There was a time when the daily routine of a school nurse involved dispensing medications, disinfecting scrapes and cuts and calling parents to come and pick up a sick child.
But when students return to school this fall in the midst of a pandemic, the weight of new and much more serious responsibilities will fall to school nurses, particularly those who oversee hundreds of students at multiple schools.
Whether you need a Band-Aid or lip balm, Becky Bell’s door is always open. She’s a nurse at Casco Bay High School in Portland who says that one of her favorite parts of the job is talking with students. It helps her get to the root of their health problems, which are sometimes very serious — the kid with a headache who is actually contemplating suicide, the student with stomach pains who is dealing with abuse.
But this year, she fears that cultivating those relationships is going to be harder.
“Yes, the school nurse offices will be severely limited. There won’t be that open door, drop in. If a student has an issue in the classroom, the teacher is going to have to call the nurse first to make sure I’m available so I can see them one at a time. Because if I have student in isolation with possible exposure, I don’t want another student in the office,” Bell says.
By “possible exposure,” she means to COVID-19. Bell will be required to contain any potential cases as quickly as possible. Her role as a school nurse is shifting, and in some ways she’s well prepared. She worked in critical care and emergency rooms for years before deciding to swap her hospital badge for a school badge a decade ago.
Bell says she feels like she’s now returning to the front lines, only less protected.
“The environment is not as safe as an emergency room where everyone is wearing PPE, the protocols are in place. Now we’re pulling students back in indoor congregate settings and then trying to manage their mitigation practices. And they’re teenagers, or they’re six-year-olds,” she says.
Bell says the thought of making sure kids abide by rules calling for them to wear face masks and stay distanced is daunting.
“I just have trouble envisioning a school lunch line with 100 students and keeping them six feet apart. That’s two football fields in length, and I just have trouble figuring that out,” she says.
It’s one of many scenarios that school nurses across the state are going over in their minds, says Janis Hogan, a nurse at Camden Hills Regional High School and the director of the Maine Association of School Nurses. The group has a mailing list that Hogan says is buzzing with questions.
“How are you going to deal with masks? What are you going to do with the kids that don’t want to wear masks? Where are the kids going to put their masks when they eat? Are they going to put them in a plastic bag, are they going to put them on a lanyard?” she says. “There are so many questions non-stop, day and night about ventilation and isolation rooms, and keeping distances, and mask breaks. It goes on and on.”
There are also questions about personal protective equipment. Hogan says the Department of Education is providing some PPE, but it’s not clear exactly what each school is getting and how much. A nurse in southern Maine who doesn’t want her name used says the uncertainty of what lies ahead is weighing heavily on her profession.
“You’ll hear from nurses that they’re feeling pretty overwhelmed. We don’t always feel that we’ve got this, that we can manage all the things that we need to do to do this as safely as we can. We’re tracking down PPE, we’re tracking down protocols, we’re tracking down medical partners to make sure we have the guidance that we need when we need it,” the nurse says.
It’s a lot of work for a job that typically amounts to a party of one at most schools, let alone nurses who serve multiple locations.
Holly Swilo covers four Down East schools: three elementary and one high school. Her hours have been boosted so she’ll be in each school one day a week. But even that, she says, isn’t enough.
“Best scenario would be that I have three clones and I would be in each school every day,” she says.
Since that’s not possible, Swilo says she has to train other school staffers to handle a potential case of COVID-19 when she’s in a different location.
“Thinking about passing on a procedure that I have been educated, trained and have experience for, to someone who really — that’s a big ask for them to do that,” she says. “That’s not what they’re trained for. And it’s a huge responsibility to pass on.”
Even districts that want to bolster their nursing staffs are scrambling to fill positions. There are more than two-dozen job postings on servingschools.com, including one for MSAD 20 Fort Fairfield, where Tim Doak is superintendent. The pre-K through 12 school has two buildings and close to 600 students. Doak says they have one nurse, but the protocols for managing student health during a pandemic amount to an additional full-time job.
“And trying to find a nurse in a regular school year is very tough in and of itself. With all the need in medical organizations around the state that need nurses too with this, with COVID being so prominent, we’re very nervous we’re going to be able to get somebody to help with that,” he says.
Without an additional nurse, Doak says he doesn’t see how the school, which will open under a hybrid model, can ultimately transition to all in-person instruction
As schools and nurses grapple with new protocols, some feel that students shouldn’t be back in classrooms at all. “Cathy” is another nurse who doesn’t want her real name used. She works in southern Maine.
“I’m not looking forward to it, I’m not 100 percent sure it’s the right thing to do, and I think it’s a public health experiment,” she says.
“Cathy” doesn’t think there’s enough understanding of COVID-19 yet — especially how it affects children, given that schools closed when the pandemic first hit. And she thinks some of the framework for reopening schools is at odds with other state guidance, such as the current limits for outdoor spectator events.
“Right now, in our state, 200 people at an outdoor gathering is allowed, and yet we don’t seem to have a problem putting 400 or 500 kids in a building,” she says. “As a nurse, that doesn’t make a lot of sense to me.”
As one nurse put it, she hopes she’s not in a position in the future when she looks back in hindsight and wonders, “What we were thinking?”
Originally published at 5:20 p.m. Aug. 17, 2020.