By Lisa Bell, BA, RN, NBCS, and Nanette Perez, BSN, RN, CSN
COVID-19 hit like a hurricane that had not been forecast. In March of 2020, when the governor of New Jersey announced that schools would close for two weeks, no one knew it would be months before most schools reopened. Now, two years later, school children know what it means to be “remote,” “hybrid,” and “in-person.”
The impact of school closures and remote learning on students with disabilities cannot be overstated. It has been devastating. They have missed therapy, instruction, social skills learning, and the routines that help them learn. But just as schools were closing, and the scope of the pandemic was becoming clear, a small group of school nurses working in New Jersey state-approved private special education schools were already planning how to get students with disabilities back to in-person learning. Students are placed at these schools by the local school district through the IEP process, and attend at no cost to parents.
Students had their last day of school on March 13, 2020. Five days later, private school nurses began planning how to get students with disabilities safely back into schools. At that time, the situation was overwhelming, and there was very little information available about the new virus. Bringing students with disabilities back to school meant myriad special considerations based on the needs of the student population, from medically fragile students, to those with autism and psychiatric disabilities. For students with autism, for example, there were concerns about whether students would be capable of wearing masks and following social distancing protocols. For medically vulnerable students, there were added concerns about hygiene and limiting exposure through staffing changes and carefully considered classroom cohorts. For students with behavioral disabilities, there were questions about compliance.
Through a virtual meeting—what would be the first of hundreds—six school nurses shared emerging information. They strategized about school-based infection control, identified ways to procure personal protective equipment (PPE), and discussed concerns. The focus then, as it has been every day since, was on getting students and staff back into school safely.
Over the course of days, then weeks and months, the nurses group grew to nearly 100. They shared ideas, and helped each other create policies, processes, and reentry plans. They shared their anxieties and expertise, and they supported each other every step of the way.
In “normal” times, the role of the school nurse for students with disabilities is already quite broad. A school nurse functions as the liaison between the school and the medical home, and is a “connection point” for many community resources. A school nurse can help students and their families get access to health insurance, coordinate care by communicating between the family and health care providers, and educate families on what health care services are available to their child at school and in the community.
According to the Centers for Disease Control (CDC), school nurses make a big difference in student health and academic achievement and they can save money. Research shows that every dollar spent on school nursing saves $2.20 by preventing emergency room visits and missed time at work when parents care for sick children.
School nursing for students with disabilities is more than Bandaids and ice packs. It is very complex because a high percentage of students have chronic issues such as seizures, mental health issues, food allergies, asthma, and diabetes, and may be on medication. A school nurse is like a solo practitioner in that there is no one else to turn to, and they need a broad skill set. On any given day, a school nurse is also a counselor, a confidante, a hygiene coach, an information and referral resource, a life coach, and a second mother.
School nurses may also see students who present with physical issues that might be somatic: a stomachache, a headache, or anxiety. Sometimes, students with disabilities just need a break, so a school nurse’s office can be a safe respite. Often, the nurse’s office has a few small toys and comfort items like squeeze balls, sensory toys, blankets, pillows, coloring books, magazines, and snacks.
Throughout the pandemic, the role of the school nurse expanded dramatically. School nurses became policy leaders and interpreters of ever changing local, state, and federal guidance. The CDC emphasizes that school nurses have a vital role in keeping schools safe and open for in-person learning during the pandemic while protecting the health and safety of students and staff.
In addition to providing school health services for students, both in person and remotely, school nurses are responsible for evaluating students for COVID-19 symptoms and exposure, and educating staff, students, parents, and community partners on COVID-19 prevention strategies.
Through frequent virtual meetings—sometimes three times a week—the nurses’ group continued to meet, solve problems, create policies, and develop reentry plans.
The first big test came in June, 2020 when a small handful of private schools were approved by the state to open for educational services for Extended School Year (ESY) services, making them the first schools in New Jersey to reopen. Many said that it could not be done… that students with disabilities would not be able to comply with mask mandates, social distancing, temperature taking, and other protocols.
Nurses were on the front line, ready to implement, test, and refine school reentry policies. Students with disabilities reentering private schools that summer did quite well, and for the most part, found a “new normal” months before other students. All the while, the school nurses were on the phone with each other, sharing insights.
School nurses were instrumental in developing individual back-to-school plans. While the state issued guidance, they left it up to each school to develop a plan. That meant that school nurses had to review the state guidelines, weigh the unique needs of the student population, and provide input into the development of a school-wide plan that would work for students with disabilities. Nurses expanded their workload with vaccine updates, forms, school-wide health screenings, medical documentation, temperature and symptom checking, staff training on universal precautions, and data collection and reporting. They also managed COVID-19 contact tracing, collaborated with the local Department of Health, and managed rules around quarantine. As the guidelines and needs shifted, school nurses made decisions in the moment, and offered critical, practical advice to school leaders.
BOX:
Input from school nurses has never been more valuable to school leaders. There are concrete steps school leaders can take to help ensure a productive role for school nurses, both now and in the future:
- Give the nurse a seat at the table. Get their input and expertise up front in planning.
- Make sure there is a team approach to school health and health policies. Make decisions as a group with principals, counselors, and nurses, so nurses are not an island.
- Provide administrative support to nurses who have added responsibility with documentation, email outreach, and other compliance matters.
- Ensure the entire school staff is trained and engaged in supporting/enforcing school health rules.
- Invite nurses to offer input into the IEP process for accommodations and medical needs.
-BOX-
While the pandemic has been devastating to schools, students, staff, families, and communities, there has been a silver lining. Before the pandemic, school nursing was a stand-alone job. Now, in New Jersey, school nurses can call each other for advice and judgment on myriad issues, not just COVID.
Lisa Bell, BA, RN, CSN is the school nurse at Chapel Hill Academy in Lincoln Park, NJ. She was honored by the National Association of Private Special Education Centers (NAPSEC) for her pioneering work throughout the pandemic. She has over 40 years of nursing experience.
Bell studied at Mountainside Hospital School of Nursing and Caldwell University. She is a Certified School Nurse in the State of NJ and a Nationally Certified School Nurse. She is a member of the National Association of School Nurses and the New Jersey State School Nurses Association.
Nanette Perez, BSN, RN, CSN is the school nurse at Honor Ridge Academy in Clark, NJ. A graduate of Kean University, she holds a bachelor’s degree in nursing and school nurse certification from Rutgers University. She has 32 years of nursing experience. She serves as a child advocate, community liaison, and safety and wellness educator and works closely with doctors in matters related to medication and side effects. She is a member of the National Association of School Nurses and the New Jersey State School Nurses Association.
