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Forced to improvise COVID policies, school nurses are reaching a 'breaking point'

Brighton High School nurse Lauren O'Malley-Singh. (Jesse Costa/WBUR)
Brighton High School nurse Lauren O'Malley-Singh. (Jesse Costa/WBUR)

Every morning before school, Lauren O’Malley-Singh’s heart races as she straps on an N95 mask.

“I feel like I’m drowning,” said O’Malley-Singh, a nurse at Brighton High School in Boston.

She’s drowning in coronavirus tests. She gives upwards of 40 rapid tests a day, isolating the students who test positive, calling their parents and finding a way to get them home. When she’s not administering tests, she’s contact tracing as best she can and getting testing consent forms signed. Amid all that, she estimates that about once an hour, she’s helping a student find a place to get vaccinated.

The work spills into evenings and weekends, often without extra pay. Even at night, she can’t escape it.

“I wake up in the middle of the night dreaming of positive COVID tests. It’s really stressful,” she said. “Whatever I’m doing, it is not enough. And it’s not what should actually be happening for our communities.”

Surging COVID numbers have made for a sometimes-disorganized return to school after winter break. There are record case counts and changing guidelines for testing and isolation. A heavy burden has fallen on school nurses, who say they feel overwhelmed and under-supported.

“I go into work, and I am ready for the battlefield,” said Erin McManus, a nurse at the Edison School in Brighton. She said COVID work has eclipsed all the other work school nurses do. “We have stacks of physical exams. We have kids that need vision screenings and hearing screenings to be referred,” she explained. “All of those things are getting pushed back.”

In this hectic environment, O’Malley-Singh said, there’s a lack of clear protocols and checklists to speed the work and make sure school nurses aren’t missing anything. Instead, she’s coming up with policies on the fly.

For example, she said, there’s no clarity about what to do if a kid tests positive, and there’s no parent to pick them up. “What if they use the school bus, and that’s their only way to get home?” she asked.

Similarly, O’Malley-Singh said there was no handout to provide to parents if their kid tests positive, informing them of what to do, and when the child will be allowed back in school. So, she wrote up her own handout and translated it into several languages.

O’Malley-Singh compiled many of the things she’s learned about handling COVID into a 28-page Google Doc that she’s shared with fellow nurses. But the lack of clear, official protocols is troubling, she said.

“That leaves many of us on the ground feeling un- or under-supported by the district, by the city and by the state,” she said. “It feels scary on a day-to-day, hour-to hour and minute-to-minute basis.”

The Massachusetts School Nurse Organization (MSNO) said many school nurses are feeling the strain.

“What we’re hearing from our members is that they are extremely overwhelmed, and they’ve reached their breaking point,” said Doreen Crowe, president of the MSNO.

Last year, she said, her organization saw people taking early retirement. Now, as the omicron variant drives a spike in cases, she’s seeing departures again as a number of school nurses take leaves of absence in the middle of the school year. Sometimes they bow out due to stress. Other times, she said, it’s the lure of hospital jobs with much better pay.

Crowe said it’s demoralizing, especially when it feels like the state doesn’t value school nurses’ expertise as it continues to deal with COVID in yet another school year.

“There has never been an invitation for a school nurse or school nurse leader to participate in the planning at the state level,” said Crowe.

The Department of Elementary and Secondary Education (DESE) said it does consult school nurses. A school nurse was on the reopening committee in 2020, but DESE no longer has a formal working group, the department said.

“We just are very grateful for everything that nurses have done,” said DESE’s Deputy Commissioner Russell Johnston, adding that the state wants to help reduce the burden on school nurses.

“We’re really looking into a variety of options right now that include staffing solutions as well as protocol solutions, and so more to come in that regard,” Johnston said.

He said the state offers webinars and recorded sessions to highlight best practices. Plus, he pointed to an email address and a phone number if anyone has a question: “We take calls from nurses all the time,” he said.

But at Brighton High School, nurse O’Malley-Singh said, she doesn’t feel like there’s a support network to rely on. In early January, her 7-year-old daughter tested positive for the coronavirus, and her family made the painful choice to temporarily separate into two households. O’Malley-Singh is staying with their uninfected 3-year-old. Her husband, a teacher, is staying with their daughter.

“My husband and I made an active decision that he would be the sick one, if someone were to get sick. That’s because there’s no one to test and take care of the kids at my school if I am home,” said O’Malley-Singh.

Boston Public Schools said in a statement that the district has a team of substitute nurses to cover absences, and they are working “as quickly as possible to address shortages.”

Still, O’Malley-Singh isn’t confident there would be coverage if she were absent. She said she’s having to choose between caring for her own child and being there for her students.

This article was originally published on WBUR.org.

Copyright 2022 WBUR. To see more, visit WBUR.

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