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The Relentless School Nurse: One good turn deserves another

By: By Robin Cogan

I am sharing testimony that I gave about the state of pandemic school nursing in New Jersey. It was an honor to represent the New Jersey State School Nurses Association. You can review the narrative below.

School nurses have spent almost twenty-four months navigating and interpreting inconsistent CDC recommendations and Departments of Education and Health guidance that lacked clarity for the complexity of school settings. We have been under fire from parents, staff, and administration for implementing the frequently changing guidance. Incivility has grown ever-present and it has taken a toll on our school nursing workforce.

Health office volume and demands have never been higher or more consequential.  In addition to being the de facto health departments in our schools, responsible for the intensive COVID-related duties like contact tracing, daily identifying and reporting of positive cases at the school, district, county, and state levels, which is more than a full-time job for one school nurse. We are also juggling sick visits, common complaints, medication administration, emergencies, first aid, mental health crises, care coordination, and health education. There is absolutely no time to complete state-mandated screenings, new student registrations, vaccination compliance because there is no one to help. In most cases, our request for assistance falls on deaf ears. 

While the majority of school nurses support in-school COVID testing, we do not have the time or the capacity to run a test to stay program. This is not a turn-on-the-light switch endeavor. There are not enough hours in the day, it is that simple and that complicated.  School nurses are working well into the evening to “catch up” on those things we cannot get done during the school day. Test to stay would certainly help to save unnecessary quarantine days. Right now, all of that is in flux as we await the NJ DOH interpretation of the latest CDC guidance that applies to K-12 schools. It is hard to imagine that such a drastic switch in isolation and quarantine days would come in the midst of a surging variant that is said to be more contagious than measles. But, here we are. 

Surveillance testing and pooled testing are happening in some districts across the state but since we do not have a State School Nurse Consultant at the Department of Education, nothing is centralized, especially understanding what is happening from district to district. The State School Nurse Consultant position was never filled, even though it was overwhelmingly supported by both the Senate and the Assembly and signed into law more than 16 months ago by Gov Murphy. It sits unfilled at this moment.

To give you an idea of the sentiment at the school level, one nurse shared:

“I feel like I’m hanging onto a lifeboat with one hand while waves continue to pummel the boat and there is no land in sight! And, in my attempt to hang on, I am going to miss something important!

We are well beyond our tipping point. School nurses are leaving the profession as they are overwhelmed, burnt out, and lack the required support. 

There is a stunning lack of decision-making from local health departments. While we are tasked with reporting to them, the direction for temporarily moving to remote learning, for example, is solely at the discretion of the school administration. Last year, there had been a coordinated approach with suggestions based on the CALI score matrix, but now districts are formulating their own protocols which may or may not align with the ever-changing CDC, local, and state guidance. 

Between December 15th when the NJDOH updated their K-12 guidance to shorten quarantine and eliminate utilizing the COVID Activity Level Index, or CALI score, that all of our decisions were based upon and 12/27/21 when the CDC announced through a media release, they were slashing isolation and quarantine time in half to 12/29/21 when their update for school guidance did not apply those “general public” guidelines to schools, to January 4, when they changed course and said schools were included, until today, when just as last night, we were told by the CC health department that we are still awaiting final interpretation of the CDC guidance from NJ DOH and until then to continue to use the 12/15/21 guidance. Do you see why confusion reigns?

Even more alarming is the abject lack of intervention by the Department of Education. Why are they silent about health issues? Do they not see that health and learning are inextricably linked? Where do we go from here? We do have a few suggestions:

  • Support filling the position of NJ State School Nurse Consultant at the Department of Education
  • Look to some exemplar districts like Perth Amboy who have a school nursing supervisor that has lobbied for proper coverage in buildings to meet the needs of the moment and beyond. There are 2 school nurses per building, support with well-paid school nurse substitutes and the supervisor is known to fill in when nurses are absent. 
  • Test to stay will work if it is a full-service program that handles the program from inception to completion and is not added to the untenable school nurse workload

School nurses are not resistant to any of the important strategies that would help to keep our students and school staff safe. We have shown dedication and problem-solving expertise and extreme flexibility, we are asking for the same consideration and support that we provide.

Robin Cogan, MEd, RN, NCSN is a Nationally Certified School Nurse (NCSN), currently in her 20th year as a New Jersey school nurse in the Camden City School District. She serves on several national boards including The American Foundation for Firearm Injury Reduction in Medicine (AFFIRM), a gun violence prevention research non-profit organization and the National Board of Certification for School Nurses (NBCSN). Robin is the Legislative Chair for the New Jersey State School Nurses Association (NJSSNA). She is proud to be a Johnson & Johnson School Health Leadership Fellow and past Program Mentor. She has been recognized in her home state of New Jersey and nationally for her community-based initiative called “The Community Café: A Conversation That Matters.” Robin is the honored recipient of multiple awards for her work in school nursing and population health. These awards include 2019 National Association of School Nurses (NASN) President’s Award; 2018 NCSN School Nurse of the Year; 2017 Johnson & Johnson School Nurse of the Year; and the New Jersey Department of Health 2017 Population Health Hero Award. Robin serves as faculty in the School Nurse Certificate Program at Rutgers University-Camden School of Nursing, where she teaches the next generation of school nurses. She was presented the 2018 Rutgers University – Camden Chancellor’s Teaching Excellence Award for Part-time Faculty.

Robin writes a weekly blog called The Relentless School Nurse. You can also follow her on Twitter at @RobinCogan.

The views and opinions expressed by My Nurse Influencer contributors are those of the author and do not necessarily reflect the opinions or recommendations of the American Nurses Association, the Editorial Advisory Board members, or the Publisher, Editors and staff of American Nurse Journal. These are opinion pieces and are not peer reviewed.

1 Comment. Leave new

  • Thank you for speaking up for all of us. You voiced our concerns well. We know the truth, to add more means something else has to go and what do we choose? We are doing the bare necessities now. Nothing is simple in schools. We have many regulations and laws to answer to. What are they willing to stop requiring to enable us to have the time to do testing?


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