The Four Percent
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When a junior high school student in western Oregon tested positive for the coronavirus last month, Sherry McIntyre, a school nurse, quarantined two dozen of the student’s football teammates. The players had spent time together in the locker room unmasked, and, according to local guidelines, they could not return to school for at least 10 days.
Some parents took the news poorly. They told Ms. McIntyre that she should lose her nursing license or accused her of violating their children’s educational rights. Another nurse in the district faced similar ire when she quarantined the volleyball team. This fall, after facing repeated hostility from parents, they started locking their office doors.
“They call us and tell us we’re ruining their children’s athletic career,” Ms. McIntyre said. “They see us as the enemy.”
Throughout the pandemic, schools have been flash points, the source of heated debates over the threat the virus poses and the best way to combat it. School nurses are on the front lines. They play a crucial role in keeping schools open and students safe but have found themselves under fire for enforcing public health rules that they did not make and cannot change.
This new academic year has been the hardest yet, they say. After a year of remote or hybrid learning, schools generally reopened at full capacity; many did so in the middle of the Delta surge and in the midst of an escalating political battle over “parents’ rights” to shape what happens in schools.
Although 12- to 15-year-olds have been eligible for vaccination since May, uptake has been slow; just 48 percent of children in that age group have been fully vaccinated, according to the Centers for Disease Control and Prevention. The vast majority of elementary school students, who became eligible for the shots just two weeks ago, remain unvaccinated.
Nurses say they are juggling more Covid cases and quarantines — and more furious parents — than ever. “I call myself a fireman and a dentist, because I feel like I’m putting out fires and pulling teeth all day long,” said Holly Giovi, a school nurse in Deer Park, N.Y.
They are, they say, exhausted and overwhelmed. Some say that, for the first time, they hate their jobs, while others are quitting, exacerbating a school nursing shortage that predated the pandemic.
“I loved being a school nurse before Covid,” Ms. McIntyre said. Last month, she resigned.
‘More than Band-Aids and booboos’
Even before the pandemic hit, the job of a school nurse extended far beyond tending to playground scrapes.
School nurses manage chronic conditions, like diabetes and seizure disorders; perform vision, hearing and scoliosis screenings; ensure that students are up-to-date on vaccinations and physicals; assist with the development of personalized educational plans for students with disabilities; help students manage stress and anxiety, and more.
“You’re doing a lot more than Band-Aids and booboos,” Ms. Giovi said.
The majority of school nurses in the United States are responsible for covering more than one school, according to a 2018 study. (One-quarter of American schools have no paid nursing staff at all.) Most make less than $51,000 a year.
“They were understaffed and overworked to begin with,” said Mayumi Willgerodt, an author of the study and an expert on school nursing at the University of Washington.
School nurses are now also managing isolation rooms for sick students, administering virus tests and logging the results, performing contact tracing and tracking quarantine periods, all while trying to reassure worried parents and keeping tabs on frequently changing guidelines.
“We are acting as the de facto health department,” said Robin Cogan, a school nurse in Camden, N.J., and the clinical coordinator of the school nurse program at Rutgers School of Nursing, Camden.
Julie Storjohann, a school nurse in Washington State, spends her days toggling between numerous spreadsheets — for students who have symptoms of Covid, students who have family members who tested positive and students who have been flagged as close contacts of other students with Covid, all of which have different quarantine and testing requirements.
“I am exhausted,” she said. “I was hoping this year was going to be a little better than last year, but it’s actually worse.”
When a student tests positive, Ms. Storjohann begins a laborious contact-tracing process, which can include trying to determine whom the student sat next to at lunch or on the bus. Students have assigned seats on the school bus, she said, but do not always stay in them, so she pores over video footage from inside the bus.
“And I’m supposed to be able to pick out this student and who is around him,” she said. “And they’re wearing a mask, and they’re wearing a hood and hat, and it’s impossible.”
And while the Covid work can feel all-consuming, students still get bloody noses, skinned knees and head lice. “Or there’s a seizure in Room 104,” Ms. Giovi said. “Or the kid that’s got tree nut allergies accidentally ate his friend’s snack, and you’re reading the ingredient list real fast. None of that stops.”
Some nurses said that they had fallen behind on routine back-to-school tasks, such as vision screenings, and no longer had time to provide as much personal attention.
Rosemarie, a school nurse on the East Coast who asked that her full name be withheld, recently noticed a student who was not wearing his hearing aid; he said he had lost it in the building days earlier.
“Pre-Covid, I would have walked around with him and tried to find that hearing aid,” she said. But she had a student in the Covid isolation room and could not leave her post.
Erin Maughan, a school nursing expert at George Mason University, said many nurses were working nights and weekends for no extra pay and were feeling “moral distress” that they still could not get everything done. “At the same time,” she said, “how many hours can one put in?”
The American Rescue Plan, this year’s Covid relief bill, provides funds that school districts can use to hire more nurses, but many struggled to fill open nursing positions even before the pandemic. “There just aren’t people to take the job,” said Linda Mendonça, president of the National Association of School Nurses.
Anger and abuse
The pandemic has also turned school nurses into unwelcome public health messengers, especially when they tell parents that their children must stay home from school for two weeks.
“They just basically hate you,” said Anne Lebouef, a school nurse in Louisiana, who said that she cries several times a week. “They’re yelling at you. They’re accusing you of fear mongering.”
Nurses emphasized that not all parents were hostile, and that they understood why so many are frustrated and upset. Ms. Lebouef said that she had students who have missed more days of school than they have attended because of repeated exposures and quarantines.
“When I have to call this one particular mom, I get so sick to my stomach, and I just want to cry,” she said. “I feel like a terrible person for cheating these kids out of an education.”
For the last year, Ms. Cogan has been running a virtual support group for school nurses across the country. “It’s a safe space for school nurses to share their experiences,” she said, “and to kind of download and say: ‘This is hard. I’ve written my resignation letter 10 times. I’m about to turn it in — can somebody help talk me out of it, help me get through another day?’”
Other nurses have had enough. “For the same pay that we were getting before Covid, having to deal with twice the workload is just too much,” said Ms. McIntyre, who will start a new job as an operating room nurse in December.
The vaccination of children under 12 could alleviate the strain on some school nurses, especially if it reduces the number of students they have to send home from school. (Students who are fully vaccinated do not need to quarantine, the C.D.C. guidelines say.)
But many nurses work in communities where vaccine skepticism is high and relatively few students are expected to get the shots.
Expanded vaccine eligibility could also create new demands on their time. Ms. Giovi said she anticipated a lot of questions from parents about the vaccines, while Ms. Cogan said that she expected many school nurses to take an active role in “building vaccine confidence and leading the efforts for vaccine compliance at school.”
It is a vital job, she said, but also one that may earn nurses even more ire from parents who are opposed to the shots.
As the pandemic smolders on, school nurses had two urgent pleas for parents: to keep their children home when they are sick and — especially, they said — to be kind.
“We’re doing the best that we can do,” Ms. Storjohann said, her voice trembling. She took a moment to collect herself, then added, “It just gets overwhelming.”
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