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School Nurses are Critical to the Safety of Our Children


Most parents probably don’t know much about school nurses and the critical role they play in our children’s health.

School nurses are specially trained and certified.  They understand and educate others about normal childhood development; they promote health and safety; intervene with actual and potential health problems; provide case-management services; and actively collaborate with physicians.

This diagram is what comes to my mind when I think of our school nurses:

On March 16th, our Irvine and Tustin schools abruptly closed in order to mitigate the damage caused by the COVID-19 pandemic.  As a pediatrician, member of the Irvine Medical Advisory Committee, and advocate for school nurses, I wanted to learn about what our school nurses are facing right now, and what they will face in the coming months (and perhaps years) as we co-exist with COVID-19.  This is what I learned.

By the time our schools closed, anxiety, fear and misinformation regarding COVID-19 was already rampant.  Teachers across Orange County rapidly responded with remote learning.  Our school nurses were equally engaged.

In the early months of the pandemic, school nurses were engaged in:

  1. Screening ill children for COVID-19;
  2. Providing accurate information about COVID-19 and dispelling bad information;
  3. Calming families whose anxiety levels were skyrocketing;
  4. Providing input at the District level regarding cleaning the environment, screening, staff and student illness, new COVID policies and travel;
  5. Ensuring communication channels with all members of the school community remained open;
  6. Preparing for school closures.

Throughout the pandemic, school nurses have maintained communication with families, especially those with special medical needs.  School nurses are providing referrals and support for our newly unemployed and food insecure families, advising families on safety at home, and dealing with both new and pre-exisiting mental health conditions as a result of COVID-19.

In addition, school nurses are responsible for making sure that students continue to receive their recommended and required back-to school immunizations, renew and adjust IEP (Individual Education Plans) and 504 medical plans, and support families who are facing new challenges and extreme stress.

The California School Nurses Association, along with other partners, are trying to determine how to reopen our schools safely for children and all school district employees.

As the school health professionals, our school nurses must play a critical role in creating a safe environment so that children and parents will feel comfortable returning to school.  How will our students, teachers, school nurses, counselors, psychologists and supporting staff be supported and assessed for COVID-19, including the sequelae and trauma associated with the pandemic?

Do we have a nurse at each school consistent with the American Academy of Pediatrics policy recommendation for a minimum of one nurse at each school?   The short answer is No.

Then, how do we measure up?  Currently, 20 nurses cover 40 schools in Irvine.  In the fall, Tustin will increase by 1 nurse so that they have 7.5 nurses covering 29 schools, which is nowhere close to the recommendation.

Across Orange County, the ratios of credentialed school nurses to students varies widely by district, ranging from 1:1,600 all the way to 1:15,000.  There is only one district in Orange County that has a full-time credentialed school nurse at every school site, and that is the Huntington Beach Union High School District.

Some would respond: Why don’t the school districts hire more health clerks?  No, they do not have the specialized training and expertise of a registered, credentialed school nurse.  When a child needs a more skilled and knowledgeable medical professional to ensure a positive outcome for their health, safety and well-being, the credentialed school nurse must be on site.

In addition to the medical needs of our school children, there is evidence that a full-time school nurse is cost-effective, saving money by preventing disease and promoting health and wellness.

So now what?  I remember City of Irvine Measure BB, authored by former Mayor Larry Agran and teacher Carolyn Inmon, and passed overwhelmingly by Irvine voters in 2012.   Measure BB provided for City funds to be used to increase the overall number of school nurses in Irvine — those administered by both the Irvine Unified School District and the Tustin Unified School District.

Now, it’s time to invest even more in school nurses as we learn to co-exist with COVID-19 and prepare for the future.  What can you do?  Support another Measure BB-2020 both with the Tustin and Irvine City Councils to focus on increased funding for schools — including more school nurses.  We will need financial support more than ever if we are to create a new COVID-19 “Safe School Plan” that will carry us forward in preparation for future threats to our health and safety.

What can parents do?  Support the goal of one full-time trained school nurse at each and every school.  And, communicate your support with your City Councilmembers and your School Board!

To review the American Academy of Pediatrics’ Plan for Students to Return to In-Person Classes, click here.

To access the American Academy of Pediatrics, Orange County Chapter COVID-19 Resources webpage, click here.

To access the California School Nurses Association webpage, click here.

To read the Journal of Pediatrics’ article, Re-Opening Schools Safely: The Case for Collaboration, Constructive Disruption of Pre-COVID Expectations, and Creative Solutions, click here.

To download the American Academy of Pediatrics 2016 Policy Council on School Health
 Pediatrics 2016:137(6) e20160852, click here.

To read the American College of Preventive Medicine’s article, The Impact of Childhood Adversity on Health and COVID-19, click here.

Phyllis Agran, MD, MPH, FAAP
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