School Nurses Reflect on Navigating Challenges and Inspiring Change for a Better Future

BY Brenna Morse

Last spring, my colleagues and I had the honor of speaking to school nurses about their experiences working through the COVID-19 pandemic. We knew from our own work experiences and from hearing the stories of others that school nurses faced many challenges personally and professionally during the pandemic. School nurses were recipients of aggressive behaviors (see news article, after news article, after news article!), managed confusion over disease mitigation policies (again, news piece after news piece!), and risked their own health and safety so that schoolchildren could receive care. These unexpected and harmful situations bothered us, and we were worried that great school nurses would leave their jobs or the nursing discipline all together. Interviewing school nurses to ensure their perspectives and experiences during this monumental time in history were recorded was important to us, as well as finding some ways to ensure they could be supported to do the work they love to do.

During interviews, school nurses told us that they felt overwhelmed, exhausted, and stressed. They talked about significant increases in their workloads due to new pandemic-related tasks like contact tracing. Unclear, unscientific, and unstable guidelines were a significant barrier to promoting public health during the pandemic. Skepticism emerged among the school and larger community, which led students, teachers, caregivers, and the public to turn to unreliable and uncredentialed sources for health information. All of this led to our participants enduring unexpected, angry, and threatening interactions with parents and caregivers.

Our participants also displayed trauma responses, such as recalling the specific date of schools closing and reacting negatively to even the thought of entering their health offices. Some school nurses compared their memories and feelings of pandemic work to those they have about national or global days of historic infamy, like 9/11. They did think about leaving their job or exploring early retirement options in their school districts, but ultimately all of our participants had not changed positions or fields as they held hope for a better future.

Although the work during COVID was challenging, school nurses shared some silver linings. They discussed a renewed focus on health assessment practices, as they could not be so sure even a minor headache or innocent runny nose was not caused by the highly virulent COVID-19 pathogen. School nurses also had a new, or deepened, awareness of disparities in their own school communities and inequities in access to community health resources for each family. A major facilitator of professional practice were interactions with students. School nurses spoke with pride about the resiliency of their students and their positive behaviors as schools opened up following the pandemic closure period.

As we spoke to school nurses in the spring toward the end of the school year, they talked about some changes they wanted to make in the next school year to protect their peace. They spoke about setting boundaries on their work time and their emotional bandwidth. School nurse colleagues need to hold each other accountable for sticking to their boundaries, and make workplaces okay spaces to have such boundaries. School administrators or managers of school nurses also need to support these practices, and respect appropriate work hours, contact guidelines, time off, fair compensation, and manageable workloads for school nurses. School nurses wanted to ensure that any health messaging was consistent across their school and district and also based in evidence. One way school nurses may address this is to create content for students and families about pertinent health topics. Content can be disseminated in school e-mail newsletters, or perhaps social media pages school nurses create for their health office. Creating content is not meant to impose more duties on the busy school nurse, but can be a fun and creative way to promote health and reduce risk in the school community.

Conducting these interviews confirmed that school nurses experienced and overcame a great deal of hardship to care for students during the peak of the pandemic to today. What the school nurses so generously shared with us underscored that with the right support and resources, school nurses can continue to do their jobs effectively and make a difference in the lives of their students.