The Changing Landscape of Substitute School Nursing A School Nurse Administrator Roundtable.

School nurse administrators increasingly express concerns over the availability of substitute school nurses with return to in-person learning after the height of the COVID-19 pandemic. While healthcare staffing concerns and shortages are not unique to the school setting, the increasing health acuity of the student population, delegation principles, and staffing models complicate the issue. Traditional methods of covering absences may no longer suffice. In this article, five school nurse administrators share strategies, comparing pre-pandemic to current day facilitation of providing coverage for the absences of their healthcare staff.

Effects of School Nurse-Led Interventions in Collaboration with Kinesiologists in Promoting Physical Activity and Reducing Sedentary Behaviors in Children and Adolescents: A Systematic Review.

The World Health Organization (WHO) recommends that schools adopt a whole-school strategy for healthy behaviors involving different health professionals. The present systematic review aimed to evaluate the efficacy of nurse-led interventions in collaboration with kinesiologists on physical activity and lifestyle behaviors' outcomes in school settings. The protocol was registered in PROSPERO (ID: CRD42022343410). The primary research study was developed through the PICOS question: children and adolescence 6-18 years (P); school nurse-led interventions in promoting physical activity (PA) and reducing sedentary behaviors (I); usual lessons, no intervention focusing on PA (C); PA levels, sedentary behaviors, and healthy lifestyle behaviors (O); experimental or observational study with original primary data and full-text studies written in English (S). Seven studies were included. Interventions were heterogeneous: besides physical activities carried out in all studies, the interventions were based on different health models and strategies (counselling, face-to-face motivation, education). Five out of seven articles investigated PA levels or their related behaviors using questionnaires, and two used ActiGraph accelerometers. Lifestyle behaviors were assessed with heterogeneous methods. Five out of seven articles showed an improvement in at least one outcome after the interventions, whereas two papers showed a statistically non-significant improvement. In conclusion, school interventions involving nurses, also in association with other professionals such as kinesiologists, can be effective in reducing sedentary behaviors and improving healthy lifestyles in children and adolescents.

The Coronavirus Disease 2019 Pandemic and Mental Health-Related School-Nurse Visits in United States Schools.

OBJECTIVE: No studies have examined school-nurse visits related to mental health (MH) during the coronavirus disease 2019 (COVID-19) pandemic. We examined changes in the rate of MH-related school-nurse visits before and during the COVID-19 pandemic. METHODS: We analyzed school-nurse visit data (n = 3,445,240) for subjects Grade K-12 in US public schools using electronic health record software (SchoolCare, Ramsey, NJ). Data between January 1 and December 31 in 2019 (pre-COVID-19 pandemic) versus January 1 to December 31 in 2020 (during COVID-19 pandemic) were compared. For each year, total visits to a school-nurse were calculated for general MH, anxiety, and self-harm. The exposure was number of school-nurse visits in each time period (2019 vs 2020). The main outcome was change in the rate of general MH, anxiety, and self-harm visits in 2019 versus 2020. RESULTS: There were 2,302,239 total school-nurse visits in 2019 versus 1,143,001 in 2020. During the COVID-19 pandemic, the rate of visits for general MH increased by 30% (4.7-6.1 per 10,000 visits, 95% confidence interval [CI] {18%, 43%}; P < .001), and visits for anxiety increased by 25% (24.8-31 per 10,000 visits, 95% CI [20%,30%]; P < .001). There was no significant difference in self-harm visits across all ages during the COVID-19 pandemic. CONCLUSIONS: Our study found a significant increase in the rate of school-nurse visits for MH and anxiety during the COVID-19 pandemic, suggesting the pediatric population is at-risk for increased negative MH-effects associated with the pandemic and highlights a critical role of school-nurses in identifying youth with potential MH-needs.

Addressing Vaccine Hesitancy Among Students and Families: Interventions for School Nurses.

Vaccine hesitance is a public health issue that school nurses often address in practice. It has become even more prevalent during the coronavirus disease 2019 (COVID-19) pandemic. Vaccine compliance among schoolchildren is essential to the health of an entire community, given that many pediatric illnesses are vaccine-preventable. School nurses are involved in the promotion of vaccines in a school district, as they provide health education to students and families and are responsible for vaccine surveillance. Promoting vaccine compliance as a matter of public health can be challenging for school nurses, especially if a community holds strong beliefs regarding the necessity of pediatric vaccines. This article reviews the history of vaccine mandates, addresses challenges associated with vaccine compliance, and provides interventions school nurses can use when providing care to students and families regarding vaccine hesitancy. In following the nursing process, a school nurse is able to identify students missing vaccine(s) and evaluate for hesitancy, before implementing interventions that provide education to students and families. Several cost-efficient and accessible interventions can facilitate effective education and promote vaccine compliance. School nurses can forge trusting relationships and engage in compassionate dialogue to support vaccine compliance in the school.

School nurse and COVID-19 response.

The role of the school nurse should not be understated when addressing the Covid-19 pandemic and its effects on children and families. Knowledge surrounding this virus is rapidly changing and quick adaptation within the school system is required. In addition to the provision of direct care and education to students, school nurse responsibilities include the development and implementation of new policies; consideration of social and emotional well-being; and effective communication with students, families, teachers, administrators, and community stakeholders. This article addresses current evidence related to the coronavirus disease 2019 (COVID-19) pandemic and the evolving role of the school nurse. A case study incorporates tips and suggestions for school nurses who will deliver professional care during this COVID-19 crisis.

Piloting a clinical mental health process in the intermediate school setting

The COVID-19 pandemic has highlighted the need for increased adolescent mental health support in the school setting. This evidence-based quality improvement project aimed to determine if implementing a clinical mental health pathway increases the number of mental health screenings completed and increases school nurse practitioners' comfort and confidence in completing mental health screenings. A Mental Health Toolkit was developed to include program-specific management recommendations, a school collaboration flowsheet, and educational and community resources for the nurse practitioner, students, and school community. The 15-week pilot intervention was evaluated using quantitative pre-and post-survey and qualitative interviews. The intervention increased the number of depression screenings performed compared to the previous school year. In addition, the post-intervention interview provided clarity to the persistent system-level and clinic-level barriers and provided personal insights into performing mental health screenings within the school setting. This pilot project allowed the nurse practitioner to model the normalization of mental health discussions. It also provided an opportunity for increased collaboration between the nurse practitioner and school partners, which can substantially impact adolescent mental health outcomes. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

The school nurse's experience of secondary exposure to trauma

The school nurse (SN) is often the sole health care expert in the school setting, providing for the physical and socio-emotional needs of others. SN may be exposed to reports of trauma, a widespread and costly public health issue. This study sought to explore the experience of the SN when exposed to reports of trauma from those in their care. Seven N.J. certified school nurses participated in two online interviews via Microsoft Teams, spaced one to two weeks apart between June 2021 and September 2021. Interviews were recorded & transcribed verbatim and thematic analysis applied. This study found that SN receive reports of trauma to varying degrees, with those in high-poverty urban settings relaying more frequent exposure than those in suburban settings. The SN identified the health office as a safe haven where students are welcome, accepted as they are, can share concerns, and seek comfort from their ailments. SN reported challenges working within the school model, and experienced obstacles to receiving reports of trauma including a lack of school-based collaboration, a lack of understanding of the SN role, and SN workload. In the eye of the storm, while receiving traumatic reports, SN focus on immediate needs. Later, while mitigating the aftermath, they process the experience and apply coping strategies, such as self-care and social support, to restore and replenish. While weathering the storm, they share concern and frustration, but acknowledge that they can only do so much. The SN in this study did not demonstrate secondary trauma but instead shared stories of resilience. Effects of the COVID-19 pandemic on the SN receipt of reports of trauma were explored. Further research is needed regarding the role of the SN, SN workload, and their experience in receiving reports of trauma. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

School Nurses' Reports on Reopening Roles, Practices, and Concerns During the COVID-19 Pandemic at the Start of the 2020-2021 School Year.

The COVID-19 pandemic has caused major disruptions to U.S. school systems since March 2020. To facilitate our understanding of how school nurses participated in school reopening and what support school nurses needed beginning the 2020-2021 school year during the COVID-19 pandemic, we conducted a national survey in late summer 2020. A sample of 747 school nurses from 43 states responded to an online survey about roles, practices, and concerns. Over one-third (36.9%) reported not being included in school reopening planning. Mitigation practices reported by respondents primarily included measuring temperatures of students before school (21.3%), mask wearing by students (79.9%), and 6 feet social distancing (76.7%). The respondents' greatest concerns were the educational impact on students with individualized education plans, parents sending children to school with COVID-19 symptoms, and the economic impact on families. Our results point to opportunities for greater school nurse involvement, improvements in practices, and measures to address school nurses' concerns.

Feasibility Assessment of a School Nurse-Led Approach Using Chronic Absenteeism to Establish the School-Based Active Surveillance Process.

This article shares what was learned from the feasibility assessment of a nurse-led school-based active surveillance (SBAS) pilot to track chronic absenteeism using myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) as an exemplar. This pilot encompassed a 3-year period with training and feedback from school nurses (SNs) on data collection and ME/CFS. SNs found that the SBAS process helped them effectively identifying undiagnosed conditions. The assessment revealed the importance of focusing outreach efforts and establishing relationships with the school leadership in developing health policies and programs in the school setting. The pilot data were used to develop a manual to guide SNs for the SBAS process. This can be viewed as a model for SNs in establishing a surveillance to identify and track conditions like ME/CFS. With overlapping symptoms of Long COVID to ME/CFS, this assessment may provide insights for additional efforts to understand the impact of Long COVID on students' education.

Exploration of California School Nurse perspectives on the impact of COVID-19.

OBJECTIVE: To explore in a sample of school nurses (SN) in California the impact of the COVID-19 pandemic on school nurse health services, how school nurses mitigated the impact of COVID-19, and moral distress levels among school nurses. DESIGN AND METHODS: Nineteen (N = 19) school nurses who work in K-12 schools in California, USA participated in a mixed-methods approach involving qualitative descriptive design, inductive content analysis, and descriptive statistics. Interviews were conducted in August and September 2021. RESULTS: Five themes emerged: (1) role of the SN during the COVID-19 pandemic, (2) coordination with school administration, (3) COVID-19 related challenges and disruptions to care, (4) moral distress, and (5) coping during the pandemic. CONCLUSION: The pandemic had a profound impact on school nurses. This study provides school nurse perspectives of the impact of COVID-19 on services they delivered, the unique skills of school nurses essential to mitigation strategies, and moral distress school nurses encountered during the pandemic. Understanding the important role school nurses had during the pandemic is paramount to fully contextualize the contributions they made within public health nursing practice and inform preparedness for future pandemics.

Symptoms of Depression, Anxiety, and Post-Traumatic Stress Disorder, and Suicidal Ideation Among School Nurses in Prekindergarten through Grade 12 Schools - United States, March 2022.

School nurses are integral to creating safe environments in U.S. schools. Many experienced increased work burden and stress during the COVID-19 pandemic. CDC collaborated with the National Association of School Nurses and the National Association of State School Nurse Consultants to distribute a 121-item online, anonymous survey to school nurses nationwide during March 7-30, 2022. Among the 7,971 respondents, symptoms of depression, anxiety and PTSD, and suicidal ideation were measured, and prevalence ratios were used to identify associations with demographics, workplace characteristics, and support. Results found high levels of work-related stressors and indicated that employment characteristics, COVID-19-related job duties, and other workplace stressors and supports affected school nurse mental health. The survey findings underscore the mental health challenges many school nurses experienced during the 2021/2022 school year. The findings can inform supportive policies and practices to reduce workplace stressors and increase workplace supports for school nurses.

The Significance of Social Development Support in Schools: The Critical Role of School Nurses.

The growth of social development entails a progression where youth learn to interact with those around them. This manuscript provides interventions school nurses may use to incorporate social development into their daily practice and interactions with students. Social-emotional skills are pivotal to children's and adolescents' health, well-being, and academic success. Healthy social development can lead to improved self-confidence and better social relationships and have long-term benefits into adulthood. There is still much to learn about how the COVID-19 pandemic has affected the social development of children and adolescents. Nevertheless, school personnel, including the school nurse, must collaborate to support students, families, and each other to cultivate an environment that connects social development with education, health, and well-being.

Changing Roles of the State School Nurse Consultants: How the Pandemic Has Accentuated Their Value and Visibility.

State School Nurse Consultants (SSNCs) played a pivotal role in navigating school health during the COVID-19 pandemic. Schools faced unprecedented challenges in which many school administrators found themselves having to make strategic decisions on school health for the first time in their careers. The work of SSNCs has been recognized and appreciated in an unprecedented way, as they became key gatekeepers in school health, forming new partnerships with State Departments of Health and Education stakeholders; supporting school nursing practice, school nurses' mental health, and pandemic fatigue; providing resources; and organizing many state-wide virtual trainings. SSNCs were strategic in developing state school health policy and providing funding support, increasing school nurse positions in their states. As their roles have changed, SSNCs will continue to be intentional in the promotion of health and disease prevention throughout the years to come.

The Changing Job of School Nurses during the COVID-19 Pandemic: A Media Content Analysis of Contributions to Stress.

School nurses and unlicensed assistive personnel (UAPs) are essential to the health and wellness of school children. However, most US schools do not have a full-time licensed nurse. During the COVID-19 pandemic, school nurses and UAPs have been integral in ensuring that the health needs of students were met. They have seen a marked increase in their responsibilities included implementing COVID-19 mitigation strategies, screening for symptoms, testing students and staff, conducting contact tracing and data collection, and ensuring the implementation of rapidly changing COVID-19 guidelines and protocols for schools. The objective of this study was to explore COVID-19 occupational changes and their contributions to stress among school nurses and UAPs through a content analysis of local and national media articles. A Google search of articles published between February 2020 and September 2021 was conducted using the following search terms: 'school nurse', 'COVID-19', 'health aide', 'stress', and 'experiences'. A search was also conducted in Nexis Uni. Articles were included if the topic discussed school nurses or UAPs and COVID-19. All articles that examined nurses in other settings were excluded from the review. We examined topics and themes temporally (from February 2020 to September 2021) and spatially (i.e. the frequency by US state). Overall, 496 media articles discussing school nurses and COVID-19 were included in our review. The highest volume of articles was from September 2021 (22%, 111/496). Other months with relatively high volume of articles included August 2020 (9%, 43/496), January 2021 (10%, 47/496), February 2021 (9%, 44/496), and August 2021 (8%, 39/496). These larger article volumes coincided with notable COVID-19 events, including returning to school in the fall (August 2020 and August 2021), school nurses assisting with vaccine rollouts among adults in the USA (January/February 2021), concerns regarding the delta variant (August/September 2021), and vaccine rollouts for children ages 12-15 (September 2021). The representation of articles spatially (national, state, regional, or local) was 66 (13%) articles at national level, 217 (44%) state level, 25 (5%) regional level, and 188 (38%) local news at the city and/or village level. Pennsylvania had the highest frequency of articles, but when standardized to the state population, Alaska had the highest rate of media per 100 000 people. Three major themes were identified in our analysis: (i) safety; (ii) pandemic-related fatigue/stress; and (iii) nursing shortage/budget. The most represented theme for articles before September 2021 was that of safety. Over time, the themes of pandemic-related fatigue/stress and nursing shortage/budget increased with the most notable increase being in September 2021. The COVID-19 pandemic has resulted in new occupational risks, burdens, and stressors experienced by school nurses and UAPs. School nurses play a critical role in disease surveillance, disaster preparedness, wellness and chronic disease prevention interventions, immunizations, mental health screening, and chronic disease education. Furthermore, they provide a safety net for our most vulnerable children. Given that school nurses were already over-burdened and under-resourced prior to the pandemic, characterization of these new burdens and stressors will inform emergency preparedness resources for school health personnel during future pandemics or outbreaks.

Piloting a clinical mental health process in the intermediate school setting

The COVID-19 pandemic has highlighted the need for increased adolescent mental health support in the school setting. This evidence-based quality improvement project aimed to determine if implementing a clinical mental health pathway increases the number of mental health screenings completed and increases school nurse practitioners' comfort and confidence in completing mental health screenings. A Mental Health Toolkit was developed to include program-specific management recommendations, a school collaboration flowsheet, and educational and community resources for the nurse practitioner, students, and school community. The 15-week pilot intervention was evaluated using quantitative pre-and post-survey and qualitative interviews. The intervention increased the number of depression screenings performed compared to the previous school year. In addition, the post-intervention interview provided clarity to the persistent system-level and clinic-level barriers and provided personal insights into performing mental health screenings within the school setting. This pilot project allowed the nurse practitioner to model the normalization of mental health discussions. It also provided an opportunity for increased collaboration between the nurse practitioner and school partners, which can substantially impact adolescent mental health outcomes. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

The school nurse's experience of secondary exposure to trauma

The school nurse (SN) is often the sole health care expert in the school setting, providing for the physical and socio-emotional needs of others. SN may be exposed to reports of trauma, a widespread and costly public health issue. This study sought to explore the experience of the SN when exposed to reports of trauma from those in their care. Seven N.J. certified school nurses participated in two online interviews via Microsoft Teams, spaced one to two weeks apart between June 2021 and September 2021. Interviews were recorded & transcribed verbatim and thematic analysis applied. This study found that SN receive reports of trauma to varying degrees, with those in high-poverty urban settings relaying more frequent exposure than those in suburban settings. The SN identified the health office as a safe haven where students are welcome, accepted as they are, can share concerns, and seek comfort from their ailments. SN reported challenges working within the school model, and experienced obstacles to receiving reports of trauma including a lack of school-based collaboration, a lack of understanding of the SN role, and SN workload. In the eye of the storm, while receiving traumatic reports, SN focus on immediate needs. Later, while mitigating the aftermath, they process the experience and apply coping strategies, such as self-care and social support, to restore and replenish. While weathering the storm, they share concern and frustration, but acknowledge that they can only do so much. The SN in this study did not demonstrate secondary trauma but instead shared stories of resilience. Effects of the COVID-19 pandemic on the SN receipt of reports of trauma were explored. Further research is needed regarding the role of the SN, SN workload, and their experience in receiving reports of trauma. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

A School Nurse and a Technology Specialist: Partnering for Improved Processes During COVID-19.

School nurses have worked tirelessly during the COVID-19 pandemic. At times, the workload has been unsustainable and there were not enough hours in the day for school nurses to complete their duties. In one school district, the high school nurse and instructional technology specialist collaborated on improving the process of collecting COVID-19 information. This resulted in dramatically reducing the amount of time it took to process information and improved the way the data were collected and shared. This article describes the steps in pandemic-related data collection and communication used before and after implementation of the improved tools and processes. The authors also provide forms, email templates, and the resulting district COVID-19 metric figures helpful to school nurses desiring to replicate the process.

School Nurses' Perceptions About Student's Wellbeing During the Covid-19 Pandemic in Sweden.

The coronavirus 2019 (Covid-19) pandemic has affected both the private and public lives of people worldwide. Countries have chosen different strategies to reduce the spread of infection, including school closures and distance learning. This study aimed to describe school nurses' perceptions about the wellbeing of students during the Covid-19 pandemic in Sweden. Interviews in five focus groups and one individual were conducted with 17 school nurses in Sweden. The interviews were analyzed using a qualitative content analysis. According to the school nurses' perceptions, students were concerned about spreading infection, becoming infected themselves, their academic performances, and longing for socialization. The change in the school situation involved a slower pace and less anxiety for some students, more or less physical activity, and an increase in screen time.

The Role of School Nurses During the 1918 Pandemic: Lessons That Apply to COVID-19.

The current COVID-19 pandemic has been compared with the Spanish Flu of 1918 that devastated the United States. With so many parallels being drawn, what could be learned from 1918 regarding the role of school nurses? Many of the activities from 1918 are still being done today. School nurses have worked tirelessly to assure the health and safety of students and school. The purpose of this article is to compare the role of school nurses in two pandemics, as well as provide suggestions on how school nurses' important contributions to history are not lost. The recommendations have an added benefit of providing school nurses with healing and building their resilience.

Leading During a Pandemic: A School Nurse Administrator Roundtable.

The ongoing COVID-19 pandemic has been taxing to healthcare workers, no less for those serving on the front lines in schools. From initial school closures and online learning to gradual reopening with hybrid learning models, to full in-person learning, school nurse administrators provided guidance in collaboration with public health officials, based on evolving information. Infection control was at the forefront, while government and scientists partnered to quickly develop effective vaccines. Technology provided new virtual platforms for learning, conducting meetings, and socialization, while also being widely used to deliver information, misinformation, and disinformation. Challenges have been numerous, but school nurse administrators and school nurses in general, with a commitment to the health and safety of their populations, continue to adapt to the ever-changing demands. The journal's Editorial Advisory Board interviewed five school nurse administrators, representative of diverse geographic locations, school population size, and employer models, to capture their reflections on school health leadership during the COVID-19 pandemic. History is deserving of their stories.