COVID-19 Will Change School Nursing – Article 2 of 2

The other day I did a poll on the Go See The Nurse Facebook Page. I asked the question, “What are you doing while the kids are “home schooling?” Two choices were presented as pictures: a school house and a private home. I was both shocked and…well…not shocked at the same time. 94% of those school nurses who responded were at home. Here we are, in a medical crisis and most all the school nurses are at home. How is it that the district’s medical staff is not needed during a pandemic? Simple: there ain’t no children at the school houses to take care of (and most of the teachers are home too).

Now, this is NOT a finger-pointing session about how school nurses need to do their parts and help out and all that rigamarole. No siree Bob! That’s up to the individual nurse and the allowances their districts make for them. We have nurses in our Idaho hospitals who are being cross-trained for when the “doo-doo hits the oscillator” (IF the doo-doo ever comes) and they still don’t have much more work than they do on any other given day (though this is not the normal across the nation (or the world)). Many of the clinics are working in shifts. One group of doctors and nurses show up one week and then sit at home “incubating” while the other half of the staff pull the workload the next week.

Right now, your district’s been running all over hell’s half acre worrying about how they’re gonna teach these children at home. Directing the school nurses isn’t a priority. With no kids in the schools, the school nurse is left up to her own resources (though most of us are staying pretty busy…I’m still showing up to the school house each day). This paradigm of being in the middle of a pandemic and sending the children AND the nurses home to quarantine will be revisited after all this is said and done. For us contracted folks, we’ll likely continue to have our jobs through the end of our contracts. For the hourly and non-contracted school nurses, who knows? The one thing I do know is things are likely to change in the near future…ESPECIALLY if the stay-at-home orders continue through the summer and into next August; there are only about 4 months until we are supposed to go “back” to school for the 2020-2021 school year. Do we all feel confident that COVID-19 will “go away” in the next 120 days?

We all have our theories about this virus. The American conversation…the world conversation…is consumed with COVID-19 opinions, blame, conspiracy theories and just a little bit of truth “peppered in” here and there. This is all too new to actually “know” anything (my opinion). We school nurse are definitely talking a lot about this cootie…it IS our conversation.

For the most part, we are all making opinions based on the drama presented to us by the news media (okay…a bit more of my commentary). But has anyone stopped to think about how school nursing will look after we get through this? When we get back to normal…whatever the “new normal” ends up looking like…what will be some of the decisions made about the school nurses? 

I do know one thing…along with hand-washing, hygiene and puberty classes, we school nurses will be teaching the children and the staff how to appropriately and effectively don a mask.

Go! Go! Go! STOP!

I will not talk much about this, but need to mention it before I get to the end of this blog article. Earlier this school year, I found myself performing cares for children that kept me fairly strapped for time. I was as busy as a one-legged cat in a sandbox. Some tasks were necessary, some were parent-insisted tasks and some tasks…well… You are all school nurses; you have school years like that. But, then the child leaves the school for whatever reason (this was a wonderful reason) and all of a sudden, a huge block of time is “handed back” to me. 

The first of the year is full of things to do. From immunization-checking, allergy-reviewing, office-setting up-ing, and 504 / IEP meeting-ing, the first 2-4 months of school are B-U-S-Y!! But, are we as busy in December as we are in September? Sometimes. How does March look (in a normal school year) compared to August? 

I remember in the hospital when we’d have those moments with just a few patients on our particular floor and we’re a bit overstaffed, our manager would move us around to other floors that had staff shortages. We’d get all geared up for one thing and end up spending the next 12-hours doing something else. It was like trying to find the forks in someone else’s kitchen. Sometimes we’d get sent home to collect our $2/hour knowing that just one admission from the ER would result in our being called back into work. Sometimes we’d have to use vacation time to “fill in” our income gaps for those low-census weeks that happened once in a while. Most medical institutions know how to “scale” their staff to meet the institution’s needs often at the loss of either income for the nurse during the slow times and loss of family time during the busy times.

Did We Even Have a School Nurse?

Growing up, I never went to the school nurse (did we even have a school nurse?). We had our not-a-teacher staff like the “lunch ladies” and the “janitor.” (We call them “dietary staff” and “custodians” in this day and age). We kids didn’t think about who worked for whom; we just saw these folks as people who worked at the school. Today, I know that our district contracts out the folks in the cafeteria and the custodial services. These fine folks work right alongside the teachers but the teachers get paid from one place and the other folks get paid from another. Our district classifies us school nurses as “contracted faculty members.” Whatever time commitment is required of the teachers, we school nurses are expected to be right along beside them. But have you ever asked “why?” We work for educational institutions and not medical facilities. What do educators really know about registered nurses? How do they utilize them in a crisis like this COVID-19 pandemic? School districts have one priority at this moment in time: TEACHING THE CHILDREN AT HOME. And that priority is occupying all their workdays (and many of their evening and weekend hours as well). School districts either don’t know what to do with the school nurses or they just don’t have the “bandwidth” to figure out how the school nurse can both be safe and effective during this medical crisis. So, many school nurses sit at home and work on this and that while helping out their children who are all now being home-schooled too. 

Bare with me; I’m getting there…

Parents Now Know How Hard Teachers Work

Speaking of homeschooling children, I need to brag about my 12-year-old. He is rocking the homeschooling and ending the last two weeks with a three-day weekend after getting his stuff done. And! His grades are going up…though they were good grades already and we didn’t see how they could have gone up. However, there are those children that haven’t done one doggone thing for the past two weeks and their parents are beside themselves! There is no structure in their day. Parents with “essential” jobs still have to go to work and leave the children to their own self-study. And, just calling an apple an “apple,” some of these parents ain’t gotta clue as to how to guide their children with math or English (have you noticed how many double-negatives I use in my articles…sheeze!!). 

We school nurses are “meeting” once a week online to “discuss” stuff. I did catch a bit of flack for requesting the meetings happen first thing in the morning and not in the afternoons. “Well, maybe Nurse Kevin can help me get my kids started with their school stuff.” Seems like a fair rebuttal to the token male nurse’s request to “Get ‘er Done” first thing in the morning. My wife even kinda got on to me for suggesting that the meeting be done at 8 or 9 in the morning. Okay…what about the nurse at the hospital or the nursing home? Who’s helping her children? Now hang on before you hit “send” on that hate mail. I QUICKLY conceded and apologized for my male-pattern-insensitivity and agreed to a 1pm meeting each Tuesday. But you still have to ask that question, “what about all the other nurses in the world?” Heck! Pandemic aside, what about our fellow nurses on any given day? I spent years working “short staffed.” Managers had to beg-plead-and-borrow to fill gaps in the schedule. Back in 2004, I worked a normal work-month at one Life Care facility and worked 31 evenings at another Life Care…yes…the whole month of May. The following June and July, I worked most of the evening shifts at that 2nd building. This is aside from the extra shifts, the doubles and the call-offs only to be called back in after a couple of hours of sleep. There’s just not enough nurses to go around. 

Get To The Point Nurse Kevin!

We’ve talked about school nurses and their role…or rather unclear role during this pandemic. We’ve talked about how the school districts contract-out certain disciplines, we’ve talked about nurses at the hospitals on the different floors are being cross-trained for the possible rush of COVID-19 patients, we talked about how hospitals manage their staff based on the hospital’s needs, and we’ve talked about our forever-been nursing shortage. I think that after this is all over with, many school districts will look at their school nurses and wonder if it would be better to have a medical institution manage the medical personnel. A medical institution may consider the challenges of assigning a nurse and her allotted hours in the springtime for a school building’s anticipated needs during the next fall based on the school building’s needs this spring. Basically, most districts plan next year’s nursing hours based on this year’s acuity but we all know things change. So many things can change during the course of a summer that often, when returning to school, the school building who needs more got less and the one that got more really could do well with less.

I think that many districts will look closely at how they can both have school nurses in their school buildings and yet have the nurses provide cares as a scalable service. Soon, we school nurses may find that we will be working in the same schools with our paychecks being provided by a different organization…like from one of your local hospital companies. This may come with a plus: a salary that is closer to the average earned by a registered nurse. And it may come with a few…well…non-plusses: working during breaks and during summers…maybe even filling in hours on the weekends and it nights.  Can you imagine a school nurse working on Christmas morning? If we were working in the schools as contracted staff during this pandemic, I could imagine that right now, school nurses would be doing something somewhere after being cross-trained and moved to a med surg floor or into a clinic until the children return to school. 

Is this a good thing? Is this a bad thing? I don’t know. Just thinking about what school nursing may look like after this pandemic ends is a bit mind boggling. We may end up right back where we started, checking temps and checking hair. But one thing is for sure, someone somewhere in some district will be asking the question, “what are we doing with the nurses?”

Doctor’s Can Bill; Nurses Can’t

One final thought. Consider the age-old question, “Why don’t we have a nurse in every school house?” That question has been asked over and over with the answer usually being: funding. The decision makers have the responsibility of making sure the organization “stays in the black.” Whether or not the money is there to fund having a nurse in every building, the districts say there is not enough (yet some districts will squeeze a quarter so tight the eagle screams). Ultimately, we have to accept our allotted hours as the final answer. But what if you could have a nurse in most every school building and have a doctor too? Maybe a nurse practitioner at least. Many children have insurance of some sort with Medicaid being a pay source as well. Could a doctor or a nurse practitioner bill for services provided in seeing a child in the school’s medical clinic? The clinic could be opened for the general population as well…and right there at the school. Physician visits could be made and medications (from Ritalin to Rx cough medication) prescribed right there at school with that doctor or NP participating in the 504 / IEP meetings.

Can you imagine registration? The mother walks up to register her kinder, “But we have an appointment three months from next Tuesday to get that shot. Can we please just register and I bring the proof then?” I can just hear that registrar’s answer, “Nope! Go down the hall to the third door on the right and Dr. So-and-So will be happy to provide that shot.”

Maybe the clinic is self-sufficient and the district’s responsibility being little more than providing a space for the clinic to exist. Granted there will be a lot of free services for Little-Miss-Every-Day, but that’s okay in this hypothetical scenario; many of the hospitals are non-profit. This will just be a visit that is “absorbed” by the clinic and “eat into” any profits that may end up needing to be spent.

Finally…My Opinion.

Now y’all, I didn’t just fall off the turnip truck. I’m not saying that any of this will come to pass. I have no idea what will happen. The one thing I know is: I don’t like change. I am NOT saying that because of COVID-19 we should completely change the way we school nurses are utilized in the education system. NO WAY! I like my job just the way it is. “That opossum’s on the stump!” (Translation: we school nurses have got it good for the most part). School nursing is a give-and-take. I have a wonderful work-life balance and I sacrifice a bit of income to have that extra time off. I love working with teachers and the children on a day-to-day basis. Y’all know what I’m talking about…sometimes those nurses are just sticks in the mud (not you but other nurses I know!). I’d do this until I retire if I could and because I do love this field of nursing, I’ll do my best to stick with it until the bitter end…or until I make my first million selling my photographs (LOL). And if I have to nurse ‘till I’m 65+…well then…happy to do so. After all, I can get glad in the same scrub britches I get mad in.

Stay safe and stay FARTHER away from folks than 6-feet; that 6-feet rule is close as cat’s breath. I think this thing is droplet and aerosol. That puts us at 15+ feet that we should be staying away from folks. 

Disclaimer: This is only an opinion article and 100% speculation. It’s what-if kinda thinking.

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