By Janice Loschiavo, MA, RN

National, state and local health officials are making every attempt to effectively deal with spread of the COVID-19. They have anticipated virus mutations and tried to prepare for further, residual health effects. Not knowing what the near or distant future will bring, they work to protect us. We do not know if the future holds a return to our previously enjoyed lifestyles or if the world population will continue to be decimated.

Publicly, many experts express optimism by pointing out the safety precautions being taken and the onset of vaccine distribution. Privately, only a fool would minimize the danger variants and resurgences of these pathogens could cause as we struggle to adapt to a new normal way of living.

Nurses have been reassigned to work in Emergency Rooms or Intensive Care Units as hospitals became over- crowded with very ill patients. Cafeterias were converted to COVID units. Freezer trucks were needed to keep bodies of deceased until they could be claimed by loved ones. Health care workers rallied and continued their selfless, front-line work.

The nurse became the most vital of these health care workers and an appreciative world responded. Lawn signs were posted outside of homes. Cheers greeted hospital staff as they exiting after their shifts. Restaurants provided free food. In any way we could, we honored these caring individuals.

One year into this nightmare, we still demonstrate our respect and honor essential workers. However, now we must recognize that the front line of the Coronavirus has shifted from the hospital, into the schools. It is now the school nurse who must take command of this pandemic in order limit the exposure and spread of disease.

A huge concern is the effect this pandemic has had, and will continue to impact, our celebrated, educational system. In March of 2020, most children had in-school experience abruptly halted. Virtual learning became a necessity. With no training, teachers were forced overnight to develop and implement a totally different approach to teaching.

Today, for many valid reasons, schools must reopen and parents must return to work. Children need to continue to learn and grow socially by returning to in-person instruction.

The School Nurse’s Role

In 1902, school nurses were hired to work in schools to control the spread of infectious diseases and to improve school attendance. This remains true today as it was more than a century ago.

In concert with CDC and local health authorities, today’s school nurse has assumed the responsibility of early detection and control of disease progression in the school community. The school nurse is the only health professional in the building daily overseeing procedures for school entry. To do this effectively, preventive protocols must be developed and implemented for school officials, parents, teachers, students, local health department and state governing agencies. The school nurse coordinates all these efforts.

The nurse alone assesses, recommends, excludes and clears for return to school, students and staff so the school environment remains safe. Preventive measures are required in order to properly control this pandemic.

Preventive health care exists at three levels: Primary, Secondary and Tertiary. Each level is defined differently and has specific strategies. All are essential in the control of disease.

Primary Level of Prevention

In Primary Prevention we attempt to avoid the onset of illness before disease or accident occurs. This is the most effective, cost efficient approach to health care and is accomplished through education.

According to National and State Student Learning Standards, Health Education is a requirement for all students. These Standards give benchmarks for what students must know and be able to do at each grade level. All students must receive lessons specific to basic preventive measures: hand washing, mask usage, physical distancing, healthy diet, restorative rest and exercise.

The school plant must be arranged in compliance with the Center for Disease Control Guidelines. These recommendations are based on the level of illness documented in that particular community and can be deemed, high risk (all virtual classes) hybrid (combination of in person and virtual) or entirely in person presence. If there is any school presence, preventive measures must be in place.

It is also important to educate the educators. The school nurse provides data based on the needs of the students. Accurate, updated Information from reliable sources must flow freely to administration, parents, staff and students.

Secondary Level of Prevention

Secondary prevention directs the school nurse to identify a problem early in the course to slow or eliminate the process by seeking proper treatment before it exacerbates. The school nurse oversees the screening process prior to anyone entering the building. Relevant questions regarding symptoms, recent travel experiences and possible exposures must be asked daily to every child and adult. Only essential persons should be permitted on the school premises. Staff should not be expected to travel to different schools. Students should remain in cohorts appropriately distanced with limited movement within the building. Children should not gather for lunch, recess or after-school activities.

The rooms should be completely disinfected daily after students have left and again mid - week.

The child with constitutional symptoms must be kept separate from one who needs first aid or counseling. An Isolation Room needs to be available for any individual who becomes ill at school. The CDC Guidelines (July 2020) demand that we repurpose unused or underutilized spaces within the school. Planning for adequate space to triage, should be a priority. Ill children must be picked-up immediately. Planning and Implementing these protocols are the sole jurisdiction of the school nurse.

Tertiary Level of Prevention

Tertiary Prevention is enacted once the child/adult is ready to return to school. The school nurse checks that they are asymptomatic and helps support their return. An Individualized Healthcare Plan must be developed for each child assuring their safe and productive reentrance to the school community.

These measures are aimed at rehabilitation once the student returns to school. The goal is to re-educate and support the recovering student. Tertiary prevention attempts to lessen the impact of an illness or injury that has already become established following the disease.

Going Forward

Clearly, this past year has caused much stress for parents, teachers and administrators. Parents became teachers, technology experts and full-time care givers while balancing work responsibilities. With little preparation time, teachers were forced to revamp their entire program of study and develop strategies for on-line learning. Administrators, already overwhelmed, now face unique challenges unheard of in our life time. The school nurse has taken on a much expanded, more challenging role.

After reading the above, it is hoped that the reader will look upon the role of the school nurse

with a different perspective. This is the time that greater understanding is essential.

As we continue to pay homage to selfless caregivers, remember that the school nurse is within that honored group. Many returned to acute care at the peak of the crisis. All are now working to maintain a safe school environment. Without the benefit of physician or another nurse - colleague presence, the certified school nurse works independently with the responsibility of caring for hundreds of students and staff.

Recognized by polls as the most trusted and respected profession for eighteen, consecutive years, 2020 will forever be known as The Year of the Nurse. Second in the poll was the teacher. The school nurse is both.

Remember to show your child’s school nurse the same appreciation and respect demonstrated to the hospital nurse. Just as we rallied to support the Intensive Care and Emergency Room nurses, so should we consider the school nurse’s role in this pandemic.

With your cooperation, trust and support, school nurses will continue the work of their hospital colleagues and hold the front line of the COVID-19 spread for you, the children, staff and nation.

Janice Loschiavo, R.N., NJ-CSN

Adjunct Instructor William Paterson University

Author Fast Facts for the School Nurse (Springer 2019) and School Nursing: The Essential Reference (Springer 8/20)