A typical day for Emily Kotkowski, school nurse at Dunbarton Elementary School, begins with health screenings.
Before students arrive, Kotkowski goes through screening forms submitted by parents to see if any are missing. Parents are usually prompt about submitting their forms, Kotkowski said. She typically gets 90% of them back. But if any are missing, Kotkowski has to get that information to the staff members at each entrance to the school building as fast as possible so they can detain and screen those students individually as they arrive.
Next, Kotkowski checks to see if anyone has reported symptoms, keeps track of who is in quarantine, who is getting tested and when they are permitted to return.
After that, the school day begins.
With many New Hampshire schools still open for in-person learning, nurses have been at the center of COVID-19 prevention and response. With the stakes so high for communities, school nurses are working longer hours and have taken on many more responsibilities than a typical year.
One of the biggest responsibilities is evaluating students who exhibit symptoms of COVID-19. The guidance from New Hampshire’s Department of Health and Human Services says school nurses should treat any symptom like it’s a positive case. But because COVID symptoms are so similar to those of a common cold, strep throat or allergies, it doesn’t take much to have to send a child home from school.
“It’s really hard to make a phone call to a parent and say ‘Hey, your kid has a runny nose. Can you please come get them?’ ” Kotkowski said. “It’s a really hard phone call to make as a school nurse, and I’m sure it’s hard as a parent to hear that.”
Jenni Lawrence, school nurse at Merrimack Valley High School, says they factor in a student’s medical history when making the decision about whether to send someone home. A potential COVID symptom like a headache or a runny nose could be explained if the student has a history of allergies or migraines.
Lawrence estimates that she sends 1 to 2 students home per day due to COVID-like symptoms.
“Our stance on that is that we would rather be cautious and tell people that we do need to quarantine instead of the opposite and find out after that they did need to quarantine,” Lawrence said.
For school nurses, the school year really began during the summer. Marcia Magdziarz, the school nurse at Weare Middle School and Center Woods Upper Elementary, was on the task force planning school reopening. She helped with planning the hybrid model of learning, the logistics of screening students at the door and choosing a screening app for parents to use.
“A lot of thought went into how does this all look and how do we logistically pull it off,” Magdziarz said.
Magdziarz continues to meet weekly with the administration to discuss the number of those in quarantine and who has returned. New Hampshire school nurses also have weekly Zoom meetings Wednesday afternoons with doctors Benjamin Chan and Elizabeth Talbot from DHHS.
Kotkowski said she had some initial misgivings about the return to school because of the risk it could pose to the community.
“You have a classroom full of elementary school kids and they are full of germs every year, not even during a pandemic,” Kotkowski said. “Putting a germy room of kids together and you add these potentially really dangerous germs – it’s terrifying from where I’m sitting. How am I going to keep these kids safe? How am I going to keep my staff safe? I was really worried about how we were going to make that happen.”
Since the school year started though, Kotkowski said she’s been pleasantly surprised by how well the safety protocols have been implemented. So far, Dunbarton Elementary School is the only school in its SAU with no cases so far.
School nurses are dedicating spaces as isolation areas where they can assess students who have symptoms. During most interactions, Kotkowski wears a surgical mask and eye protection. But when a student has symptoms, she switches to an N95 mask and a face shield. When she has to get close, she adds a medical gown.
In addition to new COVID tasks, school nurses still have all of their regular responsibilities, like caring for diabetic students who need insulin shots, students who need g-tube feedings, students with food allergies and, of course, playground injuries.
Nurses say that within their communities, families have different levels of concern about the virus – and this makes for mixed feedback in their interactions with parents.
“I don’t know of another health issue in my experience where there has been such a polarized opinion as to how this should be dealt with, from people who are very, very concerned and afraid to go everywhere, to people who think this is a government conspiracy to ruin us all,” Magdziarz said. “You are never sure what the starting point of someone you’re talking to is.”
School nurses say they’re definitely seeing heightened anxiety in their communities, particularly among students.
“It’s hard to balance the reassurance with caution. You want to let them know that things are okay and we are doing everything we can, but that the same time we can’t promise that nothing is going to happen,” Lawrence said. “It is a very challenging position to be in.”
School nurses have also been taking on the additional responsibility of contact tracing lately, as the state becomes increasingly overwhelmed with the number of cases. New Hampshire’s DHHS, which had been responsible for all the contact tracing in the state, announced in November that they are scaling back those efforts. Now when there is a positive case at a local school, school nurses are stepping up to help identify who else may have come into contact with the infected person.
At Merrimack Valley High School, which has had three COVID-19 cases so far, Lawrence examines seating charts from classrooms and buses to determine which students may have been close to the infected person. Dunbarton Elementary School also keeps bathroom log sheets to track who visits there and when, but since they’ve had no positive cases, Kotkwoski has not used them.
These extra responsibilities have increased the number of hours school nurses are working. Magdziarz says she sometimes works Sundays to make sure her spreadsheets are updated for the week.
Lawrence said the last time MVHS did contact tracing, it took her and her coworker an additional 40 hours on top of their regular work week to complete it. But although the additional hours can add up, Lawrence says it’s all part of the job, and something that is warranted under the circumstances.
“I don’t know any nurse who would look at their job and say, ‘I am not a nurse once 2:45 p.m. rolls around,’ ” Lawrence said. “Nurses have a very dedicated heart to their students. For me personally, putting in the extra hours to make sure my students and staff in this district are safe and cared for, I am willing to do that.”