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Harvard EdCast: The Need for School Nurses

A conversation about the impact of COVID on school nurses and why every school needs a nurse.
School nurse door

The school nurse does a lot more than just tend to students feeling unwell. Linda Mendonca, president of the National Association of School Nurses, says the school nurse’s office is the health hub of the school community, where everything from COVID to a student’s chronic health issues or behavioral issues may be addressed. So, it’s might be surprising to discover that most schools don’t employee a full-time nurse or that 25% don’t have one at all. 

“Sometimes I think it's hard for the education world to understand public health and health," Mendonca says. "And in the past, it's not always been a priority in schools; however, in a pandemic, it is.”

In this episode of the Harvard EdCast, Mendonca discusses the need for school nurses and how school administrators can offer more support to their nurses

TRANSCRIPT:

Jill Anderson:  I'm Jill Anderson. This is the Harvard EdCast.

Linda Mendonca says the school nurse's office is the health hub of a school community. She's a nurse and the President of the National Association of School Nurses. She knows firsthand that a 21st century school nurse addresses issues like student mental and physical wellbeing, chronic health issues, behavioral issues, and barriers to healthcare access. In some places, the school nurse might be the only healthcare provider, a student ever sees. Then there's COVID, with not enough school nurses to go around, especially in schools that need them the most. This is a challenging time. I wondered a lot about what could be done and how to increase support for school nurses. But first I wanted to hear more about how COVID has impacted school nurses.

Linda MendoncaLinda Mendonca: We're entering really our third school year that's been impacted by this pandemic, and we're still in the midst of it. It's been a lot. School nurses a year ago at this time, we're navigating through all the protocols and doing contact tracing. And, then at the end of the 2021 school year, things were starting to look a little more hopeful and people, I think, thought that we were going to enter this new school year in 2021 in a different way.

But as we know with the Delta variant, that didn't quite happen. And so we are still using all of those mitigation strategies and protocols, and there are a lot more students in the buildings this year, many had gone back last year, but in increments, if you will, and now for the most part, I think everyone's back. So we have large numbers of students and trying to deal with the mitigation strategies. I think the pandemic really certainly has demonstrated the value of a school nurse. They've really been essential members of pandemic preparedness and the whole reopening, working with the local and state health departments, using CDC guidance to make sure that protocols and mitigation strategies were in place.

Jill Anderson: This is something I'm thinking about, which is kid vaccination, which we hope, for the younger set, will be coming up shortly. In Massachusetts where I'm based, we're hearing chatter about potentially giving the vaccine out in schools. And so I'm wondering for nurses the role that they might play in administering those vaccinations, which I am guessing will vary depending on the state, depending on the school. Right?

Linda Mendonca: Yeah. Absolutely. School nurses have been part of the vaccination effort, even when staff and teachers became eligible earlier this year. And so they were there helping. And you're right, it looks different in every state. It depends how it's rolled out, how the health departments do that. Many times they use vendors to help to get that going. But school nurses are really key in coordinating that and having those school located vaccine clinics in their school buildings, it means working together as a team and collaborating with those agencies to make sure that that's going to happen. The school nurse is really a trusted person in the school community that parents look to and school nurses are key in this vaccine effort. For sure.

Jill Anderson: So you mentioned the value of school nurses. And one of the things that's interesting about that is there's this increased call for school nurses. There seems to have been a shortage for some time. And so what can you tell me about the shortage, why it exists and how schools can kind of work to get past it?

Linda Mendonca: Pre COVID and back in 2016, the National Association of School Nurses worked with a partner to do a workforce study. And so this data's a little old, but at that time they found that 35.3% of schools employed a part-time school nurse across the country and 39.3% employed full-time. So that meant about 25.2% of schools did not employ a school nurse at all. So there has been this shortage that existed prior to COVID. I think a lot of it has to do with funding, also understanding the value of having a school nurse, but since the pandemic there have been school nurses who maybe were on the cusp of retirement and this pandemic kind of sealed the deal for them to think about doing that sooner. It's been a challenge for school nurses, they're on the front lines and they're the ones telling a parent that their child has to quarantine, or they may have tested positive.

We know what's been happening across this country around different mandates, around masking and so on. They've taken some abuse, verbal abuse from parents and also working with school administrators can be challenging too. Sometimes I think it's hard for the education world to understand public health and health. And in the past, it's not always been a priority in schools, however, in a pandemic it is. So there are several reasons for the shortage, I think, but definitely looking at funding. I mean, there are a couple of legislative initiatives, the Nurse Act, which has been introduced at the federal level and trying to increase funding to secure more school nurses. And then the American Rescue Plan also provided funding for public health workforce. And it went to the states. Also states had their ESSER funds, the education world. But were school nurses at the table for those conversations? And it's been challenging. I think it's a systems problem, if you will. And how things get rolled out and making sure that the school nurse is at the table. It's so important.

Jill Anderson: What do you often hear from school nurses nowadays about how they're doing?

Linda Mendonca: So, currently at this moment, it's a lot. Yeah. I hate to use the word drowning, but just the beginning of this school year was not what we thought it was going to be, back in June or May. So there are more students in the building. Some of the protocols are a little challenging, looking at sending students home with one symptom, for example. And again, this varies across the country, what the protocols might look like. I think most are looking at what CDC puts out and kind of working from there. But again, you have to look at your own school community, the transmission level of the virus and make those kinds of decisions. So they're doing contact tracing. So they're dealing with symptomatic students and then dealing with their normal responsibilities. And honestly, started the school year, a little tired from last school year. And I'm sure many were able to take some time, but you know, we're all still living in this pandemic. And so it's not probably the typical summer break that you would have. And so when you start not as recharged as you normally are, it also makes it difficult.

Jill Anderson: Yeah. You mentioned the challenges of this being a system issue, but one of the things I picked up on is how some administrators have much better relationships and things are going well versus maybe in some other schools. I think that's probably normal for a lot of things. So what can school administrators do to help fully support their school nurses?

Linda Mendonca: The first thing that school administrators need to do is to recognize the school nurse for their expertise, for their knowledge, they are the health expert and they need to include them in decision-making and to utilize them for how they can help to make their school community healthy and safe for their students and staff. And that can be accomplished by working together and talking and working through it. And sometimes there tends to be this control issue if you will. And like you said, it's dynamics, right? I think that it's important for them to incorporate and include the school nurse in these conversations and not even just the pandemic, but in all things, health related.

Jill Anderson: One thing I learned about many years ago was the school nurse's office is really a first line of defense for children who struggle with mental health issues, struggle with anxiety. And I'm not sure a lot of people think about the school nurse office in that way. And right now we have so many kids who even as a result of COVID are struggling.

Linda Mendonca: Yeah. Absolutely. School nurse really is the sentinel in the school. Most of the time, it's some kind of a psychosomatic complaint, whether it's a stomach ache or a headache, or they're tired. Most of the time students don't say, well, I'm depressed. So I'm going to go find the social worker, right? So they end up in the nurse's office and the school nurse will do an assessment, by asking questions, get to the root of what really brought them to the nurse's office. And in that sense can then do what he or she needs to do, whether it's reach out to the parents or do reach out to the social worker, the school counselor, wherever the mental health clinician is in the school setting and really start to help the student. The other thing that I think along with not recognizing the school nurses part of this mental health, is they're not recognized as part of the mental health team, because they're not by definition mental health clinicians, but they absolutely need to be part of the mental health team.

They need to all be working together. So if it's the school social worker, the counselor, if there's a school psychologist who might be part of that team, but the school nurse absolutely needs to be part of that work and needs to be recognized as part of that mental health team. And I mean, I have heard even a Commissioner of Education, not recognize the school nurse. We all need to be working together for a student and to do that, we have to be talking and collaborating and school nurses absolutely needs to be part of that mental health equation.

Jill Anderson: What you're saying is so interesting, because it's a little bit scary to think about what might be going missed inside schools, just because the nurse isn't there. Have you seen any successful advocating or heard of any successful advocating from the community or the parents to get school nurses into a school?

Linda Mendonca: There are some states that actually, especially with this American Rescue Funding have really developed plans and not really talking totally on a national level here, but that parents that have students with chronic health conditions and have been told, well, you need to move, your child has to go to a different school. Because there's just full time school nurse at this school. It was within the same district, but maybe not be the school that their sibling is going to. Like they're asking them to move out of their neighborhood school, to go to another school. And parents in those cases have definitely advocated and really fought for that. It's always one of those things where if it impacts you, that's when you will speak up. But I think many school nurses have reached out to like PTAs, PTOs to advocate for more school nurses.

Jill Anderson: I'm concerned that maybe there'll be an increase in the numbers of school nurses, and then we'll see a fast drop off, when it seems like they're so well needed because of the many different roles that they play. Right?

Linda Mendonca: Yeah. I mean, I have seen an increase in hiring because schools that didn't have a school nurse, wanted one right now, especially like you said, during this pandemic. This is our opportunity for, especially for the National Association of School Nurses, this is our opportunity to really message. And we're demonstrating now the importance of a school nurse, for sure. But absolutely it's an equity issue that every student in this country has a school nurse and that's not the case right now. We need everybody, communities, families, parents, we all need to be yelling loudly that our schools need to be staffed with a school nurse.

Jill Anderson: Linda Mendonca is the President of the National Association of School Nurses. She also teaches community public health nursing at Rhode Island College School of Nursing and works as a school nurse consultant for the Rhode Island Department of Health. I'm Jill Anderson. This is the Harvard EdCast produced by the Harvard Graduate School of Education. Thanks for listening.