US Faces School Nurse Shortage in Pandemic

They ask to declare crisis due to lack of nurses in the US 0:44

(CNN) -

As she held out her cell phone to take back-to-school selfies with the new school resource officers last week, the excitement of the first day washed over Liz Pray, just as it had in years before.

But Pray, a school nurse, was also nervous.

"I don't know what the school year will bring," he said.

With the delta variant of the highly communicable coronavirus circulating in the United States and tensions around mask and vaccine requirements, this school year will be like none I've ever experienced before.

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For the past seven years, Pray has cared for young students in four different elementary school buildings within the Moses Lake School District in central Washington state.

Now, she will take care of the older students at Moses Lake High School, more than 2,000 students in all.

"It's so much fun to see those students come back to me and see how much they have changed in recent years and the young adults they are becoming," said Pray.

"I'm excited to see you all at the same time, but I admit I'm nervous."

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Pray is one of approximately 96,000 full-time school nurses in the United States facing an uncertain school year ahead.

Even before the pandemic expanded its workload and modified its daily tasks, the United States was grappling with a shortage of school nurses.

By the end of his first day back, Pray had grabbed a pile of paperwork.

He found time for a single bathroom break and managed a late lunch around 3:15 p.m.

"If I had to sum up the day, I would tell them to check on their school nurses, because they are not well," Pray said.

Liz Pray, a school nurse with her nephew.

School nurses and an old problem

The pandemic aside, the US Centers for Disease Control and Prevention recommends that schools have one full-time nurse for every 750 students.

Now, when students and schools may need nurses more than ever, an estimated one-quarter of schools still don't have a nurse.

The most recent data from a national study of school nurses, published in the Journal of School Nursing in 2018, found that about 39% of schools employ full-time nurses and about 35% employ part-time school nurses, while 25% do not employ school nurses.

In Washington, where Pray lives, a working paper from the Center for Educational Research and Data at the University of Washington in Seattle last year found that the ratio of students to nurse statewide during the 2019-2020 school year was a nurse. for every 1,173 students on average.

The country has had a shortage of school nurses for years, but the burden is clear now.

"I would love to see a school nurse in every school in our country," said Linda Mendonca, president of the National Association of School Nurses.

"That would be my magic wand dream, because all American schoolchildren deserve a school with a full-time school nurse. Not just to help them get through a pandemic, but to support students every day with their physical and mental health and make sure they are academically prepared to learn, "Mendonca said.

Pray said she spent the summer as she normally would - reviewing records to see which students are up to date on routine immunizations and organizing files for those with chronic illnesses, among other back-to-school tasks.

But the workload was much higher than in years past.

"When I moved to high school this year, my case count not only tripled by making that change, because I'm the only nurse in high school, but we haven't seen a good majority of those kids in the building for 18 months, "said Pray, who also serves as president of the Washington School Nurses Organization.

"So, we are dealing with all of their chronic health conditions, like diabetes, asthma, allergies, and on top of that, we throw away all the mental health pieces. The anxiety of walking in the door the first time. Depression because they have been home. without socializing with their peers, "said Pray.

"And then you have the covid."

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Back to schools in the US with masks 3:03

"You can definitely say that there is a lot of tension"

Due to the pandemic, Pray now has other responsibilities added to her plate.

Plan covid-19 testing strategies and emerging vaccine clinics, discuss ways to disinfect surfaces and improve air ventilation, preparing for potential covid-19 outbreaks and disgruntled parents who may be against masks or vaccines.

"In our district, there was a protest in our administrative office about the mask order," said Pray.

"You can definitely say that there is a lot of tension in our state right now, regarding masks and vaccines."

That tension has also been seen at the national level.

During a meeting on the use of masks in schools in Florida, discussions broke out.

Outside of a school board meeting in Tennessee, anti-mask protesters harassed a parent.

In Louisiana, protesters forced a school board meeting to close after failing to comply with a state order on wearing face masks.

The division over mask and vaccine requirements within communities tends to reflect the variability among US school districts when it comes to rules and policies.

"You can't really say anything in general about the role of school nurses during the epidemic, due to variability from district to district," Linda McCauley, dean of the Nell Hodgson Woodruff School of Nursing at the University of California, told CNN. Emory.

Nationally, some schools require that students and staff wear face masks to reduce the spread of the virus that causes COVID-19.

Others do not.

Some schools require that anyone exposed to the coronavirus self-quarantine to reduce the risk of transmitting the pathogen to others if they are infected.

Others do not.

Some schools require staff to be fully vaccinated against COVID-19 to protect young students who are not yet eligible to be vaccinated.

Others do not.

Because covid-19 policies vary across school districts, the responsibilities of the school's school nurses may also vary.

And in some schools where mitigation measures to reduce the spread of coronavirus are not followed or enforced, that can increase a school nurse's risk of exposure to the virus.

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Rural schools are more likely to have no nurses

Some of these differences in school policies, practices, and behaviors may vary by geographic region.

For example, in rural regions of the United States, acceptance of the COVID-19 vaccine has generally been slow.

And it is also in these regions, where positive COVID-19 cases cripple health care systems, that the shortage of school nurses appears to be greatest.

Schools in rural regions of the United States appear to be "significantly more likely" than schools in urban areas to report having no nurses, according to the study published in the Journal of School Nursing in 2018. In that study, 23 5% of rural schools report that they do not have a nurse compared to 10.3% of urban schools.

"When you go into a rural setting, you have school districts, before the pandemic, that saw a nurse once a week or once a month, depending on where they were. And they share nurses with various districts that could be one hour away from each other. And then you find yourself in the middle of a pandemic, and the nurses are needed, and they have never supported us in that way, "said Pray, whose Moses Lake school district is considered to be located in a rural area. .

To address the nation's school nurse shortage and also improve the number of school nurses in rural regions, funding is needed, wrote Laura Searcy, a pediatric nurse who was president of the National Association of Pediatric Nurse Practitioners and a member of the Association. American of Nursing, in an email to CNN.

"Funding is a key issue. There is an inconsistent hodgepodge of state and local funding that puts small rural school districts at a disadvantage with inadequate tax bases," he said in the email.

"And in those areas there is also likely to be a shortage of primary care pediatric health care providers."

In schools where there are no nurses on staff, teachers are often trained and trusted to provide certain aspects of health care that would normally be performed by a school nurse.

"For example, we would not accept medication being administered to a child by unlicensed support staff in a hospital. So it always puzzles me that we accept this in the school setting for our medically fragile students," Gloria told CNN Barrera, president of the Illinois School Nurses Association.

In Illinois, the Chicago Teachers Union went on strike in 2019 while asking for a full-time nurse in all schools.

Chicago Public Schools, according to its website, is still hiring nurses to meet that goal.

Even before the strike in Chicago, the American Academy of Pediatrics in 2016 recommended that pediatricians be able to advocate for a minimum of one full-time professional school nurse in each school.

"As a school nurse, I know that I am serving as a bridge between the health care and education systems and other sectors. As well as a link to broader community health issues through the students I serve. That continuity of Attention is the reason I became a school nurse, ”Barrera said.

"For any nurse considering a career as a school nurse as a specialty, we have historically played an important role in promoting public health within our schools and larger communities, and you are needed."

Wearing masks causes political tension in the US 2:36

School nurse jobs can be difficult to fill

Nationally, there is a general shortage of nurses, not just school nurses.

The American Nurses Association has even asked the US Department of Health and Human Services to declare the nursing staffing shortage a "national crisis."

But there appear to be several factors specifically driving the nation's school nursing shortage, including the funding needed to hire, the lack of a direct channel to connect nurses to schools, and lower salaries compared to other nursing roles. in hospitals or other settings.

"I know very few nurses who are just graduating from nursing school. They find it along the way, and there are several reasons for that," said McCauley, dean of the Emory University School of Nursing.

"Students who pass their bachelor's exam and earn their first nursing degree rarely have rotations in nursing school. It's not impossible, but it's rare," she said.

"Students may not be exposed to the school nurse."

Therefore, for one thing, younger nurses applying for school positions may not have as much experience in educational settings.

Then, on the other hand, the more experienced nurses might not be satisfied with the salary that is offered in the schools.

In May of last year, the median annual salary for registered nurses in U.S. hospitals was $ 76,840 compared to $ 64,630 for registered nurses in educational services, according to the U.S. Bureau of Labor Statistics. .UU ..

The disparity in pay for school nurses compared to other nursing positions could be because most school nurses do not work year-round, McCauley said.

"You have to keep in mind that they probably work 10 months out of the year," McCauley said.

"So her salary seems lower than other registered nurses, but I can't seem to say if it fits into an annual salary."

Overall, "there is a national shortage of nurses, so school districts find themselves competing with health care facilities for the same pool of applicants," said Searcy, a pediatric nurse practitioner.

"Compensation is not entirely fair, so it has always been a concern," said Mendonca of the National Association of School Nurses.

"I also heard anecdotally that nurses who were close to retirement, or who were thinking about it, that the pandemic maybe pushed them in that direction sooner than they might have been planning," he said.

"That makes the shortage even a little more critical than what we've been dealing with."

Lawmakers push for more school nurses

Some Democratic lawmakers want to help improve funding for school nurses through a bill called the Nurses for Poor Schools Everywhere Act, introduced by Nevada Congresswoman Dina Titus and Montana Senator John Tester.

The Nurse Act would create a grant program in the US Department of Education to reduce the cost of hiring nurses in public elementary and secondary schools, according to Titus' office.

School districts may apply for the grants if at least 20% of their students are eligible for free or low-cost school lunches.

Titus on Wednesday urged congressional leaders to include the legislation in the next budget reconciliation package.

The National Association of School Nurses has also announced its support for the Nurse Act.

But some school nurses like Liz Pray in Washington state wish the push for more funding for school nursing had come earlier, before the pandemic.

Now, "there is a shortage of nurses across the country," Pray said.

"From the school nurse, we thought with certainty that after the wave of covid passed last year, we would see the nurses who wanted to leave the hospital and go to something that had a firmer schedule: Monday to Friday, possibly summers free. But we are not seeing that transition is made, because there is a big drop in wages, "said Pray.

"It is not organized like the medical field. They have to do a bit of work to attract nurses, but at the same time, they are also needed in hospitals. There are shortages everywhere."

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