In any ordinary year, Waitsfield Elementary school nurse Clayton Wetzel would prepare for the first day of school by stocking up on Band-Aids and ginger ale, checking immunization records, and reminding parents to pack their child’s inhaler.
This year, Wetzel’s to-do list is exponentially longer, as he seeks to safeguard the 140-person elementary school in Central Vermont from Covid-19. He’s working 10-plus-hour days trying to prepare for myriad eventualities: What if a student takes off their face mask? What if a student with allergies has a runny nose? What if there’s a positive case — or a student’s family member tests positive?
“There’s always the “what if I didn’t think of something?” he said. “That’s what keeps me up at night.”
As Vermont schools open Tuesday with various configurations of in-person and remote education, school nurses have stepped up to engineer a Covid-safe model of education.
Covid has eradicated any conception that a school nurse’s job only involves bandaging scrapes and dispensing ginger ale. They’re now front and center in the effort to reopen schools, helping teachers on classroom setup, coordinating with local doctors, advising superintendents and principals, providing assurance to families.
Administrators have raced to increase the hours of school nurses, and hire more. They’ve layered on a host of new responsibilities to the typical nursing job description.
“A little silver lining [of Covid-19] is it’s shining a light on the crucial role of school nursing in education,” said Sharonlee Trefry, school nurse consultant for the Vermont Department of Health. The reality is, she said, there’s always existed a marriage between public health and education.
Now, the stakes are higher than they’ve ever been. “We don’t want to be the reason that someone gets sick or the school closes,” Wetzel said.
Nurse of all trades
As of last year, Vermont had 250 full-time equivalent school nursing positions, according to Trefry. The number of schools staffed by a nurse is higher than that; many of the state’s smallest schools have a part-time position, or share a single nurse among several schools. Soph Hall, president of Vermont State School Nurses Association and a nurse at Miller’s Run School in Sheffield, estimated the number could be closer to 350.
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Within two weeks of schools closing in March, Hall and the nurses association leadership started offering weekly “town halls” for nurses statewide. They included updates from the Vermont Department of Health and offered advice for self-care — ”take three deep breaths” — and tips on personal protective equipment, and advising parents about help getting food or calling 211.
Over those first weeks, nurses fielded calls from teachers and families, helped ensure the laptops that were distributed to kids were sanitized, and provided remote care to kids who needed it.
When the Agency of Education issued its reopening guidance on June 16, it told schools to appoint a Covid-19 coordinator — a school nurse, if possible — to interpret the dozens of pages of safety guidelines.
Nurses were to help create a plan for high-risk students to return to school, make sure students who were driven to school had a separate entrance from those who took the bus, and consult with teachers to make sure there were handwashing stations, adequate classroom setup, and masks for all.
They applied the guidelines to specific challenges in their own district. Becca McCray, Covid coordinator for the Burlington School District and a school nurse at Edmunds MIddle School, encouraged students to bike or walk to school rather than take city buses, and worked to translate Covid instructions to parents who speak languages other than English.
As a Covid coordinator in the Kingdom East Unified Union School District, Hall spent the summer meeting with local selectboards and the school board to share the district’s plans, and outfitting classrooms with handwashing stations and additional ventilation.
Now, all those efforts will be tested. Reopening plans vary widely district to district. On Thursday, the state teachers union gave Vermont a D+ on its readiness to reopen schools. Local union leaders provided low marks for poor ventilation in classrooms, a lack of bus drivers and substitute teachers, and inadequate statewide coordination.
The state nurses association has also raised its own concerns. The nurses don’t have enough personal protective equipment, Hall said. The association has also advocated for a full-time nurse in every school, an idea that hasn’t been embraced in every district.
People may feel worried, but the state has all the tools it needs, according to Trefry, the state nursing consultant.
“We have a low burden of disease. People know how to prevent transmission,” she said. “We have these four weapons: Wear a face covering, wash your hands, stay home when you’re sick, clean high-touch surfaces, wash your hands. It’s pretty simple.”
A nursing revival
School officials said the pandemic has brought school nursing back to its roots as an arm of public health in the education system.
School nursing started in 1902, when New York City launched a monthlong pilot project to test whether having a nurse on school premises reduced absenteeism by treating the diseases that kept kids out of school. A nurse also intervened to prevent the spread of communicable diseases, by providing treatment or sending kids home when necessary.
It worked, and the idea stuck.
As the population has become healthier in recent decades, the emphasis on school nursing has faded, Trefry said.
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They reverted to “people’s old-fashioned version of education and learning, separating the books from the social, emotional and physical health,” she said. Besides, she said, nurses can seem expensive for cash-strapped districts.
Even before the pandemic, nurses filled a public health role, Wetzel said. He provides vision and hearing exams, and helps connect families with health insurance or a primary care doctor. He knows the kids well enough to recognize when a child with a stomachache is stressed out, or if he’s not getting enough to eat at home. Many students have more contact with a school nurse than with any other health provider.
In schools with a dedicated nurse, “absenteeism goes down, and the number of kids who leave for illness goes down,” he said. “Our job is paramount to the overall health of the child.”
Administrators appear to have noticed.
As of Sept. 1, more than 30 school nurse positions were still open in Vermont, including part-time, full-time and substitute gigs. “There aren’t enough for all schools, and that’s obviously not a good thing,” said Ted Fisher, spokesperson for the Agency of Education.
“Everyone’s looking for nurses,” said Amy Rex, superintendent for the Milton Town School District. She’s advertised for an additional full-time nurse for months, but has yet to hire one. One of the district’s three nurses is serving as Covid coordinator, and has less time to fulfill her normal duties, Rex said.
Beth Kellogg, a principal at Roxbury Village School, recently hired a half-time nurse to serve the 30 students who will attend in-person this year. Kellogg increased the position from one day a week to half-time, but it still took months of searching before finding someone.
“Children have always been ill — ear infections, sore throats, bumps and bruises,” Kellogg said. “With Covid, we needed an extra level of protection.” A nurse provides that, she said.
The hiring challenges aren’t unique to schools; the state already faces a nursing shortage.
A 2018 survey estimated that Vermont would need nearly 4,000 nurses by 2020, a 26% increase. Hospitals’ costs for travel nurses have increased, because they can’t hire full-time staff members. School nurses are even harder to attract: A registered nurse can make close up to double the salary working in a hospital than they would working in a school, according to Hall.
Even after Covid, school officials say the pandemic may lead to an increased reliance on school nurses to prevent disease, not just to treat it.
In fact, school nurses have always filled that role, according to Hall. The pandemic has merely “made us visible,” she said. “That’s been one of the blessings of Covid.”
When kids and their families return to school, there will be delays — waiting for temperature checks, handwashing, and daily questionnaires about their health.
“It is going to alter your day a bit from what it was before, because now we’re going to be stopping the spread of the infection,” Hall said. But students should be assured, she said, “we’re the right people to do that.”
Correction: A previous version of this story incorrectly stated the date when the Agency of Education issued reopening guidelines. It was June 16.
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