When a middle school student in western Oregon tested positive for coronavirus last month, Sherry McIntyre, a school nurse, quarantined two dozen of the student’s football teammates. The players had spent time together in the locker room unmasked, and according to local guidelines, they could not return to school for at least 10 days.
Some parents took the news badly. They told Mrs McIntyre that she should lose her nursing certificate or accused her of violating their children’s educational rights. Another nurse in the district faced similar anger when she quarantined the volleyball team. In the fall, they began locking their office doors after repeated hostilities from parents.
“They call us and tell us we’re ruining their children’s athletic careers,” Ms. McIntyre. “They see us as the enemy.”
Throughout the pandemic, schools have been hotspots, the source of heated debates about the threat posed by the virus and the best way to combat it. School nurses are in the front line. They play a crucial role in keeping schools open and safe students, but have found themselves under fire for enforcing public health rules that they have not made and cannot change.
This new academic year has been the hardest yet, they say. After a year of distance or hybrid education, schools generally reopened at full capacity; many did so in the midst of the Delta wave and in the midst of an escalating political struggle for “parental rights” to shape what happens in schools.
Although 12- to 15-year-olds have been eligible for vaccination since May, admission has been slow; only 48 percent of children in that age group have been fully vaccinated, according to the Centers for Disease Control and Prevention. The vast majority of primary school students who were eligible for the shootings just two weeks ago remain unvaccinated.
Nurses say they are juggling more Covid cases and quarantines – and more furious parents – than ever before. “I call myself a firefighter and a dentist because I feel like I put out fires and pull my teeth out all day long,” said Holly Giovi, a school nurse in Deer Park, NY.
They are, they say, exhausted and overwhelmed. Some say they hate their jobs for the first time, while others resign, exacerbating a shortage of school nurses who preceded the pandemic.
“I loved being a school nurse before Covid,” Ms. McIntyre. Last month, she resigned.
‘More than plasters and steaks’
Even before the pandemic hit, the job as a school nurse stretched far beyond having a tendency to playground scrapes.
School nurses deal with chronic conditions, such as diabetes and seizure disorders; perform vision, hearing and scoliosis screenings; ensure that students are up to date on vaccinations and physical conditions; assist in the development of personal education plans for students with disabilities; help students deal with stress and anxiety and more.
“You make a lot more than plasters and steaks,” Ms. said. Giovi.
According to a 2018 study, the majority of school nurses in the United States are responsible for covering more than one school. (A quarter of U.S. schools have no paid staff at all.) Most earn less than $ 51,000 a year.
“They were understaffed and overburdened to begin with,” said Mayumi Willgerodt, author of the study and an expert in school nursing at the University of Washington.
School nurses are now also manage isolation rooms for sick students, manage virus tests and log results, perform contact tracing and track quarantine periods, all while trying to reassure worried parents and keep an eye on frequently changing guidelines.
“We act as the de facto health department,” said Robin Cogan, a school nurse in Camden, NJ, and the clinical coordinator of the school nursing program at Rutgers School of Nursing, Camden.
Julie Storjohann, a school nurse in Washington State, spends her days switching between several spreadsheets – for students who have symptoms of Covid, students who have family members who have tested positive, and students who have been marked as close contacts to other students with Covid, all of whom have different quarantine and test requirements.
“I’m exhausted,” she said. “I was hoping this year would be a little better than last year, but it’s actually worse.”
When a student tests positive, Ms. Storjohann begins a laborious contact tracing process, which may include trying to determine who the student was sitting next to for lunch or on the bus. Students have been allocated seats in the school bus, she said, but do not always stay in them, so she watches video footage from inside the bus.
“And I’re supposed to be able to pick out this student and who’s around him,” she said. “And they’re wearing a mask, and they’re wearing a hood and a hat, and that’s impossible.”
And while the Covid work may feel all-consuming, students still get bloody noses, skinny knees and head lice. “Or there’s a seizure in room 104,” said Mrs. Giovi. “Or the child who has a nut allergy accidentally ate his friend’s snack and you read the ingredient list really fast. None of that stops.”
Some nurses said they had fallen behind with routine back-to-school tasks, such as vision screenings, and no longer had time to give as much personal attention.
Rosemarie, a school nurse on the East Coast who asked for her full name to be withheld, recently noticed a student who was not wearing her hearing aid; he said he had lost it in the building days earlier.
“Before Covid, I would have walked around with him and tried to find that hearing aid,” she said. But she had a student in the Covid isolation room and could not leave her post.
Erin Maughan, a school nursing expert at George Mason University, said many nurses worked nights and weekends without extra pay and felt “morally distressed” because they still could not get everything done. “At the same time,” she said, “how many hours can one put in?”
The U.S. rescue plan, this year’s Covid relief proposal, provides funds that school districts can use to hire more nurses, but many struggled to fill open nursing positions even before the pandemic. “There just are not people to take the job,” said Linda Mendonça, president of the National Association of School Nurses.
Anger and abuse
The pandemic has also made school nurses unwelcome public health messengers, especially when they tell parents that their children should stay home from school for two weeks.
“They just basically hate you,” said Anne Lebouef, a Louisiana school nurse who said she cries several times a week. “They’re yelling at you. They’re accusing you of intimidating.”
Nurses stressed that not all parents were hostile and that they understood why so many are frustrated and upset. Ms. Lebouef said she had students who have missed more days in school than they have attended due to repeated exposures and quarantines.
“When I have to call this one mom, I get so sick to my stomach and I just want to cry,” she said. “I feel like a terrible person for cheating these kids out of an education.”
For the past year, Ms. Cogan has run a virtual support group for school nurses across the country. “It’s a safe place for school nurses to share their experiences,” she said, “and in a way download and say, ‘This is hard. I’ve written my resignation letter 10 times. I’m about to hand it in – can anyone help? to talk me out of it, help me get through another day? ‘”
Other nurses have had enough. “For the same salary that we got before Covid, it’s just too much to have to deal with the double workload,” Ms. McIntyre, who starts a new job as a surgical nurse in December.
The vaccination of children under the age of 12 can ease the burden for some school nurses, especially if it reduces the number of pupils they have to send home from school. (Students who are fully vaccinated do not need to be quarantined, the CDC guidelines state.)
However, many nurses work in communities where vaccine skepticism is high and relatively few students are expected to receive shots.
Extended vaccine eligibility could also create new demands on their time. Ms. Giovi said she expected a lot of questions from parents about the vaccines, while Ms. Cogan said she expected many school nurses would take an active role in “building vaccine confidence and leading efforts to adhere to the vaccine in school.”
It is an important job, she said, but also one that can give nurses even more anger from parents who are opposed to the shots.
As the pandemic continues to simmer, school nurses had two urgent prayers for parents: to keep their children at home when they are sick, and – especially, they said – to be kind.
“We are doing the best we can,” said Mrs. Storjohann in a trembling voice. She took a moment to gather herself and then added, “It’s just going to be overwhelming.”