Nurses at reopening schools brace for 'uphill fight' to keep students safe from COVID-19

DES MOINES, Iowa – School nurses have a message for parents: Expect your kids to be sent home more quickly this year if they seem even a little ill.

“There have been a lot of kids I’ve sent back to class with a headache, and now I might send them home. That will be different for sure,” said Nicole Cable, the nurse at Roosevelt High School in Des Moines, Iowa.

In normal times, a student with a headache, fatigue or slight cough would not raise alarms in a school nurse’s office. But these are not normal times.

Cable and about 600 other Iowa school nurses – along with their peers across the country – will face immense challenges in trying to keep children and staff safe as classes resume amid the coronavirus pandemic.

“It’s an uphill fight," said Cable, who leads a Des Moines school district committee working on the issue. "It’s one thing to say you have to physically distance in the classroom. It’s another thing to actually do it.”

School nurses will be on the lookout for signs of COVID-19, the disease the virus causes. It could be especially tough to sort out those cases as late-summer allergy season brings a wave of coughs and sneezes. Then schools will see outbreaks of colds and flu, which cause many of the same symptoms COVID-19 brings.

School nurses always perform crucial public health tasks, from bandaging playground scrapes and ensuring kids are vaccinated to responding to teens who are considering suicide. “It was a really complex role anyhow, and now you add COVID on top of that and it gets a whole lot more complicated,” said Sharon Guthrie, executive director of the Iowa School Nurse Organization.

School nurses are armed with flow charts to help discern the difference between everyday maladies and COVID-19. But they will have to employ a relatively quick hook this fall, sending kids home if there’s any doubt.

Once a coronavirus case is identified, school nurses and local public health officials will have to figure out which students, teachers and other school staff might have been exposed at length to the infected person. That could lead to extensive testing and quarantining.

The challenges could be particularly daunting for nurses in rural school districts. Many of them work in more than one building, and some ride a circuit of several towns. Urban districts’ nurses have backup in case they become overwhelmed or ill. Many rural school nurses lack that support.

Heather Sloma-Weber is the only full-time school nurse in eastern Iowa's Tipton school district. She monitors the health of about 700 elementary and middle-school students. A part-time nurse covers the high school.

Sloma-Weber said she enjoys the autonomy of her job, which she likens to being on an island as the district's leading medical expert. “Now everyone’s on my island,” she said with a laugh, describing the intense focus on health this year.

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Sloma-Weber said she and many other school nurses wish the state was allowing more flexibility in deciding whether to pull back from in-person classes if COVID-19 breaks out in a community. She’s concerned about state benchmarks that districts will be required to hit before they can apply for waivers to in-person teaching requirements.

One of the criteria for such a waiver is that at least 10% of students must be absent from school. “This is going to be my ninth school year, and I’ve never had that many kids gone,” even during a bad flu season, Sloma-Weber said.

The other main benchmark before a district can apply for a waiver to reduce in-person classes is that at least 15% of people being tested for the coronavirus in a county come up positive over 14 days.

“That would be pretty ugly. I hope we don’t get to that point,” Sloma-Weber said. As of Friday, Cedar County, which includes Tipton, had a positivity rate of 6%.

Sloma-Weber said she appreciates the support of colleagues who have been participating in weekly video chats organized by the Iowa School Nurse Organization. Dozens of members have been tuning in and sharing tips.

Guthrie, executive director of the professional group, said many school nurses weren’t being paid during the summer, but they devoted countless hours to planning how to prevent outbreaks.

She said some rural members of her group serve three or four schools in different towns. “A lot of people have an assumption that there’s a nurse in every building every day, all day," she said. "There really isn’t.”

Guthrie, a former school nurse who now directs graduate nursing programs at Mount Mercy University in Cedar Rapids, wishes schools had their own coronavirus testing equipment. If they did, nurses could quickly determine if a child or staffer was infected with the virus. But such equipment is not likely to be available anytime soon, she said.

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Like teachers and other staffers, school nurses face the risk of becoming infected at work. But Melissa Walker, a nurse practitioner who coordinates school-nurse programs for the Iowa Department of Education, said she hasn’t heard of a wave of Iowa school nurses resigning or retiring because of the risk.

Walker said some school districts have hired additional nurses or health associates to help respond to the pandemic. Iowa school districts employed the equivalent of 645 full-time nurses last school year, the education department reports. Walker said some districts also contract out with local clinics or hospitals to provide nursing services to students.

Face masks will be one of the main ways of limiting the spread of the virus in schools this fall. Some districts will just encourage their use. Others, including Tipton and Des Moines, will require them for almost everyone.

Nurses said they don’t expect major problems in persuading students to comply.

Cable, the Des Moines high school nurse, said it will be important for adults to set an example by wearing masks properly all the time.

“We all have a responsibility to keep each other safe,” she said.

Sloma-Weber noted that everyone is under stress, but she’s optimistic parents and school staff will show each other grace and patience as they work their way through difficult times, including the mask question.

“We all want the same thing,” she said. “We all love these kids and we all want the best for them.”

This article originally appeared on Des Moines Register: COVID-19 at school: Nurses brace for uphill fight against coronavirus