The COVID-19 crisis brought an abrupt and swift end to the in-person school year for most schools across the nation. But on May 6, as the nation honors National School Nurse Day, school nurses around the country say their roles are hardly idle, even if they aren’t in a school building.

“School nurses are the only healthcare providers some school children have access to on an ongoing basis,” says Laurie Combe, MN, RN, NCSN, and president of the National Association of School Nurses (NASN). “They are really a hidden healthcare system.” As school closings remove that immediate access, school nurses currently face many unknowns about the future and the steps they can take to help keep their students as healthy as possible until they see them again.

School nurses have been thinking about the return to school virtually since the schools began closing, says Combe, so they are going to be an essential voice for next steps. “It is essential that school nurses are included on school reopening planning teams,” she says, “as they are the health experts on their campus and can ensure that evidence-based processes and protocols are established.”

While students work virtually, school nurses watch for students who may show they are struggling by not logging into class and those who become, or continue their history of being, chronically absent. They are checking in on students who have chronic conditions, returning medication and equipment, and dispensing educational materials on everything from nutrition to keeping healthy habits.

One of the things Combe says is of particular concern to school nurses right now is the uptick in the need for mental health services that could impact the entire school population. “How are schools going to support that,” she says. “This is just a difficult situation. We will need to increase capacities for that in the schools.”

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Luckily, she says, school nurses aren’t the only professionals talking about mental health needs in the educational systems, and Combe advises current school nurses to reach out to the school staff they can collaborate with including school counselors, social workers, and psychologists. Each specialist brings a different professional skill to the table to help school children manage this upheaval.

And the students aren’t the only ones who will be trying to navigate a new reality while they are trying to recover from the disruption in their lives including potential loss of loved ones, job loss in families, or an unstable living situation that was made worse by the crisis. “If what we’ve talked about is true,” she says, “the stress on school nurses, teachers, and school administrators is going to be immense.”

Nurses, she says, need to establish a process of self care or they may face burnout. “There is talk of secondary trauma syndrome and school staff will not be immune to that,” she says. Combe recommends school nurses look at NASN’s resources dedicated to mental health and the organizations Coronavirus Disease 2019 Resources Return to School page to find information that can help. And, advocating for a school nurse in every school policy can help them feel like they are taking action when so much is uncertain.

Combe says school nurses often work quietly and behind the scenes and so many people don’t realize the enormous scope of their job duties. For the work they do, she gives them kudos, saying, “I am grateful for the school nurses who step into this space to support students, families, and staff and the larger school community.”

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