updated the School Nurse COVID Ball to include Vaccinating after Liz Pray in WA and Nurse Jenny in CA ecouraged me in their Twitter posts. I also changed the color of the word School Nurse to black to celebrate diversity and highlight your professional contributions during the pandemic. We are thrilled that Liz is using the updated image for her state affiliate Twitter account!  Others are asking for t-shirts and mugs with this image!  We will have these “keepsakes” available for purchase soon and will share updates in our weekly newsletter.  You can sign up for our newsletter here.

Wishing you a most relaxing summer with a break as you can find it from the Teaching, Tracing, Testing and Vaccinating!

Jenny Gormley & Kathy Hassey

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As a nurse of 39 years, I have often asked this question of myself and of my nurse colleagues.  We know when there is a crisis, we will step up to do what is within our professional scope of practice.  Nurses gladly volunteer their expertise often, serving on professional boards, school boards, volunteering in our schools and communities and often with their own families.    Many nurses volunteer with international medical groups to assist people in other countries and their work is incredible. Let’s agree that volunteering should be the professional’s choice, NOT an expectation.

So why do I ask the question?

During H1N1, the need to volunteer to vaccinate our communities was vital, and nurses stepped up to assist.  I worked acute care for 20 years and now have been in the school health specialty for 20 years and I still don’t understand why, especially with this pandemic, every school in this country has not realized that a Registered Nurse is necessary for every school (youth and faculty/staff).  I don’t mean moms/dads volunteering to help, I mean a dedicated RN to assist with surveillance, education, contact tracing, testing and eventually vaccination of those in our community. I came into the School Nursing specialty in 1999 and was surprised at how many times the school nurses were asked to volunteer their professional knowledge and time (school activities, town activities) on a moment’s notice and some were shocked that the nurses weren’t automatically available.  With appropriate notice given, we would be available, but not the day of or day before. 

What is different about the COVID-19 crisis?

It is clear after 12 months we are running a marathon not a sprint.  I have watched school nurses in educational settings work many additional hours especially undertaking school and community contact tracing, without compensation.  All of this work that is done during the evening hours and on weekends should come with compensation.  These school nurses have worked since March 2020, attended many school planning meetings during their “off time”, done presentations to school boards and faculty on the ever-changing COVID-19 guidelines. The hours for contact tracing they have done is astonishing!   I have volunteered for 5 clinics so far and have loved being a professional part of the solution to this pandemic.  Yet, as I have watched my school health colleagues provide hours and hours of personal time to this crisis, I wondered, “Are they being compensated?”.  The answer has been mostly “NO”, it is just expected that you make and take calls at all hours including evenings and weekends.  Some districts or local Boards of Health are compensating their nurses for all of these additional hours. I commend them for recognizing much of this work is over and above their normal duties/hours. Police officers and EMS are compensated for their additional hours worked, yet the nurses are always asked to volunteer.

It should be a choice!

We know that nurses will volunteer, it is in our character to step up in a crisis.  However, this crisis has lasted almost a year and will continue for some time. Volunteering should be the professional’s choice, not just an expectation. School Nurses advocate for their students and quality health services: check out the NASN 21st Century Framework for School Nursing Practice. Listen to two School Nurse Leaders describe how they advocate: New Jersey School Nurse Robin Cogan and Former Director of MDPH School Health Services Anne Sheetz. Choose to advocate for yourself and your colleagues!

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76% say Yes!

We asked school nurses, administrators, counselors, teachers and others this question in our Feb. 8^th newsletter mailing. 875 people participated in this simple poll. 76% responded “Yes” that direct service school nurses are leaders.  Are you curious about the 12% who said they were “Not Sure”? How about the other 12% who said “No”? We are concerned that 24% either do not perceive themselves or their direct service school nurse colleagues as leaders. How can this be true during the COVID-19 pandemic when so many school nurses are leading efforts to reduce disease transmission?

Leaders juggle complex projects

It takes leadership to juggle all these projects. You are teaching your school community about COVID-19 and tracing contacts of students and staff testing positive. You are overseeing testing of symptomatic and asymptomatic students and staff and may soon be administering COVID vaccines in school-located vaccine clinics that you are helping to coordinate.  These initiatives take effective assessment, communication, planning, coordination, implementation, evaluation, and adjustment. Looks like leadership to us!

In fact, our national professional organizations endorse leadership as critical to our practice.  The National Association of School Nurses (NASN) identifies leadership as one of 5 principles of professional school nursing practice in its Framework for 21st Century School Nursing Practice.  The NASN/American Nurses Association Scope and Standards of Practice includes Leadership as one of 12 Standards of Professional Performance for School Nursing.  

Developing the Leader in You!

So, how do you intentionally strengthen your leadership skills when you are challenged with juggling all balls in the air during this pandemic? In the past, you could apply for the Johnson & Johnson/Rutgers School Health Leadership Fellowship or the Healthy Schools Campaign Leadership program. These programs are no longer available to school nurses. You could actively grow your leadership skills in a graduate program and/or by focusing on this topic for professional development in your school district.

Another option is to join a small cohort of nurses from around the country in our monthly virtual School Nurse leadership series.  My colleague Kathy Hassey and I have been teaching these leadership topics for more than 10 years. We teach through Northeastern University School Health Academy (NEUSHA) and in the Cambridge College MEd program for school nurses.  With support from the Northeastern University School of Nursing (accredited by ANCC for nursing continuing professional development) and the School Health Corporation, we are able to invite guest speakers Robin Cogan and John Kriger to our 2021 leadership series.

Prioritizing your professional growth and well-being are key aspects of effective leadership and preventing burnout.  Whether you are a School Nurse Administrator, direct service School Nurse, or a combination of the two, you can be a leader in your own community!

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That giant COVID ball you’re now juggling along with your usual school nursing practice balls?  It’s made up of several not so small balls, including Teaching, Tracing, and Testing.  We hear the challenges of School Nurses juggling with this new outsized ball called COVID.

Teaching

All of you are teaching students, families, staff about ways to reduce COVID transmission. Our school nurse colleague Robin Cogan calls these measures the 6 W’s.  Most of you are also teaching about what it means to quarantine to those who’ve been identified as close contacts to a COVID positive individual in your school community.  Whether you are new to teaching strategies or a seasoned classroom educator on health topics, the urgency for sharing facts effectively about what we can do for individual and community health and safety during this pandemic is clear.  People need to demonstrate new skills to slow the spread of COVID, and you are helping them change behavior.  How exciting is that!

Check out these programs to learn more about general strategies for teaching effectively and how school nurses are teaching health during COVID.

Tracing

Who identifies the close contacts?  In many communities, you are the ones contact tracing with your local or regional board of health officials.  Our colleague Elizabeth (Liz) Flaherty made the case for this role for school nurses in her article published in the November issue of NASN School Nurse.  We hear that you are making and taking phone calls to alert, teach and follow-up with individuals 7 days/week.  This is a pace that is not compatible long-term with your wellbeing and effectiveness – a topic for another blog!  We know you have been key to keeping in-school COVID transmission low.

Check out this tracing program to learn how school nurses are identifying close contacts and collaborating with local boards of health during COVID.

Testing

You’ve been key to testing efforts, too!  Whether you’re referring students to testing sites, coordinating PCR or antigen tests in your schools, or actually administering the tests yourself, you demonstrate your essential role in the public health/health care systems.  Though colleagues in your education system may not express appreciation for your work,  your efforts are noticed by education leaders and journalists.  A google alert feature shows a huge increase in schools nurses identified in related publications across the country.  For example, Education Week, a well-respected news outlet for K-12 schools, featured in-depth interviews last summer with two school nurses who talk about their efforts to reduce COVID transmission. 

Check out these programs to learn more about general strategies for testing effectively and BINAX testing – the science and how school nurses are planning and implementing in schools.

Our society needs school nurses to keep sharing experiences with COVID Teaching, Tracing, and Testing to better support your efforts to keep schools a safe and healthy place for learning.  Thank you for describing the data and telling your stories!

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In a typical day before COVID, your demands as a School Nurse included providing and coordinating care for students with medical challenges, collaborating with public health officials to prevent communicable disease and chronic health conditions, and leading preventive health and quality improvement efforts in schools.  You have been responsible for the health and safety of 200 to 20,000 and more students depending on ratios and workloads, which vary widely across the U.S. and internationally.  And you have been practicing legally and ethically, following laws and regulations related to confidentiality and disabilities while reporting to 3 systems:  health care, public health, and education.

The pandemic has thrown a giant ball into this mix of balls you’ve been juggling.  Since March, you’ve been asked to provide health services virtually, develop training and teach the school community about ways to reduce risk of COVID transmission, and conduct contact tracing with local boards of health. Now, the latest for some of you. . .implement antigen testing for students and staff who develop COVID-like symptoms while in the school building!

In your school district, is there a full-time School Nurse in every school juggling the giant COVID ball?  Do all students have access to a full-time School Nurse who can implement measures to reduce COVID transmission? We invite you to share your successes and challenges with us via email.  In some school districts, School Nurses participate and lead decisions about school health services, and can advocate for more hands on deck during this public health emergency.  Too many districts, however, do not have a School Nurse in every building.  How effective can managing a pandemic in the school setting be without the expertise and skill of a School Nurse?

School Nurses, in this blog, we plan to confirm your experiences and provide support as we can.  By listening to you and creating learning experiences for you, we hope to make it easier to support your successful juggling, especially when you’re juggling a giant ball called COVID. We welcome your ideas; share your thoughts here!

How many school health balls can you juggle successfully? It all depends on whether you’re leading the school health show and how many hands you have!

Jenny Gormley, DNP, MSN, BA, RN, NCSN with Kathy Hassey, DNP, MEd, BSN, BA, RN

NEUSHA Directors

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