Pandemic weighs on school nurses

Oct. 25—In Staci Brown's office at Astoria Middle School, there is a whiteboard with the phrase, "It is a no bones day."

It's a TikTok-inspired theme from an aging New York City pug that means it's a day to unwind and do something for yourself. But a few minutes before, Brown was notified of a coronavirus case at Astoria High School, and as the school nurse for both schools, there is no time for relaxing.

Since the pandemic struck, the day-to-day responsibilities of school nurses have been transformed. While each day is different, school nurses are in charge of monitoring students' symptoms, assisting in contact tracing and communicating with parents.

"When you think about the two fronts that are getting hit hard by this, you have the health care front and the education front, and they're at the crux of both of those ... I know in our district, we could not have been safe and operating school concurrently without their work," Tom Rogozinski, the superintendent for the Warrenton-Hammond School District, said during a news conference in September with other school leaders.

Tara Johnson, who handles nursing duties at Astoria elementary schools, has worked in the school district for over three decades. The past year, she said, has been unlike any other.

"It's mostly COVID now," Johnson said. "We don't want staff or students here at school if they are not feeling well. It's a lot of staff asking questions, too ... That's changed a lot, too, because we didn't usually deal with staff so much. It was mostly just the kids."

'Putting it all into practice'

For Brown, school nursing was meant to be a part-time gig while she settled into her new home in Astoria. Just before the pandemic, the school district increased her hours. Shortly after, it ramped up to full time.

"Last year was really hard, keeping up with all the new guidance that was coming out every six weeks. Everything was new. We didn't really know a lot, trying to stay up on the CDC (Centers for Disease Control and Prevention) website, the Oregon Health Authority website and talking with our health department," Brown said. "Now that we know a little bit more, that research side is a little bit better, but now it's putting it all into practice because we do have kids back this year."

While there is an overall better understanding of how to operate through the pandemic, schools have had to constantly adapt to the state's changing protocols and framework.

"As soon as you know what you're doing, they change the rules," said Kate Gohr, the principal of Astor Elementary School.

When a virus case arises at one of the schools, the nurses, administrators and superintendent drop what they are doing to stay on top of any possible spread.

"The first thing is we have good communication with our families," Brown said. "The health department will try to let us know if they hear of a positive case, but really it's mostly the parents calling us and them taking that first step."

The team then pulls up seating charts in classrooms and communicates with the positive student or staff member to determine who else they need to reach, including who they rode to school and ate lunch with. They eventually conduct a video conference call to make sure all the bases are covered.

The school district hired medical instructional assistants at each school to assist with the school nurses' duties during the day.

"It's certainly a challenge, but there's lots of support from the district and we all work together as a team," Johnson said.

The constant communication with parents has been key to keeping schools open to in-person classes.

"I talk with parents constantly, pretty much every day," Johnson said. "There is always somebody that doesn't feel good, or we have to follow up because (a student) hasn't been at school ... Overall, most families are pretty responsible about keeping kids home and calling to tell us what is going on."

'Responsible for hundreds of patients'

They also work closely with the Clatsop County Public Health Department. Along with weekly meetings to give schools a chance to ask questions, the health department provides a retired school nurse that they can call at any point during the week.

By following the guidance and protocols, Johnson and Brown will often send several sick students home throughout the day in order to deter any spread of the virus.

"When we think about infrastructure and ratios, and staffing shortages, we tend to go to clinics and hospitals," Margo Lalich, the county's interim public health director, said during the news conference. "But when you really think about it, our school nurses aren't responsible for two, three, four or five patients. They're responsible for hundreds of patients every single day.

"It is extraordinary what they do, particularly in extraordinary times like this, and that we actually do as well as we do is just remarkable."