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School Nurses: Critical to School Reopening


My professional organization — the 67,000-member American Academy of Pediatrics — strongly advocates reopening America’s schools with in-person, traditional classroom learning…if it can be done safely.

But, can it be done safely?  And, how?  Here in Irvine — as everywhere else — pediatricians, school nurses, teachers, parents and community members have been hard at work, struggling with the practical difficulties of ensuring safe return to school for everyone.  One thing is clear to me: No matter what reopening plans emerge, we must have our essential school health workers — School Nurses — in the lead.

Our School Nurses are the qualified experts to take the lead.  In meeting all of their other responsibilities for the health and safety of the school community, they have the population-based health knowledge to be able to address the Coronavirus emergency.  They know how to screen, triage and care for students, staff and visitors who may come to school with COVID-19 symptoms or develop symptoms while on campus.  School Nurses are also central to the continuing health education and preventive measures — masking, hand-washing, and so much more — essential to reducing the risk of spreading the virus in the school community.

Here is the overriding problem: It is shameful that for years we have not had enough School Nurses to cover all Irvine schools — both IUSD and TUSD schools in Irvine.

Do we have a School Nurse at each school, which is the national standard prescribed by the American Academy of Pediatrics?  No!  We are not even close.  Can we substitute “health clerks” for professionally trained and licensed School Nurses?  No!

Pay attention to these figures: Currently, IUSD has 21 FTE (full-time equivalent) School Nurses covering 43 schools.  We need to hire 22 additional School Nurses to bring Irvine up to the national standard.  The average cost of 1 FTE School Nurse is roughly $100,000 per year.  Accordingly, the cost of hiring 22 additional School Nurses would be about $2.2 million per year.

The growing magnitude of the Coronavirus public health emergency requires an emergency response for the next 2 to 3 years.  The City has a “Rainy Day Reserve” with a current fund balance of more than $50 million.  The City of Irvine should come to the aid of the school community — and our entire Irvine community — by immediately allocating $2.2 million per year for the sole purpose of hiring School Nurses to manage the COVID-19 crisis so our schools can reopen safely … and stay open safely.


To read the American Academy of Pediatrics (AAP) Policy on the Role of School Nurses in Providing School Health Services, click here.

To download the American Academy of Pediatrics, COVID-19 Planning Considerations: Guidance for School Re-Entry, click here.

To download the Harvard University School of Public Health – Risk Reduction Strategies for Reopening Schools (June 2020), click here.

To read the California Department of Health’s Guidance for School Reopening, click here. (You’ll need to scroll down to the “Schools and Universities” section.)

To read the Orange County Department of Education’s Guide for Safely Reopening Schools in the COVID-19 era, click here.


What Do YOU Think:  Should Irvine Hire More School Nurses?

The latest Irvine Community Poll asks our readers if you agree with Dr. Agran that Irvine should invest in hiring more school nurses so that IUSD and TUSD schools meet the nationally recommended standard of one nurse per school.

To take the poll, click here.

Phyllis Agran, MD, MPH, FAAP
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