Recent media attention highlights the role of school nurses in developing pandemic-related health and safety plans for school-age children. We hope that this brings attention to the need for a stronger school nurse workforce. School nurses provide a valuable yet complex community health service. Putting a priority on solving the school-nurse shortage is long overdue, and the key to preventing and withstanding a community spread disease like COVID-19 or similar future pandemics.
While children have not suffered the brunt of COVID-19, children can bring the virus home, and if carrying the virus when attending school, can expose more vulnerable school personnel. Though the school closures since last spring have been necessary, school closures cannot be indefinite.
Only a balance of population health and community-based strategies such as school health services, along with a robust acute care system in hospitals, can provide the comprehensive response we need to end COVID-19.
In March, the Washington Center for Nursing and the University of Washington Center for Health Workforce Studies published a comprehensive report on Washington’s registered nurses. Alarmingly, only 2.5% of RNs work in school-nurse services. Though the state enrolls more than 1 million K-12 students, many schools share a nurse because they cannot afford their own. And in rural districts, a nurse can travel an hour or more from one school to another. According to Liz Pray, President of the School Nurse Organization of Washington, school nurses are funded by the state at about one nurse per 4,600 students. This number of students per nurse far exceeds the recommendation of one nurse for every 1,500 students established by Washington’s Nursing Care Quality Assurance Commission and the State Office of Superintendent of Public Instruction over 20 years ago (Staff Model for the Delivery of School Health Services, pg. 14): “One nurse per school building is preferred — for safety and equity reasons.”
Though not as visible as hospital nursing, school nursing involves complexities unknown to the general public. Providing health care in a school environment — where children with disabilities, mental-health disorders, special needs or chronic health conditions are entitled to care — has its challenges. School nurses must work independently and are often critical in addressing health disparities resulting from institutionalized racism. The knowledge of resources a school nurse needs to do the job well during typical times is immense.
Behind the scenes, school nurses are proactively planning for schools to reopen. Examples include working with public-health officials to adopt consistent messages to students, parents and staff about COVID-19. They are developing protocols for students and staff when returning to school grounds to prevent community spread. These steps are critical for older or at-risk staff vulnerable to more severe complications from COVID-19.
School nurses train other school staff to identify and track students who may be symptomatic for COVID-19. They work to ease student anxiety and guide teachers, administrative staff and families as they work to keep everyone as safe as possible.
Compounding the need, school nurses are aging and retiring, adding to concerns of a more rapidly shrinking nursing workforce due to decisions to retire early because of the stressful nature of being a nurse during the pandemic. There will need to be a lot of work to replace the loss of school nurses who chose to exit in the near term.
COVID-19 serves as a wake-up call to address gaps in care, such as school nursing. Addressing the school-nurse shortage can help shore up some of our gaps in community health care, which is key to creating communities resilient to any health crisis.