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Unprepared and Out of the Loop: The School Nursing Shortage Hits Home


School districts across the country are in the process of making a difficult decision: reopen in the fall or keep students at home to limit the spread of the coronavirus. Most health experts, including the American Academy of Pediatrics, agree that it’s best to bring K – 12 students back on campus whenever possible, so they can reap the benefits of in-person learning, socialize with their peers, and access free or discounted lunches as well as healthcare and mental health services. However, schools must take sweeping precautions to bring students back safely, so they don’t spread the disease back to their parents and family members.

For the districts that choose to reopen, they will need to depend on onsite providers, including school nurses, when implementing these new safety policies. However, many schools do not have an onsite nurse. Many nurses who do hold positions within school districts say they do not have a seat at the table when it comes to making these important decisions. 

The Facts on School Nursing

As licensed professionals, school nurses are responsible for the health and well-being of the students on campus. Their responsibilities usually include:

  • Using evidence-based medicine to promote individual and population-based student health
  • Coordinating care with the larger population
  • Advocating for quality student-centered care
  • Advancing academic success

However, the U.S. doesn’t have the best reputation when it comes to school nursing. The National Association of School Nurses (NASN) recommends that, at minimum, each student have daily access to at least one full-time baccalaureate-prepared registered nurse (RN).

Yet, there are only 95,776 full-time equivalent school nurses in the country, compared to the 56.6 million K – 12 students who enrolled in elementary or secondary school in the U.S. in 2019. Just 39.3% of schools employ full-time school nurses, and 25.2% of schools do not have a school nurse.

Furthermore, 81.9% of public schools have a full- or part-time nurse, while just 34.6% of private schools can say the same. Elementary schools are also much more likely to have an onsite provider than secondary institutions.

Preparing for the Worst

This shows us that many schools do not have the resources in place to bring students back on campus safely this fall. 

The APA acknowledges that testing every student for the virus is not feasible in many areas. Testing students before bringing them back on campus is not the best line of defense, according to health experts. Students can still contract the virus in the classroom, even if they test negative at the start of the day. It is also possible that the nasal swab virologic test result can be negative during the early incubation period of the infection.

School nurses will need to help these institutions come up with a way to quickly screen students for symptoms, such as frequent temperature checks. They will also need to help craft containment and closure protocols in case a student tests positive for the virus.

During the early days of the pandemic, school nurses were already working to keep students healthy, disinfecting surfaces, educating students and staff about the virus, and preaching consistent handwashing. When schools closed in mid-March, nurses continued to help their students from a distance. Many went on to educate their local communities regarding the latest prevention methods. Some started working with chronically ill children to help them learn from home. With school out of session, others were checking in on their students remotely using telecommunications.

Today, many nurses are working around the clock over the summer to help their institutions prepare for the coming school year, including both in-person and remote learning.

However, many say they have been cut out of the planning phase. Based on a recent study from the National Association of School Nurses, around 60% of their members were part of the conversation with their school teams concerning COVID-19, while 40% of school nurses weren’t involved in the conversation.

Many nurses have said that the administrators are making the big decisions in a vacuum. 

In addition to preventing the spread of the virus on campus, schools will also need to support the emotional and mental health needs of their students. Many kids have been displaced since the start of the pandemic, while others are suffering from anxiety, depression, and post-traumatic stress disorder. Children from low-income households tend to be the most at risk. 

Separated from their friends and community, many children have had to internalize these issues. Some may be afraid for their own well-being or that of their parents or loved ones. Poverty, food shortages, and overall uncertainty add to these concerns.

Nurses will need to overcome a long list of challenges to bring their students back to school. For now, families, educators, and providers face a lot of unanswered questions, but the sooner we get kids back in the classroom safely, the better off they’ll be.

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