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Could school nurses become the new front-line medics?

Barbara Gant-Johnson, a registered school nurse at the Marshall School, a pre-K and kindergarten in Hempstead, spoke to Newsday about the provisions and measures being taken to protect students and staff from COVID-19 when schools reopen in the fall.  Credit: Debbie Egan-Chin

School nurse Barbara Jacobowitz said a plastic shield is going up around her desk at Drexel Avenue School in Westbury. The masks, gloves and gowns are coming in, and the school has set up a separate room for any student with symptoms that might be COVID-19.

Now she's waiting for the first kids to arrive — and the first cough.

In this new normal, school nurses could become the front-line medics against the coronavirus, standing between the children and their possible spread of the disease. Many nurses, though, admit they worry about keeping the building population — and themselves — safe as schools prepare to reopen in September. They worry about having enough masks and gloves for themselves. They worry about situations that haven't been scripted in plans. And they worry what will happen if people in their school start getting sick.

"Of course I'm concerned," said Jacobowitz, a school nurse for 13 years. "I'm concerned about the kids being able to socially distance and wear a mask."

Kids like to play close together and share their books and crayons, she said, and many teens believe they are impervious to illness. Consequently, the first days of school will be challenging, she said.

"Having a little child maintain a 6-foot distance will be difficult," she said. "They're not used to staying 6 inches away."

Nationally, some schools already have restarted, with mixed results. In Georgia, a high school outside of Atlanta had to shut down because of a COVID-19 outbreak. 

Changing roles

Looking ahead, Long Island school nurses say they expect more foot traffic through their offices, more paperwork, and more calls home to parents. Preparations are still coming together at many schools, but school nurses said they will be bound by the general guidance put out by the state, as well as the more specific plans of their individual districts.

Schools also are building partnerships with parents, asking them to reinforce with their children the three Ws: wear a mask, wash your hands and watch your distance, said Jacobowitz, a registered nurse.

Much already has come together at the Marshall School, a pre-K and kindergarten in Hempstead, school nurse Barbara Gant-Johnson said. She's been visiting the school weekly to speak to the principal. She's located the supplies of personal protective equipment and established an isolation room should a child show symptoms of the virus.

In addition, she's watched a district-required 2 1/2-hour webinar by Northwell Health that shows the proper ways to put on a mask and gown, and discusses situations that can arise. Gant-Johnson said she'll be helping with taking children's temperatures every morning, but she's not sure of her role in contact tracing should a child come down with the virus.

Like many school nurses, Gant-Johnson, 63, had worked for years in a hospital, so she's accustomed to dealing with infectious diseases.

"I feel fine. I don't think there will be a problem," she said. Still, she said, "It's going to be different for me. The kids hug me, but they can't hug me."

Children have comprised fewer cases of COVID-19 compared with adults, according to the Centers for Disease Control and Prevention. Hospitalization rates in children are significantly lower than adults, suggesting that children may have less severe illness compared to adults, the CDC said on its website.

It is unclear whether children are as susceptible to infection compared with adults, and whether they can transmit the virus as effectively as adults, the agency said. Much of the research occurred after schools were shut down. More will be learned after more children return to in-person school, the agency said.

The state has spelled out many safety protocols, including schools must establish a separate isolation area to hold children they suspect have the virus. This should be a separate room, if available. Face coverings are required any time individuals cannot maintain appropriate social distancing. Students must be 6 feet apart or be separated by a barrier while consuming meals.

While no state law exists that explicitly requires a nurse in schools, schools by law must provide health services for students with chronic health conditions. Many of the services require a licensed school nurse. 

The state allows for schools to approach certain safety measures differently. Some are asking parents to take their child's temperature every morning. At the Wood Park Primary School in Commack, school officials are setting up a machine that looks like an airport metal detector that can take the temperatures of dozens of children in a minute, school nurse Paula Saltzman said. 

School nurses said that when a child comes to them feeling poorly, the plan will be to err on the side of caution. The days of a child spending an hour in a nurse's office until they feel good enough to return to class may well be over, they said.

"If a child shows symptoms consistent with COVID-19, and that's a long list, we will send them home," said Jacquelyn O'Donnell, president-elect of the New York State Association of School Nurses. O'Donnell, also the lead nurse in the William Floyd school district, said her district is mandating that school personnel watch a webinar on defending against the virus. 

Staffing challenges

Unlike New York City, which is scrambling to fill vacancies for school nurses, Long Island does not suffer from a major shortage of them, O'Donnell said.

She said she expects the vast majority of school buildings on Long Island will have their own nurse. Most are full-time employees, though some districts turn to substitute nurses to fill gaps. These substitute school nurses are in short supply across the state, O'Donnell said.

Freeport Superintendent Kishore Kuncham said he believes there is a shortage of school nurses on Long Island. Finding school nurses has never been easy, considering the pay can start at about $40,000, and the pandemic has only made it harder, he said. His district started advertising in June to replace four nurses who decided to retire, and is only now finishing the hiring process, he said.

"They make more money in the medical setting," Kuncham said.

Will all schools on Long Island have a school nurse in place? That's hard to tell.

Unlike New York City, which has one chancellor for its public schools, Long Island is a patchwork of more than 100 districts, each with their own superintendent. Moreover, most Island school nurses don't have a labor union dedicated to serving only them. They are represented by numerous unions that oftentimes represent custodians, teachers, teacher aides, clerical and food service workers. In recent weeks, ads have appeared online for nurses for several Island districts, including Levittown, North Babylon, Oceanside, Hicksville and Eastern Suffolk BOCES. 

Julie Lutz, chief operating officer of Eastern Suffolk BOCES, said the district will have at least one nurse in every school building in her district.

"We are hiring extra nurses to cover our expected additional needs related to COVID," she said. "Taking of temps, covering isolation room, the possible need for nurses to be out in case of exposure to COVID. We have struggled to find sub nurses in the past, so we wanted to be certain we were well staffed."

School nurses tend to be among the older workers in schools, making them more vulnerable to COVID-19, said Kimberly Nowakowski, vice president of the United Public Service Employees Union, which represents 180 Island school nurses. Many came to the schools after years working in hospitals, looking for more family friendly hours and a less intense setting, she said.

"I had school nurses asking to take a leave of absence," Nowakowski said. "They have medical conditions. … They're concerned that if this experiment fails, the district will become inundated with COVID-19."

For all the hundreds of pages of plans, school nurses know they will encounter scenarios for which there is no written protocol. To help with this, the Nassau and Suffolk health departments recently issued some joint guidance.

What should happen if a student tests positive for the virus? The student should remain at home for at least 10 days, the guidance said. School staff should provide the local health department a list of probable close contacts, defined as being within 6 feet of the student for at least 10 minutes. These identified close contacts should remain at home for 14 days from the date of exposure, the guidelines said.

For all that, school nurses say they still expect to run into unscripted situations. 

"We don't know everything about this virus," O'Donnell said. "We're waiting to see what comes through the door, and we'll deal with it."

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