Nurse shortage could make reopening campuses difficult

School nurses could play a key role in helping school campuses reopen and ensure the health and safety of students and staff during the COVID-19 pandemic, but many California schools don’t have one. In districts that have nurses, most divide their time between multiple schools.

The lack of nurses on campuses can be challenging for schools, which must meet a raft of strict health and safety requirements in order to reopen campuses, including screening staff and students for symptoms of COVID-19, testing and contact tracing, and determining if anyone needs to be removed from the school and quarantined.

“School nurses should be involved in all conversations about school reopening and student health,” said Pamela Kahn, president of the California School Nurses Organization. “But in many districts, nurses aren’t even at the table.”

In the 2018-19 school year, the most recent data available, there were 2,566 school nurses in California, according to KidsData, a report from the nonprofit Lucile Packard Foundation for Children’s Health. That’s about one nurse for every 2,400 students. In some rural counties, like Alpine and Sierra, there are no school nurses.

That means it will likely be teachers, administrators, yard supervisors and other school staff who will have to decide if a sniffle or sore throat is a symptom of COVID-19 or just hay fever.

The lack of school nurses isn’t new. It’s been many years since every school had a nurse of its own to conduct on-campus health screenings, review immunization records, tend to students’ minor medical needs and perform other duties

intended to keep students healthy. But that was before a pandemic required schools that are reopening to follow a list of health and safety protocols that go far beyond most educator’s job descriptions.

“School nurses are not easy to come by,” said Dave Gordon, superintendent of Sacramento County schools. Nurses and speech therapists are hard-to-fill positions because the private sector pays more, he said.

In California, the average salary for a nurse is $113,250, according to a May 2019 survey by the Bureau of Labor Statistics. Meanwhile, the average salary for a school nurse in L.A. Unified was less than $80,000 in 2019, according to the district. In Fresno Unified, a school nurse is currently paid between $56,000 and $91,000 for 185 days of work, according to the district.

School nurses often work fewer days than nurses working in hospitals and clinics, but they have to accept a lower annual salary and must take additional classes and pay more fees to get the job, which requires a School Nurse Services Credential.

A preliminary credential requires at least a bachelor’s degree, a Registered Nurse License, an application, fingerprints and requisite fees. To earn a full credential, a school nurse with a preliminary credential must first successfully work two years as a school nurse and complete a school nurse program at a college or university, which is usually about 22 units of coursework.

Kelly Pagan is the only nurse serving 3,846 students and 475 teachers and other staff in the Enterprise Elementary School District in Shasta County, which is open for in-person instruction five days a week. She started working at the district this school year.

Pagan is assisted by one licensed vocational nurse, as well as health clerks at each of the nine school sites who manage the day-to-day health needs of students, said Annie M. Payne, the district’s director of Special Education and Health. Licensed vocational nurses generally assist registered nurses, but aren’t qualified to be school nurses in California.

Pagan has trained the health assistants to administer first aid, give most medications and monitor things like glucose levels in students who are diabetic. They are also being trained to help with contact tracing.

When Pagan isn’t training staff, she is helping students and staff with their health needs, administering hearing and vision tests, as well as tests to determine if students have special needs that need to be met by the school district.

She tests staff for the coronavirus, does contact tracing and notifies those who test positive that they must quarantine. She also has to ensure that state and county COVID-19 protocols are being followed by schools.

“It’s a one-man show this year ,” Pagan said .“CO VI Din itself is more than a full-time job. So I’m covering three full-time positions to keep the doors open. The pressure is extreme.”

Parents also call Pagan to report coronavirus cases in their families and to ask her for medical information, as well as the rules around quarantining. Pagan says she is sometimes the only access to health care some students have in the community.

“I’m definitely working 24/7,” said Pagan, a mother of four children. “I can’t think of a single weekend I haven’t been on the phone and email.”

As schools reopen, school nurses can expand their role by educating students, families and staff about vaccines, quarantines and other issues; evaluating students who are sick; working with local county public health departments on campus safety protocols; and serving as a general resource for health-related matters, Kahnsaid.

The Centers for Disease Control and Prevention agrees, saying that when a school has a school nurse, the nurse should be the designated staff person to respond to COVID-19 concerns. There is no federal requirement that schools have nurses, although the National Association of School Nurses recommends that all students have direct access to a registered nurse.

There are a number of steps that school districts can take to attract and retain nurses, including paying the fees associated with a nursing credential and pairing new nurses with a mentor, said Michelle Larsen, the health and nutrition director for the Shasta County Office of Education. New nurses were paired with mentors when the county was able to fill nurse positions and had a nurse who had extra time to be a mentor, but currently there aren’t enough nurses to fill all the open positions in the county.

“School nurses are essential for schools and needed to keep students in school, healthy and ready to learn,” Larsen said. “We have open positions and no applicants to fill them.”