How School Nurses Are Handling a Return to In-Person Learning

School nurses will play a vital role in planning and executing a safe return to in-person learning. Nurses are the most trusted profession in the United States and are uniquely positioned to educate parents and guardians about health precautions and how to ensure safety for students and staff alike.

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"I was on the frontlines from the moment the shutdown began in March 2020." — Nurse Debbie Vaccaro, BSN, RN

Schools must weigh different factors in planning returns, including local factors such as the local vaccination rate, number of students, physical layouts of schools, and school transportation. They must also consider different kinds of risks and the trade-offs, such as the risk of children falling behind academically and socially versus the risk of increased spread of COVID-19. There are also political pitfalls, given partisan views of COVID-19. By collaborating with and advising school administrations, parent groups, teachers and staff, and other stakeholders, school nurses can help schools and communities make the right choices and ensure that those choices are carried out effectively.

How the Role of School Nurse Changed Since the COVID-19 Pandemic

Debbie Vaccaro, BSN, RN, describes how her role as a school nurse evolved during the COVID-19 pandemic. "My role has expanded to encompass public health and communication responsibilities in addition to my role as school nurse," she says. "My insights and expertise have been absolutely critical to ensuring the health and safety of our students and staff members during the pandemic."

Especially early on in the pandemic, information, even information from credible expert resources, was often contradictory or incomplete. Nurses helped schools make sense of the rapidly changing information and determine how to apply the latest findings. School nurses also oversaw new practices for school hygiene, the use of PPE, and monitoring student and staff health. They will also need to understand the mental/behavioral impact of COVID-19 and address those needs.

"My role has always been enormously complex... However my role was made exponentially more complicated as a result of the Coronavirus pandemic," says Vaccaro.

The National Association of School Nurses provides resources for safe reopening, including recommendations on the role of school nurses in returning to school. These include:

• Evaluating the ability to perform mass screening, if required.
• Establishing policies and procedures for students or staff who are infected or have an infected family/household member.
• Collecting and distributing data.
• Coordinating care for those who are infected.
• Delivering culturally-competent care.
• Anticipating and addressing behavioral health needs, including providing trauma-informed care for students.

New Responsibilities for School Nurses

With expanded roles have come a long list of new responsibilities for school nurses which must be balanced with existing duties. "I educated our management team, teachers, teaching assistants, clinical and support staff on the ever evolving protocols regarding the virus," says Vaccaro. "I became an expert on all factors of virus treatment and prevention and stayed abreast of a voluminous amount of conflicting information from local, state and federal sources."

Vaccaro also became a certified contact tracer and researched, wrote, and updated her school's reopening plan. In a survey conducted by the National Association of School Nurses, nearly half of school nurses indicated they were responsible for educating staff on COVID-19 infection control measures and 41% reported they were involved with updating or developing reopening plans. Depending on the individual school and its needs, school nurse roles may also include:

• Collaborating and coordinating with local health and school authorities, such as departments of health, school districts, and other government functions.
• Developing and updating policies and procedures.
• Screening students and staff with COVID-19 symptoms, maintaining an isolation room, and reviewing documentation for returning to work or classes.
• Overseeing hygiene, cleaning, and PPE practices.
• Communicating with students, staff, and parents/guardians about prevention, vaccination, policies, and best practices.
• Identifying and debunking misinformation.
• Learning about potential emotional/mental/behavioral health impacts of COVID-19, identifying appropriate measures, providing trauma-informed care for affected students.
• Identifying and addressing special needs.

Creating a School Reopening Plan

School reopening plans establish the thresholds for reopening, create policies and procedures for safe operations, and include guidelines for revising plans as needed. Vaccaro described her role in creating the plan as including "navigating information from state, federal and local authorities...interpreting and communicating rules regarding travel, quarantines, distancing protocols, and reporting requirements...ensuring understanding and compliance with rapidly changing protocols among our staff."

Plan elements include:

• Standards for cleaning, hygiene, and the use of PPE.
• What to do if students or staff have COVID-19 symptoms or are infected.
• Approaches to address emotional/mental trauma.
• Communications guidelines.

School reopening planning should include experts and stakeholders on school administration, health and wellbeing, building engineers, families, local governments, and other parties as needed. School nurses contribute both health and logistics perspectives.

Challenges for Students With Disabilities and Special Healthcare Needs Returning to School

Students with disabilities or special needs face even more challenges returning to school. Vaccaro notes that many students have trouble wearing masks. Additionally, she notes, "our students work closely with many clinicians including speech language pathologists and physical and occupational therapists. These require close contact and masks can be a significant impediment to those sessions." Psychologically, "routine is also crucial for our students and this year has been full of disruptions to their normal schedules."

The National Association of School Nurses provides guidelines for students and staff with pre-existing health conditions that increase the likelihood of COVID-19 complications, conditions like asthma that affect breathing, and mental/health conditions. It also offers guidelines for addressing health equity concerns for school reopenings.

Meet Our Contributor

Debbie Vaccaro

Debbie Vaccaro, BSN, RN, has been the school nurse at ACDS's early childhood education center since March 2017. She received her BSN from Liberty University in 2016. Prior to joining ACDS professionally, Debbie was an ACDS parent and co-president of our PTO. Debbie's sons both attended ACDS and currently are in the 5th grade in Oceanside Schools. In addition to her many work responsibilities, Debbie is a tireless advocate and connects with new parents of babies with Down syndrome, sharing her wisdom, humor and support. In addition to her role at ACDS, Nurse Debbie works with terminally ill and actively dying patients in her capacity as a registered nurse for Northwell Hospice Care Network. Her expertise and empathy are key attributes as she provides end of life care for patients and comfort to their families. Debbie is a true beacon of light for ACDS, her family, and her community.