Op-Ed: I'm a School Nurse. Every Day Feels Like a 'War Zone'

school administrator taking temperature checks on students wearing masks and backpacks

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Amy Isler, MSN, RN, is a school nurse in California working with students in kindergarten through eighth grade. Here, she shares her experience responding to surging COVID-19 cases, and explains why the administrative toll of keeping schools open is worth it for students.

The highly contagious Omicron COVID-19 variant is spreading like wildfire across the country. COVID case surges have left school districts, administrators, parents, and students in crisis mode after returning from winter break, and it doesn’t seem to be slowing down.

School leaders are scrambling to make sense of how to best control the situation. The results are mixed, ranging from school closures and teacher union feuds in Chicago to high school students organizing walkouts across the country. But the concern is always the same: safety.

As a school nurse in California, I’m in the middle of a fire storm that is the biggest health emergency to fall upon schools in recent history. My school district plans to remain open. Coming to work every day feels like arriving at a war zone. School personnel are stressed, overwhelmed, and at a breaking point—and it’s only mid-January.

But we’re doing everything it takes to keep our school open.

School Is Now a COVID Command Center

The phones started ringing off the hook the morning of January 3—when we returned from winter break—and they haven’t stopped. The influx of calls are reporting positive COVID cases for both students and family members.

Our staff was blindsided by the sheer volume of post-holiday COVID-19 cases and unprepared for the days ahead. But the front office swiftly turned into a crisis center, putting together a system within hours. Everyone in the office had a role by the end of the day, and a Google Sheet became our shared brain. My role became focused on testing students and staff with COVID symptoms or exposure to someone who tested positive.

I have been a school nurse for seven years, and I can say with confidence that these last three weeks have been the most stressful days I have dealt with in my career thus far.

The true heroes of this pandemic are the students that come to school each day ready to learn and be with their friends even though the adults around them are in crisis mode.

The Classrooms Are Safe

The good news? Running a makeshift testing center has given me the insight and the data to understand that COVID-19 is not spreading in the classroom. It is being brought into the school via community exposure. This means that the safety measures implemented by our school district in the fall are working: masking, social distancing, testing, at-home symptom checking, and contact tracing. To me, it proves that the classroom is a safe place for our staff and students. 

The true heroes of this pandemic are the students that come to school each day ready to learn and be with their friends even though the adults around them are in crisis mode. The highlight of my day is getting to interact with these kids. Even though our interaction involves me swabbing the inside of their nose a couple times a week, they participate with a smile and a great attitude. Some even say “thank you” as they run back to class, giggling with their friends.This is now a normal part of going to school. 

The bad news? Now that I’m a COVID testing machine, that leaves me without the bandwidth to manage my core day-to-day school nursing responsibilities. COVID-19 issues now take up 95% of my workday, but insulin still needs to be administered to students with type 1 diabetes. Students with epilepsy still need to be monitored. Asthma attacks still happen. Playground injuries are inevitable. 

With 900 kids on campus, my biggest worry right now is not the spread of COVID-19 in the classroom, but the inability to identify and react to a preventable health emergency. 

The 'New Normal' Is Not Sustainable For Schools

For parents, we have a script: the latest version of COVID-19 school guidelines developed by our state and county public health departments. But it’s so much more complicated behind the scenes. 

There are flowcharts to help determine protocol if someone tests positive when they’re vaccinated, unvaccinated, exposed while wearing a mask, or exposed while not wearing a mask. The contact tracing administrative tasks required for each student that tests positive is astonishing. Teachers and staff must code attendance properly, send a detailed letter to a student’s home, create independent study packets for remote learning, and make phone calls to anyone who may have been exposed.

Protocols at My School

  • If students or staff test positive, they have to quarantine whether they are vaccinated or not. They can re-test after 5 days, and if the result is negative, they can come back to school on day 6. If they are still positive, they have to stay home for the remainder of the 10 day quarantine, but don't need to test again to come back.

  • If a family member tests positive, and the student is unvaccinated, they have to quarantine for 20 days. But if the student is vaccinated, they can stay in school unless they experience COVID-19 symptoms and/or test positive.

  • If a student has an unmasked exposure at school (this happens at the lunch table), then they have to quarantine for 10 days, unless they are vaccinated. If they are vaccinated, they can stay at school unless they experience symptoms and/or test positive.

  • If a student has a masked exposure (within 6 feet of the infected person for longer than 15 minutes), they can stay at school. If they are unvaccinated, they have to be tested twice at school within a 10 day period. If they are vaccinated, then they can stay at school and testing is recommended after 3 days from the date of exposure.

Meanwhile, the CDC’s quarantine and isolation guidance recently changed, further complicating things. 

As a staff, we feel like there are more questions than answers. The safety protocols are endless. Are these guidelines sustainable enough to keep a school functioning? Keeping all of this up feels unmanageable and unattainable, especially when the staff is sick or quarantining, too.

My biggest worry right now is not the spread of COVID-19 in the classroom, but the inability to identify and react to a preventable health emergency.

Fractures in school systems emerged as soon as COVID did. My district has fared well thanks to a slew of previously-implemented protocols, including a system for both PCR and antigen testing. But the winter surge of the Omicron variant has hurt many educational systems. And I worry that they will not be repaired without a complete re-evaluation of what education in America means today. 

So many people working in education have stepped up and pivoted to meet the moment, but come the end of the school year, I wonder how many will jump ship and decide it’s no longer for them. 

How You Can Help

If you have a school-aged child, the best way you can help is to be patient and flexible. The school staff are doing their absolute best to manage the influx of positive cases. If you receive a call or email from the school, please answer it right away and provide them the information they need. 

Get your children vaccinated. This not only helps curtail the spread of COVID, but it will also significantly reduce the amount of time your child is out of the classroom if they are exposed to someone who tests positive. 

The information in this article is current as of the date listed, which means newer information may be available when you read this. For the most recent updates on COVID-19, visit our coronavirus news page.

By Amy Isler, RN, MSN, CSN
Amy Isler, RN, MSN, CSN, is a registered nurse with over six years of patient experience. She is a credentialed school nurse in California.