Illustration by Sébastien Thibault
illustration of a woman in a vise
A typical day for a school nurse can include administering student meds; sitting in on students’ Individualized Educational Program (or IEP) meetings; triaging kids with runny noses, rumbly tummies, and broken bones; providing mental health support; making sure students stay up to date on vaccinations; looking through students’ hair for lice; screening students for eyesight and hearing impairments; preparing EpiPens and any other necessary medical supplies for field trips; and educating staff to administer said devices on said field trips. And all that’s when there’s not a pandemic raging.
Many high school nurses see 60 to 70 kids per day, or about 10 per hour. In Minnesota, there is only one licensed school nurse per 1,403 students (the National Association of School Nurses recommends one per 750, and a much lower ratio for students with daily health needs). Without a professional nurse, some kids with complex health needs can’t go to school, says Deb Mehr, health services coordinator of the Rosemount-Apple Valley-Eagan school district and president of the School Nurse Organization of Minnesota. But since Minnesota law only requires a licensed school nurse if there are 1,000 or more students in the district—and only requires one LSN in a school district of 6,000 students—two-thirds of Minnesota students don’t have access to a licensed school nurse. Schools without LSNs often get by with other staff who aren’t necessarily licensed nurses.
Add onto a nurse’s day all the additional pandemic-related tasks—which can include fielding phone calls from parents whose kids are quarantined; weighing in on social distancing procedures, hand-sanitizing procedures, lunchtime procedures, and hybrid school procedures; and lots of contact tracing—and, well, it’s not good.
“It’s crazyville,” Mehr says.
When schools shut down for COVID, nurses kept going in. And when schools reopened, school nurses kept taking care of all the kids in the building.
“You have the whole building’s worth of kids to keep safe,” says Stacey R. Hurrell, an associate professor in the Nursing Department at St. Catherine University. “Everything’s good when things are running smoothly, but if the school nurse is sick, all of a sudden people notice.”
In Minnesota, a license to be a school nurse requires specialized classes in education on top of being an RN. But most LSNs make less money at schools than they would as an RN at a hospital, Mehr says. People who love working with kids, like Tara Bubar (being a year-round camp nurse would be her dream job), take the financial hit in order to do what they love. But in her 20-plus years of nursing in Anoka-Hennepin schools, none compare to the pandemic years, she says, pulling out a white binder about 1.5 inches thick. “This is my COVID bible,” she says. “It’s everyone here who has had COVID.”
With about 1,700 students, Andover High School is a quieter site for an LSN. But one Monday in November highlights what it’s like for most school nurses during this phase of COVID. Bubar’s week almost always starts with 20–30 voice mails collected over the weekend, and this particular Monday morning was no different—parents calling to ask what to do if a family member or a close contact of a student had COVID, for help understanding the school’s guidelines, for help finding the school’s guidelines.
On this Monday, however, Bubar also found out that a student she knows well had experienced a family tragedy the day before. While she was processing the news, she was called to a bathroom upstairs to handle a chemical use incident that almost turned into a 911 call. Then a call came in from elsewhere in the school: She was needed there on a mental health emergency.
“All of that was before 11,” she says.
And Bubar is lucky. She has a full-time health paraprofessional who can triage the flow of kids coming in for meds or temperature checks if she needs to see a student elsewhere in the building; usually about 30 students come to the health office every day, but that Monday over 60 kids came.
In normal times, kids most often stopped by for cold or flu-like symptoms. The runny noses haven’t stopped, but kids increasingly come in with mental health complaints (or physical complaints that turn out to be rooted in anxiety, Hurrell says).
“I can’t stress enough the mental health that we’re dealing with,” Bubar says. “It was getting worse pre-COVID. We got a fourth counselor [in addition to] a social worker and a therapist contracted to work in the school.”
But a referendum question that would have extended funding for some of those services was voted down this fall. And the time to deal with mental health issues is in short supply, Bubar says. On the Monday after the aforementioned incidents, for example, Bubar participated in a student meeting she felt was important for her own mental health.
“I felt like I needed that—but that’s a half hour,” she says, and she spent much of the time worrying about the student involved in the chemical use incident.
In Hurrell’s nursing classes at St. Kate’s, students discuss the mental health presentations of anxiety.
“They’re coming in for a tummy ache, but these little kids who had never been in school might have separation anxiety,” she says. “And high schoolers and teenagers haven’t been able to be together.”
The nursing staff is hardly immune: Bubar had to take a rare day off while waiting for her own COVID test to come back in December. It was negative—a relief for the building since substitute nurses are rarely available. But despite the general resilience of nurses, despite the support of administration, despite her school staff’s chosen theme this year of self-care, they are burnt out, Bubar says. And Mehr, Hurrell, and most everyone else on the planet concur.
“I went to a school nursing conference in November, and one of the big sessions was on resiliency,” Hurrell says. “We’re in the exhaustion stage. It’s one thing to do this for a while, but it continues on.”
The good news is, despite the myriad current challenges, the future of school nursing still looks bright.
“Our enrollment is strong,” Hurrell says. “Plenty of people want to go out there and be nurses.”
