SARAH: This is At the Core of Care. A podcast where people share their stories about nurses and their creative efforts to better meet the health and healthcare needs of patients, families and communities.
I’m Sarah Hexem Hubbard, executive director of the Pennsylvania Action Coalition and the National Nurse-Led Care Consortium.
As part of our special COVID-19 coverage, we’re going to spend this episode hearing extensive firsthand accounts from two school nurses in Pennsylvania.
They ’ll share with us their thoughts about what a safe and healthy return to school will look like.
We’ll hear first from Lori Kelley, a school nurse in southwestern Pennsylvania and the current president of The Pennsylvania Association of School Nurses and Practitioners — or PASNAP. In response to the pandemic, the organization has been supporting its 1,100 members around the state in various ways. There are now regular regional Zoom meetings and free online continuing education resources. PASNAP is also advocating for their members to be part of the planning process in their communities to help reopen schools.
And then later, we’ll hear from Lynn Heard, a school nurse in northeastern Pennsylvania. Lynn will tell us what her job was like pre-pandemic and how she’s now thinking about the return to school. And by the way, PASNAP named Lynn as the 2019 School Nurse of the Year for the state. And now she’s in the running for the national Nurse of the Year award from the National Association of School Nurses. Good luck to you, Lynn!
My name's Lori Kelley. I'm a school nurse in North Allegheny School District, which is in the suburbs of Pittsburgh. This is my second year there. Before that, I was a school nurse and Bethel Park School District for 15 years. Before I was a school nurse, I did some critical care and I did some hospice and I did some med-surge. So I'd been a nurse for a long time. Right now, I serve as the president of the Pennsylvania Association of School Nurses and Practitioners.
I think our nurses have a lot of concerns for returning to school in the fall. And we're reaching out to the Department of Health to try to get some answers to these. So some of the concerns are how do we social distance in schools? How do we monitor for kids who may have had COVID affect their lives? How do we support the families with their needs? How do we support families who've lost employment and now need more financial support? How do we do our mandated screenings when you can't have the kids socially distance while you're trying to do height, weight, vision hearing and scoliosis screenings? How do we account for the fact that many pediatricians offices aren't offering the well visits during the pandemic? And there are kindergarteners, seventh graders and 12th graders who have immunization requirements going into those grades. Will they have the opportunity to get those? And if not, should schools have school based immunization clinics? How do we advocate for our students to keep them safe? So there are so many questions.
Where are our nurses going to get enough PPE when the priority is and should be the hospitals? But again, many of those items are on back order and can't be obtained by school nurses, you know, many administrators are talking about doing temperature checks at schools, but does that make sense. If only 40 percent of the people that may be contagious or presenting with a temperature, how is that feasible when particularly in a building like mine, where I have between 1,400 and 1,500 students, the required staff that goes along with that and no more than two nurses on any given day. How does that look and how do we make that happen? So the weight of the health and safety of our students rests heavily on our shoulders, at least we feel that. And we want to be sure that we're following all appropriate guidelines to make sure our students are healthy. How do we meet needs of kids who had an exposure to a known COVID exposure and now are having to self isolate for 14 days? How do we seamlessly continue their education so that they don't have gaps in their education this year, in the coming years, when we return to school? How do we manage the kids that are immunosuppressed with conditions such as rheumatoid arthritis because of the medications they're on or malignancies or Crohn's disease and the medications that render those children immunosuppressed?
So there's a lot of thought being had about how we meet those needs and what guidelines are going to best lead us to make sure that all of our students are safe and healthy, because as we all know, students can't learn unless their basic needs and health is there for them.
So many of us are monitoring the CDC website, National Association of School Nurses has a wonderful website where they provide guidance as well, and they are actually working closely with the CDC to develop their guidelines. We're trying to advocate with our administrators to be included in the planning. Some of our nurses are speaking to state legislators. Some of us are participating in state taskforce, many of us are participating in local committees to make sure that the latest information from the CDC and the Department of Health are heard. School districts are very different across the state, depending on whether you're suburban or rural or urban. So the settings are definitely different. Pennsylvania's very blessed with our school nurse regulations, though. In Pennsylvania, we do at least have a ratio. School nurses cannot have more than 1,500 students on their caseload. Now, for some of us, that means we're traveling from built to be building to building. For me personally, my caseload is all in one building because I'm in a very large building. Some states, some of the school nurses can have up to 5,000 students. When we go to the national conferences, we're reminded that Pennsylvania has a lot to offer our school students because of the regulations. In Pennsylvania, you're required to have certification from the Pennsylvania Department of Education, which many states don't require a certification. And with that certification, you have to have 22 post bachelors degrees credits.
So many of us have our master's degree in various things from public health, mine is in nursing education, some are in education, so that additional education provides school nurses that are particularly qualified to help the students in their school, because practicing in a school setting is very, very different than practicing in an acute care setting.
I'm not saying there's a lot of positives that came out of COVID. I can think of almost none. However, it's really required us as an organization to up our game with communication with our members and what we're able to provide to them in a virtual setting, and our members have told us that they feel that this will be beneficial moving forward even after we're through the pandemic. So a relative, very, very dim bright spot. It's still a bright spot that we've learned how to communicate better with our members and how to connect in a virtual space. If that is what is required to us. Nurses are nothing if they're not adaptable. We are often asked to adapt and make things happen with not enough supplies and not enough time. And I'm not speaking for school nurses, I'm speaking for all nurses when I say we're adaptable and have to function and make things happen even in less than ideal situations. So it's part of being a nurse…
I think a important thing that I would like to say is to school district communities, utilize your school nurse as a resource. We are there for you. We want to be there for you. Don't hesitate to call us. Don't hesitate to email us. Don't hesitate to ask us questions. And I promise you, if we don't know the answer, we will find the answer for you.
My name is Lynn Heard. I'm a nurse at North Pocono's School District. I have my masters in nursing and my doctorate in nursing practice. And I've been with the school district for 24 years. Prior to school nursing, I worked in a hospital setting. I was an ICU nurse and then I was an assistant clinical director for the ICU and the emergency room and telemetry. So I did hospital, I did hospice, I did home health, and then I went into the school setting.
My desire for school nursing specifically was because I was in a hospital setting in intensive care. And you saw the same people coming in over and over. And I always thought, gee, maybe if people knew better when they were younger, they wouldn't get so sick when they were older. So I try to make an impact on an every student and try to educate them about ways to keep healthy and to get the best out of their life.
There's close to 950 students at the high school right now, and it’s a very steady flow. I see anywhere from 50 to 70 kids a day and they come in for a variety of reasons. You know, whether it's like they have a test and they don't want to take the test or they're there for a stomach ache. You know, each kid's assessed into each student is assessed individually for any type of symptoms. Routinely we check their temperature if they're having any respiratory illnesses or any stomach issues. If they have a fever, we send them home. If they just think they need a break, they're allowed to lay down for maximum of one period and encouraged to go back to class. Students often have a lot of health related questions and concerns and I'm the resource for them. So if they have questions, they typically will come into my office to look for answers. Like it could be something simple like this, something they saw on Facebook that there's a virus going around and do they possibly have those symptoms? It could be something more involved, you know, relationship issues or family issues. They could just come in to say, you know, I have a hole in my pants and I either need a change of clothes. They'll come in for if their glasses are broken, I do a lot of glasses repairs. So I have many different hats in there, and I try to problem solve and deal with every issue that comes through the door.
We do see a lot of anxiety and mental health illnesses. And as the nurse, I work closely with the guidance counselors to to meet those needs for the students. People label anxiety as a diagnosis and anxiety is something that everyone has. I don't think that it's always a clinical diagnosis that's needed. I think we need to build on resiliency. And I think that our students need to understand that anxiety is a normal part of life. It's something that we need to learn some coping skills, you know, so I try to work with students on that. But again, if their anxiety is so debilitating that they can't function, that's when we make sure that they get referred to the appropriate provider so that they can get the treatment that they need. Besides just the routine office visits, I'm very involved in our student assistance program. And I do coordinate that program. And that's if students are struggling either academically or attendance or they're having family issues. We do try to find them supports and resources to make things better for them. So that’s the the student assistance program. I'm also very active with the Health Advisory Council. I do oversee the council and we work closely with all types of health related issues in the school setting.
The transition back is going to be very frightening for a lot of students and for a lot of families. My concern is that parents are not going to want their kids to go back for fear of, you know, exposure to the COVID virus. And I think that there is a lot of education needed, a lot of information that needs to be shared. I think the process is not going to be an easy process. You know, there is a lot of talk about staggered schedules and limiting the number of students in classrooms. You know, so those are all things that are going to be frightening if they're not in the same class with their friends, if they can't sit at lunch and socialize with their friends. You know that that's going to increase their anxiety. So there's so many factors that will play out. And so we have to take one day at a time. And over the past two months, believe it or not, it has been extremely busy. Not a lot of student interaction. I wish there was more. I have reached out to some students and families that that I knew were in need of assistance or that, had some concerns and they have reached out to me. But a lot of my role right now has been in educating myself and keeping up-to-date on the latest information and research regarding the coronavirus and also doing the end of the school year reports and paperwork. The other school nurses and I do have a virtual meeting at least once a week to discuss some concerns and to make preparations for our return back to school. You know, we do have a an active health advisory council and we will be meeting to begin to address some of our plans for our return and gathering up some PPE and ways to maintain safe behavioral practices. So those are all things that I've been working on, along with the others nurses in our district.
We have received guidelines and direction, some direction, but there is misinterpretation of the guidelines. And I hope that, you know, moving forward, we can get some clear cut direction. I think everyone will do what's best for their district and I think that's the best way to proceed. But even with the guidelines, I think sometimes they confuse us. So at this time, I would expect that because this is something we've never had to deal with before. But we'll get through it and we'll be better for it. As long as the students are there and we're back together. It'll make it much better.
SARAH: Special thanks to Lori Kelley and Lynn Heard as well as other members of PASNAP who took time to share their perspectives with us.
And if you’re a nurse who would like to share your COVID-19 experience with us, you can send us a voice memo recorded on your smartphone. For more information about how to create and submit a voice memo, drop by our homepage at paactioncoalition.org. You can also find us on social media @PaAction.
Funding for At the Core of Care comes from the Center to Champion Nursing in America, which is a joint initiative of the Robert Wood Johnson Foundation, AARP, and the AARP Foundation along with the Pennsylvania Action Coalition.
Stephanie Marudas of Kouvenda Media is our producer and we had production assistance from Brad Linder.
I’m Sarah Hexem Hubbard of the Pennsylvania Action Coalition and the National Nurse-Led Care Consortium. Thanks for joining us.
