Iowa school nurses may be first line of defense for coronavirus-positive students and staff

For students showing symptoms of COVID-19 in the classroom, a school nurse will be the first line of defense for their symptoms, isolate them from other students and staff, comfort them when they're scared, and start contact tracing.

School nurses - already responsible for writing individual student health plans, dispensing medication, assessing injuries or illness, and training staff on how to care for students with seizures, who need feeding tubes or catheter care - now are taking on the added responsibility of evaluating students for COVID-19 and contact tracing in the schools.

'We do take care of students on a daily basis with their regular medical needs, and this adds another layer of responsibility. The COVID-19 pandemic that everyone is dealing with, it's brand-new to all of us,” said Colleen Elliott, College Community School District supervisor for Health Services.

At College Community, eight nurses serve about 6,500 students. A health secretary in every building, who is trained in First Aid, CPR, blood-borne pathogens and medication certification, also assists with day-to-day care of students.

If a student is showing or complaining of symptoms - including a new cough, headache or loss of taste or smell - she or he will be sent to the 'special ops” room to be evaluated by a school nurse, Elliott said.

If the student has one high-risk symptom or two low-risk symptoms, the student will be sent home and parents or guardians will be asked to consult with their primary care provider.

When a student tests positive at College Community, the district will enter the information into a COVID-19 dashboard, which lists what classrooms the student has been in based on the class schedule and what other students are in their household.

If a family doesn't have access to a primary health care provider or is underinsured or uninsured, the district will refer them to Linn County Public Health.

» STAY HOME? When does a child stay home, return to school after exposure to COVID-19

While Elliott said she believes COVID-19 cases will rise when school resumes in-person classes, she is reassured by the hybrid and online learning options.

About 750 students in the College Community district have chosen online learning. The rest are split into A and B groups, attending classes 50 percent on-site and 50 percent online, so less than half students are on campus at a given time.

'The entire reason we're trying to get back to school in a different way is because we're trying to stay healthy and avoid COVID-19,” Elliott said. 'This is amazing for all of us to figure out how to run a school completely different from we've ever run it before in every aspect - from busing, classroom set up, the cafeteria - every aspect is different this year returning during a pandemic.”

School nurses on standby

Sandra Byard, Cedar Rapids Community School District Health Services facilitator, said on a normal school day, nurses might see 30 students who are sick or injured.

The Cedar Rapids district has 20 school nurses who are each assigned one to two buildings and a health secretary at each school trained in First Aid, CPR, medication administration and blood-bourn pathogens.

The district is using an agency, which Byard did not want to name, to add health staff to the buildings as needed. The hourly cost to the district for a registered nurse from this service is $112.

School nurses have been working on plans for each building for how to isolate ill students waiting to be picked up by their parents or guardians, contact tracing, following up with sick students and educating families.

Each sick room will have a HEPA air-filtration system and plexiglass barriers.

'There's a few nurses who are a little nervous about (returning to school), but we're providing as much personal protective equipment” - a gown, mask, shield and gloves - 'to our nurses and health secretaries as we possibly can, knowing there is a good likelihood they are going to be exposed to positive kids,” Byard said.

Iowa City increasing nursing staff

During a normal year as a school nurse 'it's a lot of windshield time,” said Becky Berk, a nurse at Alexander and Grant Wood elementary schools and Tate High School. 'A lot of eating lunches in the car if you're going to eat lunch.”

The Iowa City district has nine nurses and a health services coordinator that serve 22 schools. The school board was in support of adding at least three additional full-time nurses this year.

As a nurse in the Iowa City district, Berk said she will be the 'eyes and ears in the school,” working with Johnson County Public Health to do contact tracing in collaboration with teachers who will be with students all day long under the hybrid learning model.

Berk made the difficult decision this year to send her son, who is in a special-education program, to the hybrid learning model for his sophomore year at City High School.

'I felt, for him, going back to the classroom would benefit him more, and I also thought since I was going to be back in the building and potentially exposed, I could potentially be exposing him anyhow,” Berk said.

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