New Mexico school districts approach reopening amidst COVID-19 with shortage of nurses
LAS CRUCES — With the 2020-21 academic year quickly approaching statewide, schools must prepare for the return to campus. Guidelines released by the New Mexico Public Education Department require all staff to be screened for COVID-19 daily; students are also encouraged to be screened.
These guidelines, among others, have turned the spotlight onto school nurses, who are considered the primary source of health information in the school setting, according to Ashley Garcia, health services coordinator for the Safe and Healthy Schools Bureau of NMPED.
There is still uncertainty around how these screenings will work; Garcia said the process will vary from district to district.
“Whether they decide to do a self-screening at home or if it's actually being conducted on-site by the school staff,” Garcia said. “There could be the potential for nurses to be doing some screening for COVID symptoms — not to say that nurses are the only ones that could do that — but I think they would be positioned well to lead those efforts.”
Sasha Poole, executive director of the New Mexico Board of Nursing, said there would be “no way that a nurse could do her job and screen everybody."
“Just because a staff member has to answer a questionnaire and/or have their temperature taken doesn't necessarily mean that the school nurse has to be the person to do that,” she explained.
According to these experts, it’s likely that other staff members will need to help, either by screening their peers or conducting self-screenings through visual wellness checks and taking temperatures. If there is any sign of symptoms, they may be directed to the nurse for a more thorough analysis.
“It’s not rocket science. … There's sometimes this tendency to assume that something healthcare-related must be conducted by a nurse,” Poole said. “Not every school district in New Mexico has a nurse at every school, so those sorts of things would be exceedingly difficult for one nurse to cover more than one school to do screenings every morning.”
Nurse shortage at many schools
According to the Annual School Health Services Summary Report for the 2018-19 academic year, approximately 1 in 5 districts reported having less than one full-time school nurse. The American Academy of Pediatrics recommends a minimum of one full-time professional school nurse in every school.
Additionally, the National Association of School Nurses recommends 750 students to one nurse for healthy students, but in case of students with more demanding medical needs that require daily services, that ratio lowers to 225 to one nurse. Garcia said she didn’t know if these ratios could be affected by COVID-19.
Every region in New Mexico meets that initial ratio of 1:750 except the Northwest region, which consists of 13 school districts and has one nurse for every 896 students.
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At Farmington Municipal Schools, many of their schools must share nurses or fill those positions with health aids. Renee Lucero, FMS's public information officer, said that this team has been working hard even through the summer by performing screenings on bus drivers delivering meals and on staff members working inside the buildings.
She said the district has several nurse positions open, but the current nursing staff has been working hard to fulfill all the needs of the district. The district is still making plans to create news ways to serve all its students and staff with the upcoming school year.
"We'll look to them for techniques that they're trained in," Lucero said. "They've always been really valuable resources for us, but they're going to become even more valuable now."
These rural areas experience more difficulty finding school nurses to fill the empty positions in their districts, according to Lisa Crawford, president of the New Mexico School Nurse's Association.
This is due to a combination of lack of funding and location. Crawford said that, because these schools are in remote locations and nurses are paid less in a school than they would be in a hospital, many do not choose to work in these regions.
'A very precarious balancing act' for nurses
Even for schools that have full-time nurses, Crawford said they will be stretched very thin.
On top of the need to assist the approximated 43% of students with identified medical diagnoses — via the Annual Health Services Summary Report — they will now be the main point of contact for health issues concerning COVID-19.
“The pandemic is going to pretty much swallow up the time that school nurses have, and they still have state requirements, immunizations and screenings that need to be done for students,” Crawford said. “It's going to be a very precarious balancing act to get all the things done that need to be done and still address the issues and concerns regarding the COVID virus and the pandemic.”
Las Cruces Public Schools is one of the few districts in the country that has a full-time registered nurse in every school in its district, according to LCPS Public Information Officer Kelly Jameson.
Even with this assurance, Jameson said it will be an “overwhelming task” to perform daily screenings of all staff members.
“We're anticipating that first period teacher is going to be conducting some sort of symptomology or visual wellness check and then they will then forward on those students that they feel might meet certain criteria,” said Jameson citing flushness, fever or feeling unwell. “They'll recommend them for a secondary screening with a school nurse.”
Rising cases may delay school reopenings
With cases continuing to increase across the state, some officials are expressing wariness in returning to in-person instruction. As of Thursday, state public health officials had confirmed 12,520 positive cases and 356,637 total tests performed.
In a virtual news conference on Wednesday, state Human Services Secretary David Scrase said New Mexico schools "were not on a trajectory" to reopen as anticipated because of the rising rate of infection.
The school year is set to commence in August, with many districts opting for a hybrid learning model under NMPED’s guidelines to practice social distancing.
With additional cuts to education funding statewide, there has been no indication of hiring more school nurses or medical assistants.
“Now, more than ever, we need the knowledge and skill sets of school nurses to best support our students, families and communities,” Crawford said.