School nurses expected to lead coronavirus response in districts
ON FRONT LINES: Health professionals who’ll seek to contain spread not on every campus
The nurses Stacey Diamond supervises in Humble ISD never had “normal” days at work, even before COVID-19 began infecting people in Greater Houston and Texas, causing the governor to close all public schools in the state.
Now, the coming school year seems even more unpredictable. All nurses in the district northeast of Houston are taking contact tracing training offered through Johns Hopkins University and are helping principals map out plans for what to do if someone appears to have been infected with the new coronavirus.
“They’re going to be assessing more for illness and requirements for sending people home,” Diamond said. “And they’re going to be sending people home quicker and not letting them sit in the clinic, so not to expose themselves.”
Exposure may be hard to avoid. When campuses reopen in Texas, school nurses will be at the forefront of containing and responding to possible coronavirus infections in educational settings.
Although the logistics of how students and staff will return re
main murky in most districts, health professionals agree school-based nurses likely will have to train teachers to screen students for potential exposure to the virus, teach students and staff the correct ways to use personal protective equipment, provide breathing treatments for anyone who may struggle and isolate students or staff who may have COVID-19.
Some campuses, however, will be without that extra help.
Texas does not require schools to keep nurses on staff, making it among the 30 states that did not mandate the position as of October 2017, according to the Network for Public Health Law. While some local school districts, including Humble and Cypress-Fairbanks ISDs, have opted to staff all their schools with nurses, 37 of Houston ISD’s 273 campuses did not have nurses working there each day in 2019-2020, according to district records.
Houston ISD declined an interview request but issued a statement saying more campuses would have nurses on site “to respond to the coronavirus pandemic.” Some campuses will share a nurse if there are two schools on the same property or if they have an enrollment of less than 350 students, according to the statement.
“A COVID-19 Nurse Team was created to assist with current trends to reduce exposures,” HISD officials wrote. “Extra PPE has been ordered for the nurses’ protection during daily encounters with individuals that may be COVID-19 positive.”
In schools that do not have nurses, the work of keeping kids healthy often is delegated to teachers and, sometimes, school secretaries, said Laurie Combe, president of the National School Nurse Association and a retired Klein ISD nurse.
The Texas Education Agency does not keep data on how many schools or districts lack nurses nor who serves in that role when none are present. Combe is lobbying TEA to begin collecting that information this year.
“The risk for the schools in Houston that don’t have a school nurse would be the same for any school: Who is interpreting the medical evidence for the staff and helping them to understand how to safely bring students back into the classrooms?” Combe said. “Infection control is a pretty precise science, and often people don’t think of all the little things we need to be concerned with.”
Then there are the nonCOVID-19 illnesses and health issues. Combe and Diamond said families may have skipped checkups or trips to get required immunizations since much of the country shut down in March.
Many school nurses already were swamped when COVID-19 came around.
Carleen Johnson, health service coordinator at Alief
ISD, said at some of the district’s larger elementary schools, between 150 and 200 kids shuffle in and out of the campus clinic each day. The high demand is born out of necessity — about 84 percent of the district’s students are economically disadvantaged, and Johnson said many are not covered by insurance.
“We’re going to have to streamline visits. We will have to go to appointments because after each visit we will have to clean the clinic,” Johnson said. “And we’re still looking at things students normally have, there are still going to be stomach aches and sore throats to take care of. But a lot of those symptoms are closely related to COVID.”
She said her staff likely will have to refer students to free clinics, like the Memorial
Hermann Alief Clinic, which serves Alief ISD high school students free of charge. Even with that additional help, Johnson said the coming school year will look far different for nurses than any in recent memory.
“We’ll be doing 150 percent more just trying to keep everybody safe,” Johnson said.
In the Rio Grande Valley, where counties have ordered refrigerated trucks to preserve the remains of COVID-19 victims and the U.S. Army is helping hospitals care for the sick, two school nurses told the Chronicle they rarely got breaks between injured and sick students before the pandemic.
And although the Cameron County Health Authority and Hidalgo County Judge Richard Cortez ordered schools to postpone bringing students back, and other counties may follow suit, both nurses said they worry about the day students return.
For now, they are workshopping ideas for how to keep themselves and their school communities on Facebook: What type of masks should we wear? How much can we depend on the state and our districts for PPE when even hospitals are struggling to find the right gear? How can we best isolate sick people without getting sick ourselves?
“We’ll probably have the highest exposure, because we’ll see all the sick kids,” one of the nurses said, asking her name and district be withheld because neither she nor her colleague were authorized to speak to the media.
“It’s just waiting for that first person to get sick,” the other said. “Where do we go after that? As soon as that starts, that’ll be interesting to say the least.”