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The Critical Role School Nurses Play in Keeping Us All Safe


According to the American Academy of Pediatrics, the recommended national standard should be one full-time school nurse per school.  Here in the Irvine Unified School District, there are only 21 FTE (full-time equivalent) school nurses to cover 43 schools.  That’s a problem, especially in the middle of a global pandemic.

I have been advocating for increasing the number of school nurses for years.  COVID-19 has intensified our efforts to do all we can to ensure we have at least one nurse for each school.

Although most parents and school board members/administrators think that school nurses simply bandage a kid with a scrape or handle an occasional emergency, the truth is that their core functions are so much more.  They are the school health care providers.

Before the pandemic, school nurses were responsible for creating, distributing, and coordinating care plans for children and teens who need additional physical and/or mental health support to be successful in school.  They perform medical procedures that are needed during school hours.

They are also responsible for administering screenings for vision, hearing, BMI and scoliosis, and they run flu shot clinics.  School nurses train others, such as showing staff how to perform CPR, first aid and emergency medication administration.  They perform state-mandated immunization reviews and collaborate with social workers and guidance counselors to set up home schooling for students too ill to attend school or those who are hospitalized.  They are members of the team providing individual education and medical plans for children with neurodevelopmental disabilities and chronic diseases.

Data collection is another essential role of the school nurse.  If you take the time to review the data as I do on an annual basis, you will be overwhelmed by the medical services that our school nurses provide.

And now with the COVID-19 crisis, certified school nurses are the most qualified health professionals to be in charge of the policies and procedures that will be critical to reopening in-person classes for our children.

When Irvine schools reopen, school nurses will be implementing a number of new safety measures, such as:

  • Designing and implementing the essential public health procedures — physical distancing, hand hygiene, masking, surveillance and management of a student or staff who becomes ill during school;
  • Assisting students and families with bringing their own supplies such as water bottles instead of using water fountains;
  • Designating one-way hallways to maintain physical distancing between classes;
  • Creating a separate “sick” area for students and staff who have symptoms, and figuring out whether they have COVID-19;
  • Establishing protocols for contact tracing for students, staff, and families in collaboration with the public health department;
  • Administering the medical procedures that they always have done, but now with the added responsibility of using medical-grade personal protective equipment (PPE);
  • Planning for new outbreaks.

Monitoring and data collection will be critical so that we can keep track of the impact of in-person school on the entire school community.  The Director of Research at the National School Nurses Association has added 14 new COVID-19 data points to consider.

As you can see, that’s a lot to expect of our school nurses, and it’s simply too much to expect them to do at more than one school.

Here’s the message to public officials:  School nurses will be key to keeping us all safe.  They have the population-based health knowledge to be able to address the Coronavirus emergency when schools reopen.  They know how to screen, triage and care for students, staff and campus visitors.  They are central to developing and implementing school protocols to reducing the risk of spreading the virus in schools and in the general community.

As a pediatrician, I find it unacceptable that Irvine schools will reopen without a full-time nurse at every school.  The City of Irvine has a Rainy Day Contingency Fund with $53 million in reserves.

To bring Irvine up to the recommended national standard — one full-time nurse per school — we need to hire 22 school nurses, right now.  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.  That’s a small price to pay to protect our children, our teachers and school staff, and our community.

If protecting our schools — and our community — in the midst of a global pandemic isn’t a time to dip into that Rainy Day Fund, I’m not sure what would be.

New York City went on a hiring spree as soon as the pandemic hit so that schools would be prepared when they reopened.  That was the smart thing to do.  Unfortunately, the Irvine City Council and IUSD School Board have demonstrated no interest in increasing the number of school nurses.

I urge every Irvine resident, whether you are a parent or not, to contact the City Council and the School Board, to ask if they plan to hire the additional 22 school nurses to bring Irvine up to the national standard.  And I urge every voter in town to ask candidates running for City Council and School Board what their position is on this critical matter.

NOTE:  Last month, Irvine Community News & Views asked our readers to share your thoughts on Dr. Agran’s proposal to hire 22 additional school nurses to bring Irvine up to the recommended national standard of one full-time nurse per school.  The response was overwhelming, with 92% supporting Dr. Agran’s recommendation.  We will be publishing those results in an upcoming issue.


Journal of the American Academy of Pediatrics:  Role of the School Nurse in Providing School Health Services

Open Letter of Support for School Nurses. American Academy of Pediatrics-Orange County

UCI Letter in Support of School Nurses in the COVID-19 Pandemic

New York Times:  School Nurses are on the Front Lines: But Many Schools Don’t Have One

Phyllis Agran, MD, MPH, FAAP
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