ELKHART — School nurses aren’t foreign to performing public health tasks, but in the age of COVID-19, their role is more vital than ever as they are serving on a new front line in keeping students safe.
Classes resumed for school districts in Elkhart County this month offering both in-person and online options. At Elkhart and Goshen school districts, a school nurse is stationed at all buildings, which is key to the work that is required to prevent exposing students to the potential viral spread, school leaders said.
At Elkhart Community Schools, 66 percent of students physically returned Aug. 13 under the district’s “hybrid” model, which allows for two days of in-person instruction in addition to e-learning days. The rest are doing remote-only learning.
To prepare for the eventuality of cases in schools, the district has developed coronavirus tracing and mitigation practices to monitor and prevent the spread.
In a normal year, a student with a headache, sniffle, cough or fatigue would not raise alarm in a school nurse’s office.
But this is not a normal year. Students and staff displaying symptoms of COVID will be treated with more care, and possibly sent home based on the school nurse’s assessment.
“We’ve been provided a decision-making tree by the State Department of Health that helps assess on whether this student who is really coming down with symptoms that might be serious or whether it would be OK to send them back to class,” said Lorrie Bjornstad, a registered nurse who’s working in student services at Elkhart Community Schools.
Determining the right approach for a symptomatic student in part depends on what nurses already know about the student, Bjornstad said.
“For example, if this is a student who’s coming down with a running nose and we have in our information here at school that this kid had documented allergies to anything under the sun, like leaves or grass, then it would be safe to assume since the student has no other symptoms of COVID, that we could feel comfortable sending that student back to class,” she said.
It also helps if the school nurse has worked in a particular building for a while, Bjornstad said, because they’re more familiar with the medical history of students.
“If you’ve known this student from second to sixth grade, you probably know that they have allergies in the fall,” she said. “So that would be a student that you feel comfortable sending them back to class. Now, there are other situations where we’d say, ‘No way. We’re going to have to look into this a bit further.’”
Each building has a designated isolation room for symptomatic students to wait until going home.
Though school nurses are firmly on the lookout for signs of COVID-19, it could be difficult to discern those cases as late-summer allergy season also brings a wave of coughs and sneezes.
“Some of the basic problems this time of year is when kids get chickenpox, fevers and strep throat; there’s a lot of diagnostic pieces with COVID,” said John McClure, a school nurse at Roosevelt STEAM Academy. “So, it’s sometimes very difficult to sort that part out.
Nurses use a CDC-issued flowchart to help distinguish the difference between everyday maladies and COVID-19.
Preventing the spread is a collaborative effort that involves school leaders, nurses, health professionals and parents, said Sarita Stevens, assistant superintendent of student services at Elkhart Community Schools.
“It used to be where we’d have a lot of leniency on whether a parent could come and pick up a child, but now, if a child is exhibiting a fever, we’re asking parents to be a part of that process in getting that child home and isolated away from other children,” she said. “Sometimes that’s difficult for parents who are working, but we’re also asking for them to include their emergency contacts to help us keep everyone safe. So, it’s constant communication to keep everyone on board.”
Doug Thorne, the district’s chief of staff, offered a similar sentiment.
“We’ve asked parents to be cognizant of those COVID symptoms and if their child is demonstrating those symptoms, don’t send them to school,” he said. “We’ve done some things in terms of availability of benefit time for our employees. So, if our employees are evidencing symptoms of COVID, they could use a benefit day and not show up at school and create that event where there’s a spreading of the disease.”
When the district receives word of a confirmed case, school officials begin contact tracing and send out a notification email alerting staff and families in that particular school building.
Any individual who tests positive will not be allowed to return to school for at least 10 calendar days since symptoms first appear, upon the condition that all symptoms have improved and they have been fever-free for 24 hours without fever-reducing medicine, the district said.
So far, two students and two staff members at the district have tested positive for the virus since schools reopened.
But when the district does receive notification of a positive case, that does not mean that individual contracted COVID from the school, Bjornstad said.
“There’s a lag time in some of these tests in getting them back,” she said. “Some people will get the rapid test, but there’s controversy over the accuracy of them. So, when we get a report of a positive case, that does not mean at all the person acquired COVID from the school, that just means that we heard about it.”
Stevens touted the district’s mask requirement as a safety measure in preventing a spike in positive cases and said there hasn’t been anyone who’s been non-compliant about the rule.
“For the most part, parents and staff are on board with masks,” she said. “So, that lets us know that we’re all in for protecting each other and it’s allowing us to continue with some extracurricular functions and activities, so all those agreements are very important and appreciated.”
At Goshen Community Schools, 14 students and two staff members have tested positive; 60 students and 12 staff members are quarantined, according to the district’s dashboard, which was updated Thursday.
The district has similarly established isolation rooms at each of its buildings for symptomatic students, said Wendy Swallow, coordinator of school nurses.
“Every building has a little bit of a different situation going on,” Swallow told school board members this week. “For example, West Goshen (Elementary) is very lucky since they’ve got an entire art room with a door that leads outside. So, that’s the safest way to help keep parents from having to come into the building. Other buildings are using rooms right next to the nurse’s office. Some of them have a monitor so they can see the students while they’re still working.”
Nurses at GCS are assisting staff in setting up pods or cohorts in classrooms to limit close contacts if quarantining is needed. Staff comes to the school for education and clarification related to student and family questions, Swallow said.
Also, nurses are distributing and collecting daily self-assessment agreements from families to ensure that students are staying home when needed based on the recommended criteria.
“When it comes to contact tracing, any positive case that comes in, once we get that information, we start pulling everything you can imagine – bus, lunch and even if we need to look at cameras, we can do that for any concerns,” she said.
Although the new role school nurses have with COVID-19 can be overwhelming, it’s vital in keeping the community safe, said Susan Stiffney, director of human resource services.
“I think our nurses feel like it’s an opportunity to serve our community and to do the work that needed to be done all along but there weren’t people to do it,” she said. “So even though it can be hectic, it’s a great opportunity to help the community out which makes it all worth it.”