Through the Looking Glass

Reflections From Three School Nurses Amid the COVID-19 Pandemic

Catherine A. Grano, MSN, RN, CSN-NJ; Eileen M. Gavin, MSN, FNP-BC, NCSN; Robin Cogan, MEd, RN, NCSN

Disclosures

Online J Issues Nurs. 2021;26(2) 

In This Article

Abstract and Introduction

Abstract

School nurses play a critical role as public health nurses and are guiding school communities through a global pandemic unlike anything seen in the past 100 years. Due to the coronavirus pandemic and worldwide shutdown, remote education became a necessity. In this article, three New Jersey school nurses share reflections about the COVID-19 pandemic. We illustrate the roles included in the National Association of School Nurses Framework for 21st Century School Nursing Practice, to describe school nurse contributions to address the COVID-19 community spread via contact tracing and care coordination. We describe school nurse advocacy through promotion of legislative inclusion in the state of New Jersey and efforts to mirror vaccine confidence. Our conclusion offers action steps to increase the presence of school nurses in key areas and build a more robust public health infrastructure.

Introduction

We are living through such an unusual time. School nurses play a critical role as public health nurses, guiding school communities through a global pandemic unlike anything seen in the past 100 years. Due to the pandemic and worldwide shutdown, remote education became a necessity. The United Nations Educational, Scientific, and Cultural Organization (2021) reports that more than 1.5 billion students, or 91.3 % of global enrollments, were directly affected by school closures. School nurses have navigated uncharted territories as we traveled from the first few identified cases of COVID-19 in the United States (US) in March 2020 to current times. This public health emergency has demonstrated itself as fluid and forever changing, but nonetheless offers lessons and actionable steps that can inform the future.

Who is better suited to lead the approximately 56.4 million students that were initially projected to attend elementary, middle, and high schools across the US (The National Center for Education Statistics, 2019) than school nurses? Grounded in public health, school nurses have historically been involved in communicable disease surveillance and contact tracing. With this foundation, school nurses are ideally situated to lead a coordinated pandemic response in partnership with the local health department.

In 1902, Lillian Wald appointed Lina Rogers as the first school nurse in New York City (NYC), overseeing 10,000 students in four schools. Ms. Rogers pivoted from a practice of exclusion to one of treatment, education, and return to the classroom, greatly reducing absenteeism (Filiaci, 2016). Ms. Rogers was a leader in the coordination of care; she developed practice standards, actively engaged in disease surveillance and mitigation, and utilized continuous quality improvement strategies. What began as a thirty-day trial period resulted in the beginning of school nursing as we know it today.

The pandemic of 1918 resulted in the closure of many schools for up to four months (Battenfield, 2020). A few school systems, such as NYC, and Chicago, equipped with robust public health strategies that included school inspection programs and healthcare teams, determined that students were "better off in school" and committed to keeping them open throughout the pandemic (Stern, Reilly, Cetron, & Markel, 2010). In recent years, financial cutbacks have taken a detrimental toll on the public health infrastructure, including suspension of needed services and a depletion of school nurses (Stern et al., 2010). The current coronavirus pandemic has further highlighted the need for a robust public health system, one that can provide support during "normal times" as well as during times of public health emergencies.

The World Health Organization (2019) has designated 2020–2021 as the International Year of the Nurse and Midwife, in honor of the 200th birth anniversary of Florence Nightingale. This designation held an extraordinary premonition for school nurses, spotlighting them as the only public health expert in the educational realm. Within this year, school nurses were sought for their expertise, problem solving skills, flexibility, and innovative practice. The National Association of School Nurses (NASN) Framework for 21st Century School Nursing Practice ™ (NASN, 2015; 2016a) provides structure and focus with the five key principles and components of current, evidence-based school nursing practice. The Community/Public Health principle describes the existing components of school nursing practice that were amplified during the COVID-19 pandemic, facilitating a quick and timely response (see Figure).

Figure.

Framework for 21st Century Nursing Practice
NASN, 2015. Used with permission.

In this article, three New Jersey school nurses share reflections about the COVID-19 pandemic. We illustrate the roles included in the framework above to describe school nurse contributions to address the COVID-19 community spread via contact tracing and care coordination. We describe school nurse advocacy through promotion of legislative inclusion in the state of New Jersey and efforts to mirror vaccine confidence. Our conclusion offers action steps to increase the presence of school nurses in key areas and build a more robust public health infrastructure.

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