With nationwide shortage, CT school nurses key amid pandemic

Nurses have historically been kept busy providing medications, caring for students with lifethreatening allergies and dealing with other health-related issues that come up on a given day. But the coroanvirus has made for even busier days since schools resumed last month.

That’s been the case for nurses in Wallingford, where each of the 13 schools has a nurse, in addition to a school nurse coordinator and health office assistants, who are primarily part-time and help with paperwork.

“We feel very fortunate that we’re able to keep on top of everything because we have a nurse in every school,” said Kathy Neelon, the Wallingford nurse coordinator and president of the Association of School Nurses of Connecticut

But that’s not the situation in a quarter of schools across the country, according to the National Association of School Nurses. Thirty-five percent of schools have part-time nurses, the association states.

Connecticut is better than other states in this respect, with many schools reporting to have at least one nurse.

But the coronavirus pandemic has highlighted the need for these professionals and the challenges they face, experts said.

“Having a school uncovered without a registered nurse in it these days—with the complexity of medical issues students have and emotional issues—it would be quite taxing for a non-nurse,” Neelon said.

Sandra Chafouleas, a Board of Trustees professor in UConn’s Neag School of Education, said she has seen more openings than ever before for school nurse and psychologist positions. Districts have become more focused on supporting students’ physical and mental health, she said.

“The school nurse is the central person for monitoring physical health,” said Chafouleas, a school psychologist. “They were already stretched thin with the volume of typical daily tasks like athletic clearance, public health surveillance, and supports for students with more intensive needs.”

Schools should have one fulltime nurse for every 750 students, the Centers for Disease Control and Prevention recommends. This is not the case in some schools.

“It’s just one nurse for a lot of students,” Neelon said.

In some cases, school nurses were furloughed at the beginning of the pandemic, while a small number were even laid off, which Neelon described as “foolish.”

“It took all the time between when we shut down and now to prepare for opening schools,” she said.

Substitute challenge

Finding substitute nurses is difficult because pay is low compared to other areas of nursing, Neelon said.

The pandemic exacerbates this problem because nurses could be out for weeks or months with the virus.

“You really want to try to get your staffing as much as possible so that you have coverage, so you don’t leave that burden to a nonnurse,” Neelon said

This led New Fairfield to hire a float nurse this year, Superintendent Pat Cosentino said. Each of the district’s four schools has one nurse.

“It’s difficult to hire daily subs,” she said.

Retired nurses used to primarily serve as subs, but more active nurses are becoming interested, Neelon said.

“I have a lot of younger nurses working in acute care and eventually maybe looking to get into school nursing, so they’re looking to see what it’s like,” she said.

Districts have not had much trouble filling open permanent positions, Neelon said. Pay is improving and the hours are traditional, unlike at hospitals.

For example, Hartford is close to filling two open school nursing positions. Registered nurses are at all 39 schools.

“We have the necessary nurses we need,” school spokesman John Fergus said.

Neelon said she has heard anecdotally that some districts are turning to licensed practical nurses, who earn less money, but must work under a registered nurse and are not as qualified.

“It’s penny wise and pound foolish,” she said. “You have to hire the person that has the expertise and educational background to oversee all the nuisance of a health office in normal times.”

All districts that responded to requests from Hearst Connecticut Media reported hiring registered nurses.

Stamford does not require its school nurses to earn a bachelor’s degree in nursing, but they must have some experience in related fields, city spokesman Arthur Augustyn said. There is one nurse, hired by the city health department, at each of the 21 schools.

“Stamford has its own challenges hiring school nurses but we do not believe our experience can indicate if there is or is not a nursing shortage in the state or country,” Augustyn said. “Our challenges are offering competitive salaries for the experience we’re asking for from applicants, but we have not had a shortage of applicants.”

School nurses a ‘priority’

Norwalk has 24 full-time registered nurses with bachelor or master’s degrees, school spokeswoman Brenda Wilcox Williams said.

“We do have nurses in each regular school, plus an additional one for a building we are using as extra space to enable social distancing, and a float nurse who fills in where needed,” she said.

Greenwich has one nurse in each of its 11 elementary schools and three middle schools, as well as two nurses in the high school, school spokeswoman Sasha Houlihan said.

Meriden has a nurse in every school.

“Meriden is very fortunate to have a team of public health nurses working in both our clinic and in our school health offices,” said Lea Crown, Meriden director of health and human services. “We have not had any issues filling open positions, now during the pandemic or in the past.”

In Bethel, there are seven registered nurses for five schools. Each school has a nurse, in addition to a district wide health coordinator and a float nurse who covers schools during absences.

Superintendent Christine Carver said this has been the case since before she joined the district in 2014.

“The health of our students has always been a priority to the Board of Education and the school district,” she said.

Challenges facing nurses

Before the pandemic, nurses were needed to support students with complex medical issues, such as diabetes, seizures, lifethreatening allergies and rare diseases, Neelon said. One Wallingford school has 72 students with life-threatening food allergies.

“You don’t really want nonmedical people serving those students,” she said.

Nurses give medications and ensure students have their physical exams and immunizations. Meanwhile, students with ongoing medical issues must have individualized health care and emergency action plans that are revised annually, Neelon said.

“If you don’t have a nurse in the school, those students aren’t getting those care plans,” she said.

Nurses also support students’ mental health, which districts have said they are focusing even more on due to trauma students may have experienced during the pandemic.

“In addition to physical health, school nurses play a critical role in emotional safety as they can often be the first person to see a student, notice something isn’t quite right, and connect to mental health support staff,” Chafouleas said.

Nurses regularly call doctors and families, Neelon said. Wallingford recorded 43,000 student and between 1,5000 to 2,000 staff visits in the 2018-19 school year.

“In COVID, it’s all that, plus COVID,” Neelon said.

In New Fairfield, nurses have handed out personal protective equipment, assisted with contact tracing and worked closely with the health department, Cosentino said.

“They have increased communications with family and staff when there are questions on whether students should come to school, if they are not feeling well,” she said. “The nurses keep track of student absences and follow up with families. Our nurses are dedicated professionals, we are fortunate to have them.”

Nurses must also keep up with the latest guidance, watch for virus symptoms and triage students over the phone, Neelon said.

Chafouleas said school-based health centers may be a good way to fill gaps. Danbury, Hartford and New Haven are among the districts with these centers, which provide physical, mental and/or dental care within schools.

“It may be possible to strengthen availability of services in some locations, particularly if they contract with outside entities,” she said. “In other communities, there may be potential opportunity to build partnerships with medical professionals as well as hire additional supports such as aides or use alternative/ emergency certification pathways.”