Often overlooked in the ordeal of in-person schooling during the Covid-19 pandemic has been the role of the school nurse. For every teacher, bus driver, principal, and custodian who has had to do temperature checks, wear masks, and ask inquisitive questions about a student’s health, there’s a school nurse who could easily say, “Welcome to my world.”
And that school nurse would be excused for saying it sarcastically. “We are all at a point where we keep coming back for more, because that’s who we are,” said Sylvia Compton, who has been with the district for 12 years and is Lead Nurse with Orange County Schools. “We love our job. If we didn’t love this, we would not be here.”
At a recent school board meeting, Compton and Orange County Schools Deputy Superintendent Patrick Abele, presented some of the challenges facing school nurses during the pandemic. Compton said nurses were nearly at a breaking point, and Abele described some of the ways the district was planning to alleviate the workload.
The News of Orange County sat down with Compton, Abele, and OCS Superintendent Dr. Monique Felder to discuss the often-overlooked role of school nurses, and the efforts being made to help them help students and staff navigate a pandemic.
NEWS OF ORANGE COUNTY: How would you describe this school year so far?
SYLVIA COMPTON: It’s been a big learning curve. It’s been an adjustment, not just for me and all nurses, but everybody in the school system. At this point in time, school nurses are doing contact tracing and we’re trying to do prevention of spreading Covid within the school system. We just didn’t realize it was going be this massive. We knew it was going be a lot of work but we didn’t realize it was going to be this much work. We want to maintain in- person learning, but we’re not doing this alone. We do a lot of the work on the ground to try to figure out what’s going on, but we have to have support from our administrators, our teachers, and our office staff. They are our eyes and ears. They are the ones who know when their students don’t show up in class. They’re getting emails, they’re getting phone calls, and when we let them know when a student is on quarantine or isolation, we send them the dates. They let us know if they come back too early. Or if a student didn’t get a test result and they still show up. I like to think of it as a complete, whole team, especially right now. It has taken everyone at a district level. It’s very overwhelming.
NOC: Pre-Covid, what was a typical day for you?
SC: There’s never a plan for school nursing. You think you have a plan and you go in there and you have an agenda, and it never comes out the same. Pre-Covid, when school opens, the first 30 days are always the busiest. There’s so many things we have to do: we have to get health plans together, we’ve got to train staff, we have to do record evaluation with immunizations, health forms, and get all that lined up. That’s what we normally would be doing around this time of year. But keep in mind, even though we’re still doing contact tracing, we’re still doing all of that as well. And there are, of course, the challenges of trying to manage seeing children throughout the day, making sure if you’re sick, you stay home.
NOC: You mentioned the experience has been a team effort: how has your relationship with teachers changed during the pandemic?
SC: It’s different. It has grown stronger, and it’s grown to a point to where we’re keeping each other on track. We’re keeping them updated with the changes because things change frequently with with guidelines with our local health department and the state. All varies on the positive cases, in case loads within within our county. We always have a relationship, but it wouldn’t be more focused on the health and safety on a daily basis like this. They’ve always been our eyes and ears when it comes to the students’ health and safety.
NOC: When the pandemic subsides, is there anything you would like to keep in place going forward?
SC: I have high hopes. We’re fortunate in this county that we’ve had one nurse to every school for years, other than Partnership Academy. I’m the nurse for that school which is great. We’ve hired a float nurse that we’re going to have on board soon, so it would be nice to keep that position, because we don’t have substitutes.
NOC: What makes it so challenging to find substitutes for school nurses?
SC: It’s not something you can just be a nurse, get your license, and jump into. You have to have training. Any area in nursing you go into is a specialty, so you have to have a training in that specific field. Same thing for school nursing. We’re autonomous. We’re independent. We’re in our own building and the only health care professional within the building. We have to have good assessment skills, communication skills. A lot of kids don’t realize when you come to me, you tell me you have a headache, and then I start talking about something else, I’m really doing an assessment. I’m seeing how bad do you really feel. For those kinds of things you have to have that intuition, and that doesn’t happen overnight.
NOC: What is your biggest challenge right now?
SC: I know what the challenge is in the first 30 days without Covid. I know what the challenge is right now with Covid. So, it’s like doing two full time jobs within the parameters of one, you know, and and and it’s always been a challenge to try to get done what we need to get done, because we have to document everything we do. Some things can wait. That’s been one challenge. The other challenge is just learning the other parts of this role that I have with the state, what is required of me to pass along, what information and what documentation do I need to do, what flow charts do I need to have ready to for the end of the year, how and when do I communicate all of this with my nurses?
NOC: Do you take your job home?
SC: Absolutely, yes.
NOC: Dr. Felder, has your perception of school nurses changed as a result of this experience with the pandemic?
SUPERINTENDENT DR. MONIQUE FELDER: I would say so. Health and safety has always been a priority. I’m very grateful that I’m in a district where every school has a school nurse. That’s not been my experience. I know that they play a critical role in the education of a student. We won’t be able to educate our students well if they’re not in environments where they are healthy and safe. Covid has elevated the work, and added even more layers to the work, for our school nurses, our teachers, our administrators, our bus drivers, and for our custodial staff. But I think nurses in particular. Infectious diseases are not new to them. But this particular infectious disease, and all it has turned out to be, and all the pivoting, and how we deal with it has compounded and complicated the way they (nurses) work. More than I ever have before, I’ve grown to understand the work they do.
NOC: Deputy Superintendent Patrick Abele, we spoke earlier about changes that have been put in place by the district to help the school nurses perform their duties. Are there other ways OCS is planning to further assist school nurses?
DEPUTY SUPERINTENDENT PATRICK ABELE: Some of the things we’ve done was hiring additional floating nurses to have individuals that can fill in, whether they’re helping with caseload or stepping in if another nurse needs to be out for a day. That way we’re not having to pull from another school. We also use a temporary agency that assists us and helps us when we need nursing support. We’re working on bringing on contact tracers with the district. One of the things that is really not known is the amount of time nurses spend with each case. Whereas, when I was a principal if, we had a child that was sick, they had a fever or they have an upset stomach, the nurse might have a brief conversation with the parent, the parent picks up the child, and take them home. A day later, two days later they’re back in school. That communication is short and brief. With every one of these Covid presumptive cases or positive cases, the school nurse is involved for 10 or more days with that case. That’s communication back and forth from the parent when they have questions regarding testing. They have symptoms that are changing. They have follow ups from the health department or from the medical provider. It’s not just one thread they’re following. They have this ball of yarn and all of these cases that are intertwining and all of those are points where parents may want an answer, they have a question, they want to communicate, and they reach back out to the school nurse. So, they’re spending tremendous amount of hours just responding and answering questions for each and every one of the cases that they’re monitoring.
NOC: Have you ever reached a point, during the last two years, where you thought, “Maybe I don’t want to do this anymore?”
SC: Honestly, we’ve all had that. Every nurse. I took this role with a goal in mind. I knew it was going to be difficult. I was not ignorant to what I was walking into, because I lived it last year. The goal was to advocate more for our nurses. Why do we not talk about our nurses? Yes, in a school system it is education, but when you look at the whole picture, it starts with health and safety. It’s kind of like Maslow’s hierarchy of needs, so you’ve got to start at the bottom. Yes, everybody has a breaking point, but we’re in it for the long haul. I try to keep the utmost positivity with my nurses because I feel that’s what why I’m in this role. I can’t break down in front of them. I don’t want to. I would rather say, “You need a break. I’ll cover for you. Go.” Because that’s what we do.