DiversityNursing Blog

The School Nurse shortage is not a new issue. The pandemic highlighted the importance of having School Nurses. As schools across the nation open back up,
concerns are again rising.

The US Centers for Disease Control and Prevention (CDC) recommends schools have one full-time Nurse for every 750 students.

The latest data from a study, published in the Journal of School Nursing in 2018, found approximately 39% of schools employ full-time Nurses and about 35% employ part-time School Nurses, while 25% do not employ School Nurses.

With out School Nurses, teachers and staff with no medical training would be responsible for providing care such as dispensing medication, managing allergies and asthma, and monitoring blood glucose levels.

Not only are School Nurses responsible for providing care, they also play a vital role in the management of COVID-19 safety protocols and updating staff and parents.

According to a survey from the National Association of School Nurses (NASN), 78% of School Nurses say they took time to review data to see new trends in COVID infections. The survey shows 43% of Nurses spent time updating and developing school health policies and nearly half said they were spending time answering phone calls from parents and the community.  

“I spend most of my day dressed up as a ghostbuster in personal protective equipment,” Rhonda Cranford, a School Nurse at Northside Elementary with 34 years of experience, shared. “I’m answering the phone constantly with questions regarding isolation and quarantine. I spend hours documenting and sending emails. Ninety-five percent of my day is consumed by COVID activities.”  

Many schools have a tight budget and can lack the funding needed to hire a School Nurse.

Laurie G. Combe, NASN President said, “When budgets are tight, administrators make decisions to hire Teachers over Nurses, but what many administrators don’t understand is that having a Nurse on staff can actually save dollars."

A glimmer of hope arose in May when the Biden administration announced the American Rescue Plan. The Plan includes dedicated funding of at least $500 million to hire School Nurses to help schools safely reopen and remain open for in-person instruction.

It’s important to remember there is a Nursing shortage across the country. School districts are competing against healthcare organizations for Nursing applicants where wages in hospitals and other settings tend to pay more.

Between the Delta variant, mask protocols, and vaccine mandates, schools need Nurses now more than ever. 

In the wake of the COVID-19 pandemic, higher education is seeing a rise in demand for health and medical education.

According to Kaiser Health News, enrollment in baccalaureate Nursing programs increased nearly 6% in 2020, to 250,856, shown in preliminary results from an annual survey of 900 Nursing schools by the American Association of Colleges of Nursing.

“It’s unprecedented,” said Geoffrey Young, senior director for student affairs and programs at the Association of American Medical Colleges. In the past two decades, the average yearly increase for total applications to medical schools has been about 2.5%, he said. This year, applications are up 18% over all.

Glen Cornwall, the Dean of Tampa Bay’s Galen College of Nursing says as people see the need in the community, they’re enrolling in greater numbers. “With this pandemic, it’s that extra urge to say this is the time," he said.

Dr. Ken Kaushansky, Dean of Stony Brook University’s Renaissance School of Medicine believes the reasons behind the surge are inspired by the pandemic and the need for financial security during a time of job loss and unemployment.

"This is my 11th year and I don’t remember us going up by 14% in any year," he said. "More typical is a 3 to 4 percent increase year over year."

Dr. Demicha Rankin, Associate Dean of admissions at the Ohio State University College of Medicine believes the influx of applicants is also a factor of the growing awareness of systemic racism.

Rankin said, “It is not just the viral pandemic but also is the awakening of the dedication to addressing racism has also been a motivation for many to try to bring equitable care to their own community."

Most schools are conducting interviews virtually so students do not have to pay for in-person travel costs.

Dr. Beth Piraino, the Associate Dean of admissions and financial aid at the University of Pittsburgh School of Medicine said, "Now applicants don't have to pay to travel to interview, so they could easily interview at 20 places whereas before they may have had to restrict it."

In the midst of a global pandemic, the approach toward the academic year is very different from previous years. Nursing schools in 2021 will be a mix of online classes, in-person  clinicals, virtual and in-person simulated experiences, and some in-person and online testing.

Southern Illinois University Edwardsville School of Nursing Dean, Laura Bernaix, PhD, RN is encouraged by the increase in enrollments and believes the key to successfully adapting to this surge is the faculty.

“Great faculty, who not only are great educators in the classroom but also experts at curriculum design, are the key,” she said.

Chief Nursing Officers have a wide variety of responsibilities. Their role has become more complex with the COVID-19 pandemic, social injustices, and systemic racism in the United States.

The pandemic is straining the healthcare profession. Nurses are under immense stress and Nursing leaders need to use best practices to address the mental and emotional trauma their teams are enduring.

In an article by HealthLeaders, Penn Medicine Princeton Health Chief Nursing Officer, Sheila Kempf, PhD, RN, NEA-BC said they are implementing many strategies to care for Nurses' mental health.

Some of those strategies include training staff to recognize the signs of being at high risk for emotional distress, and when peers should be referred to the Employee Assistance Program (EAP).

Also the hospital has contracted a trauma clinical Psychologist to talk with staff and run support groups with the EAP and the Ministries department.

CNO's should recommend frequent breaks or a quiet space for Nurses to retreat to.

Nurse leaders are also facing the challenges of short staffing, low resources, and supplies.

According to a survey by Inspire Nurse Leaders, 53% of Nurse Leaders reported difficulty meeting work and family needs due to inadequate staffing.

Risley-Gray also said, health systems need to hire outside help when Nurses become infected or get exposed to the virus. Aspirus is offering Nurses who have at least one year's experience a $15,000 signing bonus, as well as employing contract Nurses via private staffing companies.

2020 not only brought forth a pandemic, it also put a spotlight on systemic racism and racial health disparities.

Sharon Hampton, PhD, RN and Director of Clinical Operations at Stanford Health said, "We've discussed our ethical and moral responsibilities to deal with this crisis. Nursing is really in this position to help the public understand and to advocate."

Healthcare systems and Nurse leaders should be promoting diversity and inclusion at all levels of the workplace.

Kelly Hancock, RN, DNP and Executive CNO of the Cleveland Clinic Health System, said more diversity would help the Nursing workforce “provide more customized, culturally-sensitive and safer care” and “better assess, accommodate and cater to the healthcare needs of different minority groups.”

Those in leadership positions should reflect the diverse patient populations they serve.

According to HealthLeaders Media, a study by the Institute for Diversity and Health Equity found that racial minorities represented 32% of patients in hospitals that participated in the study, but similar representation wasn't found among the health care leadership. According to the study, 19% of first- and mid-level management positions, 14% of hospital board membership positions, and 11% of executive leadership positions were held by racial minorities.

Hospitals and health systems must commit to increasing diversity within their leadership to improve patient outcomes, reduce racial health disparities, and build stronger communities.

Nurses are a critical part of healthcare and make up the largest section of the health profession. According to The American Nurses Association (ANA), more Registered Nurse jobs will be available through 2022 than any other profession in the United States.

As predicted by health officials, the United States is seeing surges of Coronavirus cases from the holiday season. As health systems and hospitals deal with the surges, they are worried about finding enough medical workers to meet the demand.

“What we see now is just the beginning of the post-Thanksgiving peak,” said Eric Toner, senior scholar with the Johns Hopkins Center for Health Security. “It’s going to be huge, and it’s going to be awful.”

The problem is especially dire in intensive care units which are overcrowded with a record number of critically ill patients.

An article from the New Yorker stated, at least half of all states are now facing staff shortages, and more than a third of hospitals in states such as Arkansas, Missouri, New Mexico, and Wisconsin are simply running out of staff. Usually, an ICU Nurse might care for two critically ill patients at a time. Now, some are caring for as many as eight patients at once.

In some situations, patients have been transported hundreds of miles for an open bed. Some patients have been moved from Texas to Arizona as well as central Missouri to Iowa.

According to ABC News, hospitals in some states are enlisting retired Nurses and Nursing students. In Alabama, more than 120 students and faculty members from the University of Alabama at Birmingham’s Nursing school began helping with care last week at UAB Hospital.

In some states, health officers have amended orders that allow health care workers who tested positive for COVID-19, but are asymptomatic to continue working.

To free up healthcare workers, hospitals are asking medical and Nursing students, firefighters, and EMTs to administer Coronavirus vaccines.

According to Reuters, nearly 10 million doses have been delivered across the country, but only about 1 million administered due to staffing shortages at hospitals and the special requirements for preparing the shots.

Nancy Foster, the American Hospital Association’s vice president of quality and patient safety, said she’s heard from two dozen hospital leaders over the past two weeks, warning her of staffing shortages.

Travel Nurses are usually a good option to help fill open positions, but the pool of available travel Nurses is drying up as demand for them jumped 44% over the last month.

Dr. Mark Ghaly, California’s Health and Human Services secretary, said the state is “lucky to get two-thirds” of its requests for travel Nurses fulfilled right now.

The main hope here is for cases to decrease by people following COVID-19 guidelines such as quarantining and wearing masks.

More Universities and Colleges have considered hiring Chief Health Officers (CHO) as the COVID-19 pandemic rages on. Some responsibilities of the CHO would be to lead campus health and safety measures, create connections with state and local hospitals, and be the voice of information to students, employees and parents.

Dr. Preeti Malani has been CHO at the University of Michigan since 2017 and is a great role model for someone who is considering taking on this position.

Dr. Malani has been highly visible throughout this outbreak, sharing safety tips on social media, appearing in a number of interviews, and participating on coronavirus task forces.

When a school feels strongly about a certain topic, they create an executive role around it, like a Chief Diversity Officer for example. Now, health is an imperative issue that should be properly addressed.

“The mere appointment of a CHO would send a strong message about the school’s commitment not only to the well being of its students, faculty, and staff but also to the health of the public at large,” said Malani.

After the pandemic passes, Malani hopes her visibility at the University of Michigan will help her make progress on other college health issues like vaccines, health-care equity and student mental health.

Dr. Benoit Dubé is the Chief Wellness Officer (CWO) at The University of Pennsylvania. He’s part of a Recovery Planning group tasked with examining the elements needed to be in place to allow a safe return to more normal campus operations.

Dr. Dubé explains the best approach for reducing COVID-19 transmission is to follow a hybrid in-person and online semester model. The University is also mandating the flu vaccine this fall.

Ohio State University’s CWO, Bernadette Melnyk developed several anxiety-reducing strategies to use to help manage and prevent the spread of this infectious disease. She created a webinar video Key Strategies for Relieving Anxiety During the COVID-19 Pandemic.

Melnyk also created the acronym COPE COVID:

Control the things that you can, not the things you can't
Open up and share your feelings
Practice daily stress reduction tactics, including physical activity
Engage in mindfulness; be here now; worry will not help!

Count your blessings daily
Overturn negative thoughts to positive
Volunteer to help others
Identify helpful supports and resources
Do your part to prevent spread of the virus

Schools that don't have the resources to bring on a CHO can try other options, like working with local and state health agencies, hiring a health consultant, and partnering with close institutions or academic medical centers.

An estimated 4%, or about 150,000, Nurses in the U.S. are Filipino, but comprise nearly a third of Registered Nurse deaths due to COVID-19.

Business Insider reported, Nurses of Filipino descent account for 31.5% of the workforce's COVID-19 deaths.

In California, where about 20% of Nurses identify as Filipino, they account for nearly 70% of COVID-19 deaths in the profession, according to the Mercury News. Statewide, Asian Americans make up about 5% of coronavirus cases and 11.7% of deaths, compared to their 15% of the population.

Zenei Cortez, an RN who works at Kaiser Permanente’s South San Francisco Medical Center and, as co-president of the California Nurses Association/National Nurses United worries that her fellow Filipino Nurses are less likely than other Nurses to demand workplace protections.

“Culturally, we don’t complain. We do not question authority,” Cortez said. Many Filipino Nurses feel a strong sense of group loyalty, or the importance of putting the welfare of the group over that of the individual; in Tagalog, the word is pakikisama. “We are so passionate about our profession and what we do, sometimes to the point of forgetting about our own welfare,” she said. “We treat our patients like they are our own family.”

It’s the lack of proper PPE that has pushed some Filipino Nurses to speak out, when in the past they stayed silent about their working conditions.

“What I am seeing now is that my colleagues who are of Filipino descent are starting to speak out,” Zenei said. “We love our jobs, but we love our families too.”

Catherine Ceniza Choy, a professor of ethnic studies at UC Berkeley whose work has focused on the history of Filipino American Nurses said, Filipino American Nurses are more likely to work in higher risk roles such as the intensive-care unit, emergency medicine or telemetry, putting them directly in the path of COVID-19.

“Filipino Nurses, here specifically in the U.S., are concentrated specifically in in-patient critical care services,” Choy said. “Many of them are also caregivers at home, not only of children, but also their parents and other elders. And so part of the problem with the pandemic is these multiple layers of vulnerability and exposure.”

Jollene Levid and other volunteers have been keeping track of Filipino health care workers who've died from the disease worldwide. Their website, Kanlungan.net, which means shelter or refuge, is an online memorial with pictures and stories of those who've been lost.

The website reads "KANLUNGAN is intended to be a memorial to the transnational people of Philippine ancestry who make up a huge sector of the global healthcare system. This is to remember them as human beings, not simply as a labor percentage, a disease statistic, or an immigration number. And since the Internet is forever, we hope that KANLUNGAN will keep reminding the world of the skills, dedication, and the self-sacrifice demanded of health care workers so humanity may be healed."

School Nurses have become the main point of contact for any and all things COVID-19 related. They are a key component in making sure schools stay open.

The American Academy of Pediatrics (AAP) recommends that every school have a Nurse on site.

But, according to the National Association of School Nurses, before the pandemic, a quarter of American schools did not have a Nurse.

Now states are scrambling to hire School Nurses as students go back to school.

“Most school Nurses are the only health care experts in their school community able to understand infection control and do disease surveillance,” said Linda Mendonca, president-elect of the National Association of School Nurses (NASN). “But not every school has a Nurse who’s going to look after the children and staff. You need that expertise as a resource to safely reopen schools.”

COVID has made the role of a school Nurse even more complex, adding many challenges and new responsibilities for keeping children and staff safe.

They're responsible for complying with applicable federal, state, and local laws, regulations, ordinances, executive orders, policies, and any other applicable sources of authority, including any applicable standards of practice.

Nurses will also have to create plans for how high-risk students will return to school. They'll also help with screening protocols, creating safe classroom setups, hand washing and sanitation stations, and PPE distribution.

The school Nurse should collect and share school data in compliance with state and federal confidentiality regulations.

Once a coronavirus case is identified, school Nurses and local public health officials will work together to determine which students or staff might have been exposed to the infected person.

Face masks will be one of the main ways of limiting the spread of the virus in schools this fall. However, with younger students there's a risk of children trading masks or not keeping them on.

Social distancing is another key factor in keeping everyone safe, NASN guidelines suggest, staggered start times, small group and outdoor activities, no sharing of musical instruments, and meals in classrooms.

Liz Pray, MSN-Ed, RN, NCSN, School Nurse for the Moses Lake School District in Washington State and President of the School Nurse Organization of Washington said, "If I could offer any words for nurses feeling overwhelmed, I would encourage them to allow themselves and others a little grace. Everyone is struggling. Tempers are short, people are on edge and it’s been very difficult for students, parents and team members to adjust to these changes. Remember to take a step back, take a deep breath and take care of yourself."

Healthcare workers across the country are fighting tirelessly against COVID-19. They're wearing head to toe PPE around the clock. They're hot and frustrated while wearing it, and… they also lose their identity. Patients just see masks, suits, gloves, and goggles. Hospital staff wants this to change.

"Share Your Smile" and the "Button Project" are just 2 examples of a small, but positive movement. To look less intimidating to patients, healthcare heroes are attaching large photos and buttons of their faces, to their PPE.  

The goal of these projects is to eliminate or reduce a level of fear and anxiety for patients, especially children, who find comfort in seeing the smiling faces of healthcare team members.

San Diego respiratory therapist Robertino Rodriguez started the "Share Your Smile" idea. Rodriguez said, “Yesterday I felt bad for my patients in ER when I would come in the room with my face covered in PPE. A reassuring smile makes a big difference to a scared patient. So today I made a giant laminated badge for my PPE so my patients can see a reassuring and comforting smile.”

The movement is catching on amongst health care workers. Peggy Ji, an ER Doctor in Los Angeles, wrote on Instagram, "I was inspired by Robertino Rodriguez who works as a respiratory therapist in this COVID pandemic. I didn’t have a preprinted photo or a color printer so my polaroid will have to do. I wanted to bring a personal touch to caring for patients through my PPE. My hope is that our patients will know there’s a reassuring smile under this mask, and that we’re here for them."

Nurse Derek also posted a photo of himself and fellow coworkers on Instagram saying, "thought it was a beautiful way to bring ease to our patients during this stressful time. Thank you to all the healthcare workers out there for battling on the frontlines."

The Button project holds the same meaning and started at Monroe Carell Jr. Children’s Hospital at Vanderbilt.

Adelaide Vienneau, Director of the Children’s Hospital Family Resource Center (FRC) said, “When we were asked to take the lead on this project, I immediately said, ‘yes.' The FRC team likes finding solutions for staff and providing resources to assist patients and families in having the best possible experience during their health care visit. We are delighted with the anecdotal comments on how the photo buttons have been well-received.”

Any time in the hospital as a patient is a scary time for the patient. The personal connection is so important, but difficult to achieve with all of the PPE. What a simple, yet creative way to put patients at ease to feel a more personal connection with the healthcare team.

What is your place of employment doing about this? Please share with our community. Thank you!

COVID-19 has shone a light on how systemic racism plays a role in health disparities among Black people. 

According to Scientific American, the overall death rate from COVID-19 is 2.4 times greater for African Americans than it is for white people. 

Camara Phyllis Jones, an Epidemiologist who recently served as president of the American Public Health Association said, “People of color right now are more likely to be infected, and we’re more likely to die. What we’re seeing here is the direct result of racism.”

Hypertension, obesity, diabetes and other risk factors for severe coronavirus complications, are more prevalent in minority populations.

According to an article from STAT, Black people in the U.S. are more likely than white people to live in food deserts, meaning they have limited access to fresh fruit or vegetables. They are also less likely to be able to access green spaces, and more likely to live in areas without clean water or air.

Household spread is the most common form of virus transmission. Many people of color live in overcrowded homes and communities so it's difficult to social distance. It is also difficult to find an outdoor place to social distance as there are fewer publicly provided resources, such as parks and bike lanes, for minority-dense neighborhoods.

The best advice to fighting the virus is to stay at home but, unfortunately essential workers don't have this option. Not only are fewer Black and Latino adults able to work from home, but they're also overrepresented in essential jobs.

These health disparities are further worsened by an unequal healthcare system. People of color often have unequal access to care, and when they do receive care it is often poorer quality.

The National Academy of Medicine (NAM) released a report that found “racial and ethnic minorities receive lower-quality health care than white people—even when insurance status, income, age, and severity of conditions are comparable.”

In order for things to change, the entire health care field, from medical schools to hospitals and even medical device manufacturers, need to work to unravel and address racism within the healthcare system.

Progress will take time and efforts must occur on every societal level. This involves a wide range of actions, like improving wages and closing pay gaps, improving access to health insurance, providing better access to fresh foods and green spaces, and ensuring more diversity in the health care system so healthcare workers can provide culturally competent care.

Many Nurses and Doctors said in interviews with TIME, that fighting COVID-19 is making them feel more dedicated to their chosen career, and determined to persevere and help their patients. But, many also said they were struggling with negative feelings.

Healthcare workers are afraid of spreading the virus to their families, frustrated about the lack of PPE, and feel they can’t do enough for their patients. First responders are tired from long shifts, and are extremely sad for their dying patients, of which many are passing away alone. This is heartbreaking.

Dr. Jay Kaplan, an emergency room Physician and wellness specialist at LCMC Health system in New Orleans, lets his staff know they aren't alone. He listens as Nurses and Doctors share their fears and problems.

Kaplan tells them it’s okay to get sad or angry over the coronavirus. He reads them his poems. He shares that one day he came home and cried to his wife because he was  overwhelmed by the rate of dying patients.

“We need to break the culture of silence and let people know it’s okay not to have it all together all the time,” he said.

Kaplan’s “wellness visits” are a key strategy in preventing healthcare workers from spiraling into depression and post-traumatic stress disorder during the pandemic. Many hospitals across the U.S. are launching similar initiatives.

Mount Sinai hospitals in New York City ramped up initiatives, such as a 24/7 mental health crisis line and one-on-one counseling. It also launched a wellness and resilience center that will track staffers' mental health long term.

Dr. Deborah B. Marin, Professor of Psychiatry at the Icahn School of Medicine at Mount Sinai and Director of the new center said,  “This multi-disciplinary center will consider the physical, emotional, mental and spiritual needs of our entire health care community, including those on the frontline and in supporting roles. Working closely with every department across the health system, our aim is to not only address  but to also prevent the development of mental health issues before they occur by intervening early, offering resilience training and treatment for every health care working in need. It’s important that we launch now as this crisis continues to evolve and take a toll on our community.”

Several healthcare workers in the TIME interviews said, among all the uncertainty and fear, they have found some relief in support from their families, communities, and one another.

We’re offering this article during Nurses Week as a reminder to all to be as patient, kind and loving to our Nurses, Healthcare workers, first responders, grocery store employees and all the people out there working to keep us safe. Thank you!