THE NURSE’S OFFICE inside each school building is often a hub of activity.

Students are treated for minor bumps and bruises. At times, more serious injuries like concussions or broken bones require additional medical care. Nurses administer daily medications that some children require, monitoring those with chronic health conditions or who face potentially life-threatening allergies. There are immunizations to track and health exams for student-athletes to be eligible for sports.

Communication is constant with parents and fellow staff members.

“The responsibilities of keeping our students safe have grown, but the hours in the day have stayed the same.”

ALISON SOTO

As school nurses returned to work earlier this fall, the job suddenly took on even greater importance. To resume in-person learning amid a global pandemic, school districts outlined detailed plans to account for social distancing, personal protective equipment, transportation adjustments and daily screenings, among many other changes.

School nurses found themselves on the front lines to confront the unprecedented challenge of keeping buildings with hundreds of students and staff operating safely.

Returning to school in September after the sudden shutdown last March came with many unknowns about what exactly the upcoming school year would entail.

“It was very anxiety-provoking trying to determine what we were going to find in September when we started back,” said Diana Pirolo, the registered nurse at Cutchogue East Elementary School. “I think the anticipation was worse than the actual, but we did a lot to be prepared.”

Ms. Pirolo, who’s been a school nurse for 17 years and is in her sixth year at Cutchogue East, said an isolation room was set up in the building for any student who may get sick while at school. The district set up screening protocols for temperature checks as students enter the building. She said when a student’s temperature checks above 100 degrees, the nurse will be called for further evaluation.

“Sometimes the temperature will be high because they had the heat on in the car and the kid is sitting right in front of the heater,” she said. “Not very frequently, but every once in a while on those real cold mornings when mom’s got the heat high.”

Nearly four months into the academic year, local schools have largely avoided any major outbreaks within buildings, even as students and staff test positive from time to time. Part of that can be attributed to the protocol and guidelines school nurses work daily to maintain. County health officials have said that COVID-19 cases, which have been rising for weeks, have been linked to community spread and not directly to schools. Riverhead Central School District, which has seen 60 cases among students, teachers and staff members, recently completed a mandatory testing program due to the Riverhead hamlet becoming a micro-cluster under state guidelines. (The district declined to make any of its school nurses available for this story.)

Alison Soto, the registered nurse at Prodell Middle School in Shoreham-Wading River School District, said they added a health aide position this year to assist nurses with the added COVID responsibilities. The health aide would accompany any student with COVID symptoms to an isolation room, where they would wait for a guardian to arrive and pick the student up. Each morning, attestation forms are collected to assess a student’s health as well as any travel or exposure history, she said. Those are saved for 14 days.

The health aide then calls each parent or guardian for students who may have forgotten the form or filled it out incorrectly, she said.

“The responsibilities of keeping our students safe have grown, but the hours in the day have stayed the same,” Ms. Soto said in a written response to questions. “[The] majority of us are either in early, stay late, or do both in order to try to get everything accomplished.”

Ms. Soto estimated that COVID-specific duties now account for about 75% of the workday. There are frequent phone calls with parents, staff and administration regarding constantly shifting protocols and policies from agencies like the Suffolk County Department of Health and Centers for Disease Control and Prevention.

The five school nurses in the district update a master Google Sheet document daily with all COVID-related cases. SWR has now seen 41 students test positive, plus another 13 teachers or staff members, according to the database published by the state Department of Health.

“The nurses also collaborate amongst each other regarding siblings in other buildings,” she said.

In the Southold School District, nurses limit the number of students in the health offices at any one time to reduce exposure by requiring teachers to call prior to sending any student there. They’ve also added nursing carts stocked with general first aid supplies so nurses can visit students outside their classrooms to assess for symptoms.

“We have been able to assess and triage whether the student needs more care in the health office or if a quick mobile visit will suffice,” the district’s three nurses — Cori Pearsall, Patty O’Day and Patty Amato — wrote in a response to questions. “This has been very helpful in decreasing time spent in the health office and increasing time in the classroom.”

The nurses said they dedicate a significant amount of time to communicating directly with parents about protocols for returning to school after an illness and whether their child would require medical clearance from their health care provider. COVID-19 symptoms overlap with the common cold, allergies or flu, so assessment from a health care provider is often required.

“The biggest hurdle this year is the process to return to school after having symptoms that the DOH recognizes as COVID-19 symptoms,” the Southold nurses wrote. “We are required to receive a note from the health care provider stating that the symptoms were not COVID-19 related or the provider must provide an alternate diagnosis. If we do not receive this documentation, the student must remain home for 10 days.”

An underlying issue nurses say they have seen is the mental health aspect of the pandemic. Fortunately, COVID-19 has not shown to be as devastating for children as compared to older adults. And children have adapted well in terms of wearing masks and social distancing to reduce the spread, the nurses said. But there’s an anxiety factor for children who fear getting sick, possible shutdowns or isolation that can come with a positive diagnosis.

The anxiety extends to faculty and staff members as well, Ms. Soto said. And students face added stress when a friend isn’t in school, is sent home early or is absent for an extended period.

“A lot of time is spent between the nurses, health aides, school psychologists and counselors helping students (and potentially faculty/staff) verbalize their feelings and supporting them during this time of uncertainty,” Ms. Soto said.

Nurses must constantly adapt to the changing landscape surrounding COVID-19. They check daily for updated guidance from the county health department and the state health department hosts weekly webinars with updates that the nurses share with their fellow school staff.

Ms. Soto said the nurses at SWR took the Johns Hopkins University COVID-19 Contact Tracing course, which was approximately six hours, prior to the start of the school year. Now, there are frequent Zoom meetings with the superintendent and district administrators and principals.

“These Zoom meetings, as well as frequent emails, keep us up to date on the ever-changing guidelines,” she said.