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Challenges and Collaboration in the Classroom with School Nurses (NASN) · The SHEA Podcast

• 0:10
  SPEAKER_00: Welcome to the We're All in This Together COVID-19 Allies and Infection Prevention Podcast Series as part of the Society for Healthcare Epidemiology of America, SHA Rapid Response Program.
• 0:21
  SPEAKER_00: I'm Dr.
• 0:22
  SPEAKER_00: Onu Milani, the medical director of the antimicrobial stewardship and infection prevention and control programs at St.
• 0:28
  SPEAKER_00: Joseph Mercy Health System, based in Ann Arbor, Michigan, and I will serve as your SHA moderator and speaker.
• 0:35
  SPEAKER_00: I'm also happy to welcome Lori Comb, President of the National Association of School Nurses, and is a nationally certified school nurse.
• 0:44
  SPEAKER_00: With 44 years as a registered nurse, Lori has experience in adolescent psychiatry, nursing education, and home health hospice care.
• 0:54
  SPEAKER_00: In her 27 years as a school nurse, Lori has found her passion in working with students and families, building trust that serves to support the health of students and families.
• 1:05
  SPEAKER_00: A guiding value of Lori's work is the pursuit of equity for individual students as well as underserved populations and communities.
• 1:13
  SPEAKER_00: Lori will serve as your National Association of School Nurses Nassin's speaker for today's podcast.
• 1:21
  SPEAKER_00: The National Association of School Nurses is the only national association solely dedicated to advancing the specialty practice of school nursing to improve the health and academic success of all students.
• 1:34
  SPEAKER_00: With over 18,000 members in every part of the country and affiliate organizations in 48 states, the District of Columbia, and overseas, Nassin has extensive reach at the national, state, and local level.
• 1:50
  SPEAKER_00: Nassin is located in Silver Spring, Maryland, and is a 501 public charity.
• 1:58
  SPEAKER_00: Discussion on the podcast does not reflect Shay's or Nassan's perspective, but it facilitates communication of multiple perspectives and experiences as we go through this challenging time together.
• 2:11
  SPEAKER_00: Today's episode will focus on collaborations and how we can work together to address the most important questions surrounding the COVID-19 outbreak.
• 2:20
  SPEAKER_00: Let's get started with our first question.
• 2:23
  SPEAKER_00: So, Lori, thank you for uh joining us today.
• 2:25
  SPEAKER_00: I'm very excited to talk to you.
• 2:28
  SPEAKER_00: I have two kids that are in schools.
• 2:30
  SPEAKER_00: I have a fourth grader and a sixth grader, and I'm looking forward to our conversations.
• 2:34
  SPEAKER_00: So, Lori, how do we create an environment that is conducive around learning with everything going on with the pandemic?
• 2:42
  SPEAKER_01: Well, first and you thank you and Shay for the opportunity to have this conversation.
• 2:48
  SPEAKER_01: And I think that we prepare by following the evidence, and we know that that is rapidly changing.
• 2:58
  SPEAKER_01: And that's made the situation difficult in some respects.
• 3:03
  SPEAKER_01: I know that NASN has started early, as soon as schools shut down, to develop tools for school nurses to use, and that's based on evidence, and our staff is working feverishly every day to see what is new, how do we update, and what are the resources that our members need in this rapidly evolving environment.
• 3:32
  SPEAKER_01: I think that partnerships are critical.
• 3:36
  SPEAKER_01: We partnered with numerous national organizations to share their best practices, to create best practice resources, and to disseminate NASN resources through those partner organizations.
• 3:54
  SPEAKER_00: So is there a national dashboard for what's happening in schools?
• 3:58
  SPEAKER_00: And can you maybe talk a little bit about surveillance nationally?
• 4:02
  SPEAKER_01: We're probably familiar with the Johns Hopkins dashboard, but that doesn't really address schools, right?
• 4:10
  SPEAKER_01: That's a nationwide dashboard.
• 4:13
  SPEAKER_01: The National Education Association has a school tracker, which is a self-report mechanism.
• 4:21
  SPEAKER_01: And I know they try to do some vetting, but there certainly could be some bias associated with that data.
• 4:30
  SPEAKER_01: Each school and school district may have a dashboard.
• 4:34
  SPEAKER_01: So I practice in Texas, and Texas schools are required to report to their public about COVID cases on campuses and district-wide.
• 4:48
  SPEAKER_01: And then they also have to report to the Texas Education Agency who has a dashboard.
• 4:56
  SPEAKER_01: So in our state, we can find that school-specific information.
• 5:02
  SPEAKER_00: Who ultimately decides how learning takes place, whether it's virtual or whether it's in person?
• 5:10
  SPEAKER_01: I think that that looks different in different states.
• 5:15
  SPEAKER_01: In some states, the governor makes that decision.
• 5:20
  SPEAKER_01: In other states, the health department makes that decision.
• 5:25
  SPEAKER_01: The best opportunity, of course, is a collaboration.
• 5:29
  SPEAKER_01: And I'm not saying that doesn't happen, but what I am saying is that it's a very mixed bag as we look across these United States.
• 5:40
  SPEAKER_01: It can be state agencies, local health departments, local school boards, individual schools.
• 5:49
  SPEAKER_01: Very different.
• 5:50
  SPEAKER_01: I would say no exact national standard.
• 5:55
  SPEAKER_01: When school nurses are saying, well, which guidance should I follow?
• 6:02
  SPEAKER_01: The rhetoric is, well, that's guidance, it's not a mandate.
• 6:06
  SPEAKER_01: And so often those bottom line decisions are being left to individual school districts.
• 6:15
  SPEAKER_01: That causes confusion in the community, I believe.
• 6:20
  SPEAKER_00: Yeah, I think you're right, Lori.
• 6:21
  SPEAKER_00: And I live in Arbor, Michigan, and I do think that there are differences, even when you get, you know, 15 to 20 minutes out of where I live, depending on whether schools are in person and virtually.
• 6:36
  SPEAKER_00: What is your organization really doing to address COVID-19?
• 6:40
  SPEAKER_00: And the second part of that question, I wonder if you could talk a little bit about how NASA is addressing some of the socioeconomic disparities that we've seen exemplified by the pandemic.
• 6:53
  SPEAKER_01: So NASA's done a lot of work around COVID-19.
• 6:59
  SPEAKER_01: I've really been proud of the response of our organization and also proud of our members.
• 7:07
  SPEAKER_01: And I'm going to start with school nurses first.
• 7:11
  SPEAKER_01: For our members, we have a connected community where they can have open discussion about situations.
• 7:21
  SPEAKER_01: And as far back as January 24th, school nurses were asking questions about how should they manage students or families who were traveling from China.
• 7:36
  SPEAKER_01: So already their radar was up.
• 7:40
  SPEAKER_01: That connected community has really driven NASN's response by seeing what the needs and the concerns in that community were, that community discussion, then we knew what we needed to curate for our members.
• 8:01
  SPEAKER_01: That being said, members contributed lots of great resources that may have been based on local principles, but gave us a great platform to develop a nationwide piece of information or resource for our nurses.
• 8:23
  SPEAKER_01: We have spent a lot of time informing the community about what it is that school nurses really do.
• 8:33
  SPEAKER_01: There are many misconceptions about our work.
• 8:38
  SPEAKER_01: In fact, we have a very complex practice.
• 8:43
  SPEAKER_01: And during this time of COVID-19, I've been grateful for the opportunity to field more media interviews than NASN has fielded in quite some time.
• 9:00
  SPEAKER_01: And so there's an opportunity to educate the public about the practice of school nurses and the value that school nurses bring to students' health and learning.
• 9:15
  SPEAKER_01: To address disparities, NASN recognizes, as you mentioned, that there are some school communities that are well financed.
• 9:28
  SPEAKER_01: And sometimes that even comes down to individual schools within school systems because of vibrant parent-teacher associations and organizations that contribute additional funding to that school.
• 9:45
  SPEAKER_01: But not all schools have that privilege of that robust organization.
• 9:52
  SPEAKER_01: So NASN has been advocating for increased federal spending to support the personnel, materials, and facility improvement resources needed to address those disparities in school communities.
• 10:13
  SPEAKER_01: Additionally, we have seen member organizations, and I'm going to speak specifically about the Almagar Roder, New Mexico School District Health Services Team, and they utilized CARES Act funding to purchase a recreational vehicle that they're outfitting to deliver health services directly in neighborhoods where students live because they know that parents don't have access to transportation or are fearful of public transportation.
• 10:50
  SPEAKER_01: Other school districts are hosting drive-through immunization clinics.
• 10:56
  SPEAKER_01: We know that there has been a pretty drastic decrease in the uptake of immunizations during COVID-19.
• 11:05
  SPEAKER_01: These school districts are offering immunizations and COVID-19 testing.
• 11:12
  SPEAKER_01: So people are interested in COVID-19 and, oh, by the way, we'll help you get up to date on your immunizations as well.
• 11:21
  SPEAKER_01: So school nurses are using lots of innovative ideas to address the disparities that we see in our schools.
• 11:30
  SPEAKER_00: So, Lori, how does NASA and school districts, how do they typically meet the needs for testing and immunizations?
• 11:38
  SPEAKER_00: Is that typically through health department health systems, or does it again just vary by locale?
• 11:44
  SPEAKER_01: I would say that most often any testing that needs to be completed is done via referral either to a primary health care provider or to a local health department.
• 12:00
  SPEAKER_01: Sometimes, in the case of outbreak, the health department will come to a school district and conduct that testing.
• 12:09
  SPEAKER_01: In fact, that's happening in Pasco County Schools in Florida.
• 12:14
  SPEAKER_01: They've partnered with the health department.
• 12:16
  SPEAKER_01: The health department set up a tent in a parking lot, and the community can come and receive testing.
• 12:24
  SPEAKER_01: As for immunizations, about 14% of school nurses manage school-located vaccine clinics, which would be in partnership with a community or public health provider that comes into the school.
• 12:43
  SPEAKER_01: Some school nurses, although a very small proportion of school nurses, actually provide immunization services as part of their clinic services.
• 12:54
  SPEAKER_01: The challenge there is the proper storage and monitoring of those vaccines, as you well know.
• 13:02
  SPEAKER_00: And just to tag on to this conversation, how about personal protective equipment?
• 13:07
  SPEAKER_00: How has that been handled from your perspective?
• 13:10
  SPEAKER_00: And is NASA involved with that as well?
• 13:13
  SPEAKER_01: Well, NASA has been very vocal about personal protective equipment for schools.
• 13:19
  SPEAKER_01: Early on, the guidance indicated that schools did not need N95.
• 13:26
  SPEAKER_01: And we began advocating very early while schools were still closed, that you needed to understand about the students who come to school.
• 13:39
  SPEAKER_01: So we have students who come to school with tracheostomies.
• 13:44
  SPEAKER_01: And if those children were going to be in school, we were going to need an N95 because they often need suctioning and that would air us a lives.
• 13:55
  SPEAKER_01: If we had students who needed ventilator support, and if they came to school, we would need access to N95.
• 14:06
  SPEAKER_01: And oh, by the way, emergency resuscitation happens on school campuses.
• 14:13
  SPEAKER_01: So over time, we have seen that that guidance has changed and it is now acknowledging that those aerosolized procedures can happen in school.
• 14:25
  SPEAKER_01: All that being said, anew, schools in some instances are having difficulty in accessing the appropriate PPE or the appropriate quantity of PPE in schools.
• 14:40
  SPEAKER_01: States have disseminated some PPE, but for instance, in Texas, the number of masks allotted for students would last not even a week, right?
• 14:53
  SPEAKER_01: So NASN is engaged in a partnership with Get Us PPE that was very successful in helping frontline providers in hospitals access what they need.
• 15:09
  SPEAKER_01: And we are currently in the process of beginning dissemination to some communities, and we hope that through this collaboration we can help schools meet their needs.
• 15:22
  SPEAKER_01: And the funding I talked about, remember, was for material resources as well, and that would include PPE.
• 15:32
  SPEAKER_00: Moving a little bit and talking about challenges, what has been, uh, would you say your and NASA's biggest challenge around COVID-19 and how have these been handled thus far?
• 15:44
  SPEAKER_01: Well, we've already talked about the rapidly changing guidance and informing stakeholders about the complex health conditions and needs of students.
• 15:57
  SPEAKER_01: I would say that moving forward, that it is a challenge to manage those community expectations surrounding quarantine.
• 16:09
  SPEAKER_01: Families and teachers and school staff are under stress, and school nurses are trying to adhere to the guidance.
• 16:20
  SPEAKER_01: Communities are experiencing COVID fatigue and not wanting to adhere to that guidance.
• 16:29
  SPEAKER_01: And so that has been a challenge.
• 16:32
  SPEAKER_01: And I think again, if we layer on top of managing routine school nurse duties such as daily care for students who are diagnosed with chronic health conditions but are essentially well, immunization compliance, mandated screenings for dental vision, hearing, and spinal.
• 16:56
  SPEAKER_01: And now school nurses are expected to do this intensive contact tracing, which you are aware takes quite a lot of time.
• 17:09
  SPEAKER_01: They're having to manage separate areas for students who were referred to the nurse for assessment of COVID-19, and then the nurse assesses them, thinks they're presumptive case, perhaps, is going to refer them for testing now, has to isolate them and have to keep those separate from those well children.
• 17:34
  SPEAKER_01: School facilities are not built for this purpose, and so there's been a lot of repurposing of school facility space, trying to find areas that can serve all those three populations we talked about, and still have access to restroom and hand washing.
• 17:57
  SPEAKER_01: Those have been very challenging circumstances.
• 18:01
  SPEAKER_01: And then I'd say the other piece is that in some school communities, the school nurses' expertise in public health practice and infectious disease control was not leveraged in informing a school's plan for COVID response.
• 18:22
  SPEAKER_00: Thank you for eloquently describing all those challenges.
• 18:27
  SPEAKER_00: We too have faced a number of kind of evolving challenges as science has changed and understanding of COVID-19 and transmission and treatment and management, it's really been challenging.
• 18:39
  SPEAKER_00: But I think what you're describing, many of us are not cognizant in thinking about, is that really these are a lot of added challenges and responsibilities to plates of uh school nurses and teachers in really sort of unprecedented times.
• 18:55
  SPEAKER_01: And if I might quickly add, for the school nurse, it's not so much the add-on of additional activities.
• 19:04
  SPEAKER_01: We think of it in terms of workload and how much workload can we sustain and still deliver safe care?
• 19:13
  SPEAKER_01: Because it's the student, students' health that's at the center of this nexus, right?
• 19:20
  SPEAKER_00: Exactly.
• 19:21
  SPEAKER_00: How about how common school nurses are and what schools have them?
• 19:27
  SPEAKER_00: Maybe you could just comment on, like, you know, what percentage of schools actually have school nurses available.
• 19:34
  SPEAKER_01: Thank you for this opportunity.
• 19:36
  SPEAKER_01: If we think of this in the context of about 55 million public school children, and then another 4 million plus in private, independent, and parochial schools, 25% of schools have no school nurse on site.
• 19:53
  SPEAKER_01: And that leaves school administrators to navigate pandemic guidance without that expertise at the table.
• 20:01
  SPEAKER_01: Another 35% have a part-time school nurse, many covering multiple schools.
• 20:08
  SPEAKER_01: And in rural America, that's over vast distances between those schools.
• 20:13
  SPEAKER_01: So just under 40% of schools have a full-time school nurse.
• 20:20
  SPEAKER_00: So now we're about two months into the school year.
• 20:24
  SPEAKER_00: And while I think universally schools kind of shut down early on in March and April, and at that time, but now we have many schools that are in person, many schools that are virtual.
• 20:35
  SPEAKER_00: What have we seen thus far?
• 20:37
  SPEAKER_00: And are you are you seeing evidence of spread in the classrooms?
• 20:42
  SPEAKER_01: What we hear our members saying is that there is spread among sports teams who are coming together for competition.
• 20:52
  SPEAKER_01: And I think we see that as at a national level, right, with other sports teams, that there's higher rates of transmission in those older students, not so much in the younger group.
• 21:09
  SPEAKER_01: And I shouldn't say rates of transmission, I should say rates of disease, and not as much in our younger students.
• 21:17
  SPEAKER_01: I think it's interesting.
• 21:19
  SPEAKER_01: We all thought that the younger students would struggle to wear the mask, and it's the inverse that anecdotally is being reported to be true: that the youngsters are keeping it on and the older children don't want to.
• 21:34
  SPEAKER_00: I think that that's true of what we've seen thus far and what we're learning in terms of your descriptions around transcription and where they're happening.
• 21:42
  SPEAKER_00: And it does seem that the class can be handled safely given PPE and a lot of those other aspects.
• 21:49
  SPEAKER_00: As we close out here, what opportunities are there in working together to handle the pandemic?
• 21:56
  SPEAKER_00: And how do you think Shea members could offer their expertise for those that are interested?
• 22:02
  SPEAKER_01: I participated in a call with our local health department, and it was such a great ask that happened during that meeting that local health department leaders create PSAs for deployment in school districts about the evidence, about what's necessary for mitigation, so that across a local health department's service area, all schools can be pushing out the same information to their stakeholders, that it's not piecemeal, district by district.
• 22:45
  SPEAKER_01: I think that would be the greatest help we could find in these moments.
• 22:51
  SPEAKER_00: Well, thank you very much to our speaker, uh Lori Comb for joining us today and sharing your perspectives and experiences.
• 22:58
  SPEAKER_00: And surely this is uh eye-opening for many of us.
• 23:02
  SPEAKER_00: A sincere thank you from Shay to all healthcare personnel for all that you are doing to respond to COVID-19.
• 23:10
  SPEAKER_00: This podcast can be accessed on Shay's online education center, Learning CE, under the Rapid Response Program.
• 23:17
  SPEAKER_00: You'll also find additional resources such as the recorded webinars in SHAY COVID-19 town halls and the additional podcast series COVID-19 to update what we know now, which is released every Thursday.
• 23:30
  SPEAKER_00: This concludes this episode of the Allies and Infection Prevention Podcast Series.
• 23:35
  SPEAKER_00: Thank you for tuning in.