Kristi Rice and Liz Pray: Now more than ever, we need school nurses

By Kristi Rice, MD, FAAP, and Liz Pray, MSN-Ed, RN, NCSN

With the rollout of the COVID-19 vaccine, it’s time to focus on how we will restart or continue in-person education. Bringing kids back to school is about more than academics, it is about children and adolescents’ overall well-being. Schools are where so many children learn social and emotional skills, get healthy meals and exercise, and access mental health support – things that aren’t adequately replicated online.

School nurses are more critical than ever as we move toward in-person instruction. It is paramount that lawmakers adequately fund the hiring of school nurses to meet the considerable responsibilities of ensuring the safe and healthy return to in-person learning. After decades of cutbacks that have left some districts dangerously thin on school nurses, we owe it to our kids to get them the school nurses they need.

In some places, school nurses are already implementing COVID prevention, detection and isolation measures needed to reopen schools. It is a full-time job, although school nurses can’t give up any of their other responsibilities such as managing health plans for students with serious conditions that require medication during the school day.

In Spokane, school nurse Stephanie Breckon’s days are filled with pandemic response. Each morning, Breckon reviews student attestation forms and contacts families who indicate that a student has any potential COVID symptom or has a sick family member at home. After attendance is taken, she calls every household with a student out sick to learn their symptoms and to do COVID education. When a student is COVID-positive, she must send notifications to all classes and do contact tracing that is shared with local public health.

Students who feel ill or exhibit symptoms at school are placed in a sick room with specially trained staff while waiting for a parent/guardian to pick the child up. Breckon creates a plan for next steps, assisting with COVID testing and confirming students have the resources needed, including food, during their quarantine period, as well as coordinating with teachers to ensure they have access to education.

Breckon meets with the Spokane Regional Health District multiple times a week, working through contact tracing, planning meetings for COVID testing and vaccine rollouts coordinated by public health, and much more.

While her COVID to-do list reads like a full-time job, these duties are on top of her regular work as a school nurse.

Pediatricians have long recommended having a full-time school nurse in every building, but Washington’s reality – and funding – falls far short of that ideal. Nearly half of Washington schools do not have a full-time school nurse.

As health professionals working with school-age kids, we urge the Legislature to invest in school nurses to help get kids back to school safely, with adequate provisions for responding to COVID-19 outbreaks.

Pediatricians are already collaborating with school nurses to ensure individual student health – and pediatricians stand ready to work with schools in creating safe school policies during the COVID-19 pandemic that foster the overall health of children, adolescents, educators, staff and communities and are based on available evidence.

Both the School Nurse Organization of Washington and the Washington Chapter of the American Academy of Pediatrics agree that appropriate planning can ensure a safer return to school for students and staff.

The COVID-19 crisis has laid bare the consequences of a decadeslong erosion of public health; the decline in school nurse funding is no different. This session, the Washington state Legislature has the opportunity to make lasting investments that not only address the crisis of the moment, but also move us closer to the ideal of putting a school nurse in every school. Making this investment now gives our students the ongoing support they need and will ensure we are better positioned to respond to the next health emergency our communities face.

Kristi Rice is a pediatrician in Spokane and a member of the Washington Chapter of the American Academy of Pediatrics. Liz Pray is a school nurse and president of the School Nurse Organization of Washington.