Lack of Covid guarantees overwhelms school nurses

Public schools in Hillsborough County, Florida have only had students in classrooms for two weeks, yet Katherine Burdge, school nurse for the district, said she was more stressed than at any time of the coronavirus pandemic.

The district, the eighth largest in the United States, has had to isolate or quarantine more than 13,485 students and employees since early August, and more than 2,650 of them have tested positive for Covid-19. In response, the Hillsborough County School Board on Wednesday ordered a more restrictive mask mandate after hours of debate, defying Gov. Ron DeSantis’ order that mask decisions be made by parents.

“It’s frustrating and overwhelming to be in the position we find ourselves in,” Burdge said. “We have so many children as well as teachers who are either isolated or quarantined right now. It’s really tough for nurses.

“At least we have it,” she added, referring to the new mask mandate. “It’s a guarantee. Nothing is 100 percent, but I hope it helps bring the numbers down.”

Florida Governor Ron DeSantis answers questions about school openings and wearing masks, in Surfside, Fla., August 10, 2021.Marta Lavandier / AP file

With fewer tools at their disposal, school nurses across the country are expressing their frustration and exhaustion even as the school year has only just begun.

This is especially difficult in states like Florida, where political leaders refuse to allow schools to create mask warrants and other policies that could serve as basic safeguards against the delta variant of the coronavirus, which is in rising and increasingly infecting children just as they return to school.

“School nurses here face a moral dilemma as the protocols in place and state-driven do not match their values, education, general science advice, CDC advice, or the American Academy’s position. of Pediatrics, ”said Lisa Kern, director of the Florida Association of School Nurses. “It’s unsettling.”

This cognitive dissonance is particularly harsh as many school nurses have taken on enormous responsibilities during the public health crisis.

In many schools across the country, school nurses often develop mitigation strategies, contact tracing and case management protocols. They perform Covid tests and even help with the administration of vaccines. They also act as public health educators for students, parents, and staff and often take the time to communicate and explain masking, vaccinations, and public health advice.

They must work as frontline health workers and as sounding boards for parents who appear to be divided between outraged opposition to mask warrants and genuine fear that their children may be exposed to the coronavirus.

“It’s impossible,” said Karen Schwind, president of the Texas School Nurses Organization, who works as the health services coordinator at the New Braunfels Independent School District.

“I get calls and hear from parents who absolutely want to keep their children with masks, would like their child to be in a classroom with only masks on and do not want the child in the classroom where he is there are no masks, ”Schwind said. “Unfortunately, that’s just not something that we have the capacity to do at this point. But there is the flip side where parents are absolutely tired of the masks, they didn’t even want them. last year and they don’t send their child to school with a mask on. “

In the district of Schwind, online learning is no longer an option, and it is difficult to know what to do with children who have been exposed to the virus or who have tested positive when they might miss 10-14 school days. Other districts have just restored online learning as an option due to peaks in their student populations.

Stress is wreaking havoc, especially as thousands of children in outbreak-stricken states are forced to self-quarantine in response to the rapidly spreading delta variant. Everything has come to a head as schools reopen and state political leaders remain opposed to mask warrants and other safety precautions.

Many school nursing groups advocate that their members do what it takes to protect their mental health, especially as many express frustration at not having basic safeguards. The concern is that these circumstances may accelerate the kind of pandemic burnout that has caused nurses across the country to quit or find other work.

Hospitals have reported growing shortages of nurses and other healthcare workers during the pandemic. School nurses, often overlooked, were already facing labor shortages that had left schools without health professionals on their campuses, but experts warn it could get worse – if it hasn’t already.

There is no clear tally of school nurses. National Association of School Nurses President Linda Medonca said the latest workforce study conducted five years ago showed that about a quarter of schools in the United States were operating without a dedicated school nurse. .

Medonca said the situation likely only got darker during the pandemic. She and other school nurse leaders have heard of colleagues retiring or moving to other jobs at the end of the 2020 and 2021 school years due to the stress and increasing demands of work during the health emergency. public.

“It has become really difficult because of the politics involved,” Medonca said. “School nurses practice public health, and that’s what they’re going to do in their school communities to keep people safe and healthy, and they’ve gone beyond their normal roles and responsibilities, but this can be really difficult. “

It’s especially difficult in states like Florida and Texas, where governors DeSantis and Greg Abbott, both Republicans, have refused to allow school districts to require masks – even after Abbott was recently tested. positive for Covid. These are the most notable states to have done so; Republican governors and heads of state from Arizona, Iowa, Utah, Georgia, Mississippi, Tennessee, South Carolina and other states have also erected roadblocks .

Many have also limited the ability of schools to deal with Covid cases, and this is having an effect.

More than 20,000 students in Mississippi, who have not yet completed the first month of the new school year, have had to self-quarantine due to their exposure to the coronavirus. That’s about 5% of the state’s student body, but Gov. Tate Reeves, a Republican, remains opposed to mask mandates.

Experts say that opposition from these states to basic precautions will only exacerbate the public health emergency.

“It’s a really tough place to live if you’re a school administrator or a school nurse and you don’t have options available to you that we know work in terms of reducing transmission in schools. “said Dr David Dowdy, epidemiologist. at the Johns Hopkins Bloomberg School of Public Health. “This means frequent testing, forcing children and staff who test positive to stay home and self-quarantine, requiring masks and increasing ventilation.

“We know these things work,” he added, “but without these tools at their disposal, school officials are really in a bind.”

However, some school districts, such as Hillsborough, hold firm against their heads of state.

In Texas, a school made masks a part of its dress code to circumvent Abbott’s decree. Larger districts, such as those serving Dallas, Austin, and more recently Houston, have adopted mandates despite Abbott’s demands.

Three school nurses who work in the Dallas Independent School District said they were relieved the policy was in place and they could focus on serving their students.

“The masking works, and we’ve seen it over the past year or so,” said Dawn Wilcox, a nurse at Lipscomb Elementary School in East Dallas. “We’re at ground zero here, so I was very happy that the district took this bold step, brought back the masks and put the safety of students and staff at the forefront.”

Veronica De La Torres, who is a school nurse at a girls’ college in Dallas, said she was very relieved that masks – “our first line of defense” – are back. The spread of the virus is personal to her as a nurse who also works at the local hospital, where she helped open and close the Covid ward. She once again helped reopen the room because of the recent outbreaks.

“I don’t want anyone to give up hope,” she said. “I’ve been in this battle for too long now, and hopefully we are going to be successful. We just have to come together and really get through this – and I need more parents and their children to wear their masks and make each other. vaccinate. “

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