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School Nurses Strive to Protect Students and Staff as COVID-19 Surges

US News & World Report - Health logo US News & World Report - Health 8/6/2020 Lisa Esposito
Barbara Robertson, a school nurse administrator for the Conroe Independent School District in Texas, serves more than 67,000 students on 64 campuses and almost 8,500 employees. © (Courtesy of Conroe Independent School District) Barbara Robertson, a school nurse administrator for the Conroe Independent School District in Texas, serves more than 67,000 students on 64 campuses and almost 8,500 employees.

One way or another, Texas kids are heading back to school next week. School nurse administrator Barbara Robertson is doing her utmost to keep them safe from COVID-19.

School nurses around the country work with hundreds of students in a single school. In normal times, they are there to care for sick kids, oversee medication administration, and address the physical, mental, emotional and social health needs of students. Now, they are shouldering an even bigger responsibility: helping develop COVID-19 prevention plans as the pandemic rages on.

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As coordinator of health services for the Conroe Independent School District, about 40 miles north of Houston, Robertson has a lot on her plate.

With COVID-19 surging in Texas, Robertson has the health and safety of an entire school district to consider. “We serve over 67,000 students on 64 campuses,” she says. “And we have almost 8,500 employees. Protecting all these people is a daunting task.”

As early as March, the COVID-19 outbreak was forcing changes in how kids would attend school. In Montgomery County, Texas, where the CIS District is located, public schools closed for an early spring break to enable a deep cleaning involving specialized "electrostatic" disinfectant mist sprays.

But the escalating coronavirus threat further disrupted education-as-usual and students have not been back on campus since. So, nurses began planning for every possible contingency for when classes in Texas would eventually resume, whether in-person, virtually or as a hybrid model.

Summer “break” morphed into daily strategy sessions. “We’ve continued to work really nonstop over the summer to get ready for this school year,” Robertson says. “We have developed safety procedures to mitigate the spread of COVID-19 in our schools.”

School nurses around the country, including those in Robertson's district, are grappling with myriad issues such as how to conduct daily COVID-19 screening for employees and students and how to serve breakfast and lunch safely. They're also developing guidelines for entering and exiting school buildings. Among the questions they're pondering: Will school hallways have one-way traffic? How should school buses look, which are practically the epitome of cramped quarters?

They've decided that isolating ill children to prevent co-mingling with healthy kids will require separate care areas and processes, for example. And they're taking precautions to ensure that anyone who comes into close contact with students – be it health clinic assistants or athletic trainers – understands how to prevent the spread of COVID-19.

Challenges have always existed in keeping all students, teachers and other school employees safe, says Robertson, who is a member of the National Association of School Nurses. “COVID-19 has certainly compounded those challenges,” she says. “We want our schools to continue to be welcoming and safe places for learning.”

Robertson’s expanding new role includes dealing with box after box of personal protective equipment and making sure staff members quickly get back up to speed in proper PPE donning and doffing.

“We thought we were going to open back up,” Robertson says. “So we purchased air purifiers for all of our clinics and washable gowns for anyone that’s going to care for a sick student.” Along with standard school supplies like textbooks and whiteboards, protective supplies such as N95 respirators, disposable gloves and hand sanitizer keep rolling into the Conroe, Texas district. Robertson praises the school district for its diligence in securing these essential supplies. During the spring, she says, "Like everybody else, we were trying to get in the line of getting PPE. Our district has said: 'Whatever you need, we need to find a way to get it.'"

Although the majority of students in the district will begin the school year in virtual classrooms, at least for the first few weeks, school nurses are adapting to an uncertain educational environment, figuring out how to work with kids who have chronic conditions remotely and helping all kids learn COVID-19 prevention strategies.

School nurses are well-accustomed to teaching students with diabetes and asthma how to use insulin or inhalers. “But now it’s (also) about how to wash your hands, how to stay healthy, how to wear that mask properly,” Robertson says. It’s also teaching kids about physical distancing, she adds.

In addition, Robertson has been focused on food, since safe distribution of meals falls into the wheelhouse of school nurses. “Feeding children is one of the basic things we do,” Robertson says. “We wanted to make sure that continued.”

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Throughout the summer, some school nurses in Robertson's district have been rising at dawn to screen food distribution and cafeteria workers for COVID-19, making sure they’re safe to provide the daily meals that families rely on, even when school is out of session, she says. Food distribution will continue into the school year, including for families who choose remote learning.

Robertson says the nurses she meets with are highly concerned for their school communities, particularly for the most vulnerable members, at a time when “underlying condition” is now part of the pandemic vernacular.

“They know the child who is with Grandma who has diabetes,” Robertson says. “They know the child whose parent had cancer. They know the teacher who is a cancer survivor and they’re worried about them. And we want to make sure we protect them through our mitigation strategies.” School nurses and clinic assistants will be wearing a gown, face shield and mask when caring for any ill student, she emphasizes.

Keeping potentially infected students away from others will be extremely important this fall, Robertson says. Particularly, as cold and flu season heats up, making caring for and isolating sick kids even more challenging. “We have students with chronic conditions,” she points out. “That could be asthma or cystic fibrosis – and we don’t want them in the same clinic with someone who’s waiting to have their temperature checked for a cough and sore throat.”

In this new COVID-19 normal, nurses may provide care for minor issues right outside the classroom, “kind of like house calls,” Robertson says. That can preempt students from coming all the way to the clinic and possibly being exposed to infection.

On August 12, school nurses in Robertson's district will put their meticulous plans into motion as the fall semester begins. At first, classes will be held remotely. “We’ll slowly add some select students as we ramp up to in-person,” Roberson explains.

The transition to largely in-person classes is expected to take place in early September, according to guidance from the Texas Education Agency. However, target dates to transition kids back into school buildings remain in flux throughout many Texas school districts amid pushback from parents, teachers, health officials and individual school superintendents.

The pandemic is unsettling for school nurses nationwide, just as it is everyone else. “A communicable disease on this level – we just haven’t experienced that,” Robertson says. School nurses are definitely up for the challenge, she adds, but they're worried for themselves and their families.

“We continue to see an uptick in our cases in Montgomery County,” Robertson says, explaining that Houston, a hard-hit region, is just next door. With families who work, shop and spend time in highly affected areas, she says, “We really aren’t in a bubble. What happens around us impacts our community. So we’re continuing to see a high positivity rate.”

Parents, including those whose kids have chronic conditions, are reaching out with concerns for the rapidly approaching school year. Robertson says school nurses are “trying to allay those fears as best they can, with solid plans to take care of their child.”

Robertson’s passion for school nursing shines through, pandemic or not. “My nurses talk about protecting 'their people,'” she says. “Every student, every staff member, all their families – that’s their people. And they’re going to do everything in their power to keep them safe. Kind of like a cross between a guardian angel and watchdog – that’s a school nurse.”

Copyright 2020 U.S. News & World Report

Gallery: 11 photos from around the world show how students can return to school during the pandemic (Business Insider)


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