The Journal of School Nursing
2025, Vol. 41(2) 195–196
© The Author(s) 2025
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DOI: 10.1177/10598405251316132
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Abstract
School nurses have faced many professional challenges during the COVID-19 pandemic. Focus group interviews were employed as a data collection method in this qualitative study to describe the perspectives of school nurses during the pandemic. Themes relevant to school nurse experiences and suggestions for change were identified. School nurses have demonstrated their essential role in facilitating health for students, staff, and families. Policymakers and the public must recognize this value. School nurses are encouraged to leverage opportunities for visibility within and beyond their own communities to enhance recognition of their role. School nurses should also lead the development of additional resources such as webbased health content and practice guidelines. Providing school nurses with resources needed to support their practice is essential so that, in turn, students may be cared for.
Keywordscommunicable diseases, environmental health/safety, parent/family, administration/management, legal/ethical issues, qualitative research
The COVID-19 pandemic impacted nearly all forms of education, health, and commerce globally beginning in March 2020 and continued at the time this manuscript was written. The pandemic overwhelmed the health care system, community services, families, and individuals. Early in the pandemic, global and national leaders could not reach consensus on how the virus was spread, appropriate mitigation efforts, or treatment approaches. Disagreements regarding personal decision-making and risk versus doing what is best for others led to disputes and discord among leaders, policymakers, and family members. Conflicting reports of the source of the virus, motivation of select companies or lawmakers to promote vaccination and safety measures, and true risk of acquiring infection are only a few of the points hotly contested nearly three years after Americans first heard about COVID-19. This discord added to and complicated what was already a time of great political, economic, and social divide in the United States.
School nurses faced moral injury and distress throughout the COVID-19 pandemic. Families and colleagues displayed aggressive behaviors toward school nurses (e.g., school nurse stories profiled in Anthes, 2021; Duggan, 2021; Mintzer, 2021). Communities have been caught in the middle of disease mitigation policy confusion, fueled by disinformation and political agendas regarding public health and safety (Bergren, 2021; Ceron et al., 2021; Emanuel, 2022; French, 2022; Gottlieb & Dyer, 2020). Further, school nurses risked their own safety, addressed frequent changes to health guidelines, and led arduous contact tracing efforts, all while meeting the usual care needs of students, staff, and families (Bergren, 2021; Dobbins, 2020; Duffort, 2021; Robles, 2022; Rogelberg, 2021). From a recent study of over 7,000 school nurses, researchers determined school nurses experienced PTSD (30%) depression (24%), anxiety (22%), and suicidal ideation (4%) as a result of pandemic work (Tanner & Merkle, 2022). Across nursing specialties, turnover increased significantly from work overload, burnout, poor mental health, job dissatisfaction, and other stressors exacerbated by pandemic working conditions (Falatah, 2021; Lopez et al., 2022). School nurses may leave their jobs or nursing all together following unexpected experiences in the workplace and deteriorating mental health. There is a critical need to ensure school nurses are supported during these exceptionally challenging personal and professional times.
The purpose of the study was to describe the perspectives of school nurses working through the COVID-19 pandemic. The study aims included: (1) describing school nurse experiences during the pandemic, (2) identifying barriers and facilitators of school nursing practice, and (3) determining strategies to support school nurses going forward.
Focus group interviews were planned as a data collection method in this qualitative study, as a study team consisting of a nurse researcher who was previously a school nurse in practice, two school nurses in full-time practice, and a nursing PhD student sought to describe perspectives of school nurses working through new, evolving, and unique pandemic conditions. Given the issues described in subsequent sections, the focus groups changed to individual and small-group interviews. The University of Massachusetts Lowell Institutional Review Board determined the present study to be exempt from research.
Participants were school nurses in practice between March 2020 and April 2022 in the United States. School nurses in a primarily administrative role or providing care to one student during the school day were excluded; Eligibility criteria included functioning in the health office role. The health office role involves care responsibilities for an entire school. Licensed Practical Nurses, Registered Nurses, or Nurse Practitioners were invited to participate. Interviews were conducted via Zoom.
A recruitment message posted on the “School Nursing” Facebook group in February 2022 detailed the study purpose, eligibility, time commitment, and offer of a $20 e-gift card following focus group participation. Interested school nurses were directed to follow a link to a Qualtrics presurvey where they could share demographic characteristics, email addresses, and availability during preselected dates and times for group interviews (Qualtrics LLC, 2022). Following the review of eligibility, the study team created focus group pairings with diversity across the participant characteristics and emailed the participants to confirm schedule.
A discussion guide containing prompts such as “tell us about how your practice has changed since the pandemic started” and “what have your experiences been related to enforcing COVID protocols” was used to facilitate interviews held in March and April 2022. The discussion guide contained six questions and nine prompts to employ whether the group conversation stalled. The three researchers with school nursing experience collaboratively developed the discussion guide to address the study aims. These researchers attended each interview and rotated serving as a facilitator or asking probing questions and seeking clarification. The Zoom platform provided audio/video recordings and automatically generated transcripts of each session. The fourth researcher reviewed session recordings to ensure an accurate verbatim transcript for each interview.
Pre-participation survey results were exported from Qualtrics to Excel (Microsoft Corporation, 2016) for descriptive analysis. Interview transcripts were imported to NVIVO, a qualitative data analysis software (QSR International (Americas), 2015). Conventional and directed approaches to qualitative analysis were used (Hsieh & Shannon, 2005). One researcher conducted two complete, uninterrupted readings of the transcripts, and then a third reading to note emerging themes and first impressions as part of the conventional approach to analysis. Next, the data were organized by study aims per the directed approach to content analysis. Data were then grouped into themes and subthemes, and data were reviewed for the emergence of any spontaneous themes. All study team members independently reviewed the transcripts and themes. They met to discuss any missing themes or themes requiring elimination or revision. The team was in agreement with all themes and held further discussions regarding the selection of exemplar quotes and participant experiences to share in this report.
During each interview, the facilitator would summarize responses to major questions and confirm participant agreement with the researchers’ understanding. All team members reviewed the data and results to ensure the interpretation was consistent with and supported by participant statements. Saturation (meaning, researchers did not receive any more unique responses) was reached following five interviews. Additional interviews were conducted as planned to strengthen theme confirmation and honor the willingness of school nurses to participate.
Sixty-two eligible school nurses responded to the preparticipation survey. All were invited to focus groups, 35 were accepted. Twelve focus group sessions were planned; however, due to 22 participants rescheduling, canceling, or failing to appear, 8 individual or small group interviews were conducted with 13 participants. Four sessions had one participant, three sessions had two, and one session had three participants. Interviews lasted between 77 and 116 min each (mean of 90 min.) All participants were registered nurses, 54% (n = 7) with preparation at the master’s level, and two nurses each (15%) with a diploma, associate degree, and bachelor’s degree. All participants were female and 93% were white. Table 1 displays participant characteristics.
Ten themes and three subthemes were identified. Themes are organized below by study aim. Table 2 displays exemplar responses supporting each theme and subtheme.
Unrealistic and Growing Workload. Participants reported a deluge of new professional duties following the emergence of COVID. The responsibility of contact tracing was regularly noted as a task that required the expansion of working hours to the early mornings, late nights, weekends, and holidays. Participants noted it was impossible to “unplug” during off-hours, although supervisors encouraged this, given the volume of emails, questions, positive case notifications, and work to be done to fulfill the new role of serving as the “defacto health department.” For some participants, the need to continue working off-the-clock was coupled with a reduction in their scheduled hours and pay. For others, stipends were provided to honor extra time spent doing things such as watching bus security videos or clarifying student seating charts to confirm ill contacts off-hours. Those participants receiving stipends were not ungrateful, however, stipends equated to “pennies on the hour” and did not address the root of workload issues most concerning to participants. The sentiment of taking on two full-time jobs or squeezing multiple jobs into one was commonly shared. All agreed that the additional duties throughout the pandemic were not out of the scope of school nursing practice and supported the health of the school community, but the evolving workload, sociopolitical factors in communities and across the nation, and pressure to keep students, staff, and their own families healthy was reported by many participants to be overwhelming.
Trauma Responses. Participant statements regarding pandemic experiences were consistent with responses to traumatic experiences. Many participants recalled the specific final date of pre-COVID in-person schooling, sharing sentiments such as “that famous Friday the 13th.” Participants compared these dates as well as the days following to other globally or personally notable days of infamy (e.g., hurricanes or 9/11), noting that these events did not endure for over two years. As the pandemic persisted, school nurses experienced exhaustion and “senses of doom.” They felt unrelieved stress, avoided preferred activities and socialization, and became uncomfortable entering their workplaces. Participants consistently affirmed that there was no break from work, they felt isolated and alone in their public health efforts, and the pressure of serving as the health care provider to the school community was both overwhelming and traumatic.
Participants shared that school nursing responsibilities during COVID became relentless and repetitive. In fact, as students returned to school buildings, school nurses were pleased to participate in aspects of professional practice unrelated to COVID that were previously seen as burdensome. In the middle of ongoing trauma and an unfolding global crisis, participants relished “being able to be a nurse again.” For example, one participant described calling a parent of a student with head lice and both laughing with joy as the call was not COVID-related.
“I Scroll on Job Sites… Just to See.”. Participants’ growing workload and traumatic experiences led to thoughts about leaving school health or nursing all together. All participants had at least considered a professional move, ranging from an internal thought about a new career, to online job searches, or even discussions of early retirement options. Participants affirmed they truly loved school health, working with students, and supporting the whole community. However, they expressed that COVID experiences did not allow them to thrive professionally or be treated with respect in the workplace. Although some participants remained unsure what the next academic year held for them or what positives they still associated with their work, some did report optimism for the future. Factors such as vaccine approval and uptake and cessation of duties like contact tracing made participants feel the next school year would be better.
Renewed Assessment Practices. A new respiratory condition presenting similarly to ailments that did not previously require school exclusion renewed the need for thorough assessments for many participants. With a symptom list involving some of the most common student concerns, such as headache, fatigue, and sore throat, many office visits were addressed in a more systematic manner. For example, a participant noted that when any student presented with a concern that could be indicative of COVID “you find that you’re digging deep in your assessment skills.” Participants clarified that they were not so quick to provide students, even older ones who were generally reliable historians, with requested items such as cough drops, ice packs, or analgesics. Instead, school nurses would complete a more detailed subjective interview, objective assessment, chart or personal history review, and administer a COVID test as necessary and available. Among participants, visit volume, nurse staffing, workload, test availability, and policies created a disparity in the ability to conduct such an assessment.
Distancing and Disparities. Pandemic experiences offered participants a different, more intimate, consideration of the prevalence and impact of housing, economic, and social disparities in their school community. First, participants reported that student access to a reliable, or any, internet connection to engage in remote learning was noted in the first few days of remote schooling. Given their role in educating families on health and safety in a home with COVID present, school nurses were quickly alerted of disparities beyond accessible WiFi. Depending on the employment situation of adults in the home, students excluded from school had varying degrees of supervision and support during the school day. Participants also expressed concern that the need for adults to stay home from work and care for younger children with COVID led to lost wages and the foregoing of food and other essential items. For part of the pandemic, many school districts required students to obtain a negative polymerase chain reaction COVID test at an outside facility to reenter school. Nurses reported that students had varying levels of access to facilities providing such testing, insurance coverage, and funding for this expensive test. The inability to obtain such testing led to prolonged exclusion, especially for families with few resources.
Further complicating matters was the physical space and layout of student homes. Participants were guided by national and local procedures to coach families on separating those in the home with and without COVID to prevent the disease spread. This included instruction on the use of separate bedrooms and bathrooms, which many families did not have. Health guidelines for part of the pandemic included specifications on when an individual affected or exposed to COVID could return to school based on contact and exposure. Beyond the risk of spread across a household, families with more shared space in the home needed to engage in longer quarantine, isolation, and school exclusion periods. Participants noted that students most in need of attendance, and parents most in need of paid working hours, were disproportionately impacted by longer exclusion times given their living arrangements. Families noticed the disparities, too, as they were aware of the way return-to-school guidelines differed for those with more separate spaces in the home.
Barrier: Unclear, Unscientific, and Unstable Guidelines. Participants reported that the way national and local guidelines regarding all aspects of COVID were developed and shared was detrimental to school nursing practice, professional interactions, and respect in the workplace. Guidelines changed frequently (so much so that some participants referred to following guidelines as playing “whack-a-mole”) and offered little clarity for the participants who were trying to ensure compliance within the school community. Participants felt that by the time they understood a guideline and had effectively communicated it to students, staff, and families, regulations and guidance would shift. Participants were also frustrated to learn of guidelines changing in their own schools on short notice and without nursing input. Often, the wording of guidelines was not strong and left too much room for interpretation. Attempting to enforce guidelines written in an ambiguous way was not only frustrating but hindered participants’ confidence in their practice but also ability to facilitate safety.
Participants also discussed the lack of an evidence base to support rapidly changing guidelines. Most vocalized a belief that politics and convenience directed guideline changes, not science. Members of the school community would turn to the participants for rationales regarding guideline changes, but participants were unsure of the data or evidence used to support such changes. It was especially challenging for participants to attempt to reimplement safety guidelines such as masking or daily symptom checks in winter 2021, during a nationwide increase in COVID incidence following the scaling-back of health measures across most communities. Beyond data, many participants thought each revised iteration of public health and safety guidelines lacked “common sense.” One example provided was students being able to travel to and return from distant locations such as Hawaii for vacation but need to participate in an isolation period if they crossed the border of a neighboring state.
Recipient of Anger. Nurses reported that evolving guidelines and the need to enforce them in support of public health was a clear antecedent of unexpected, angry, and at times, threatening interactions with others, largely with parents/guardians. Parent/guardian reactions were considered extreme and did not match the size of the problem at hand. One participant upsettingly shared that a parent threatened her that her “judgment day” was coming after dismissing an ill child per the prevailing guidelines. Several respondents shared instances of physical violence and aggression toward school administrators by parents/guardians unhappy with school policies and COVID mitigation practices. No participants of this study disclosed being the recipient of physical violence, but they did endure verbal and emotional. Some shared that they were aware of social media groups created to criticize specific nurses and COVID practices. Responses of others to participants fulfilling their duties left participants feeling that no decision was right. Strained and unsafe interactions contributed to an uptake of defensive practices. One participant described charting more than usual because “I will need to look back at those nurse’s notes now to know why I sent somebody back or why I sent them home because no matter what I do I’m wrong.”
Participants identified detecting dishonestly as another antecedent of anger, aggression, and unsafe interactions. Participants described instances of adults sending in their own or a sibling’s negative COVID test results for students, or adults becoming angry that school nurses compared false family-reported vaccine administrations to an accessible state vaccine registry. As the pandemic and virus evolved to include the availability of home testing, participants were faced with another instance in which adults could perpetuate dishonesty. Participants shared experiences with families changing the date of their students’ start of symptoms or positive home test. Other parents were reported to have sought evaluation and documentation of “alternative diagnoses” from community providers so that the student could reenter school sooner than permitted. Participants described challenging conversations each time a new way to circumnavigate policy emerged.
Sudden Skepticism. Nurses suspected that guideline changes and evolving community opinion on the threat and severity of the virus contributed to community members seeking and believing health information from unreliable and uncredentialed sources, and led to skepticism of health office guidelines and diminishing respect for school nurses. The social media platform TikTok was mentioned several times, in the context of students and families believing sources on TikTok over health experts regarding virus topics such as severity, treatments, mitigation efforts, and vaccines. Nurses expressed that misinformation or disinformation led to nursing contributions being questioned, and some adults believing they could function as a care provider.
A lack of respect for nursing judgment and health guidelines on the part of school administrators also created a barrier to nursing practice and community health. For example, some participants were not permitted to help students obtain excused school absences for staying home with COVID symptoms, close community contact, or the presence of the virus in their homes when a positive test result was not produced. Participants were even advised to avoid contacting public health officials for guidance on the virus or confirmation of illness and could not make nursing decisions about school dismissal.
Facilitator: Students. In contrast to adult colleagues and families, interactions with students and their positive behavior were a facilitator of nursing practice. Following a return to either hybrid or full-time in-person instruction, participants were happy to see students. Participants were also pleased to hear from students that they enjoyed coming to school a lot more than they previously realized. Participants shared positive responses and flexibility to modify milestone events such as prom and graduation. Students did experience worry, mental health challenges, and difficulty with isolation, but participants consistently noted the maturity and resiliency of students. In addition to such resiliency, students were observed to be more honest or forthcoming than adults with COVID-related information, such as sharing symptom onset or naming close contacts.
Facilitator: Value and Visibility. Participants noted opportunities to highlight the value of school nursing and be visible to local and national communities as a facilitator of practice. Tasks such as contact tracing and vaccine surveillance became more visible and recognized over the pandemic; however, several participants were able to leverage attention on public health to highlight the value of school nursing. Participants facilitated the collection of data or shared data with local decision-makers to obtain wage increases or additional personnel to help in health offices. Participants also described partaking in more opportunities to write for newspapers or respond to a call for nursing comments from media programs regarding the pandemic and student health. Media opportunities contributed to, what participants felt, as a refreshed public understanding of what school nursing is.
Setting Boundaries. To support their well-being going forward, participants identified setting boundaries as essential. Thoughts such as “I start at 8am and quit at 3pm”, and “I don’t take phone calls on my cell phone… because I don’t want to answer your COVID question when I’m not on duty” were common as participants reflected on how practice may change in the coming school year. By working through a global respiratory pandemic and facing the associated traumatic experiences, participants realized they could not maintain their evolving role while also staying healthy enough to work. Many participants noted that making more time for themselves and to spend with family would be a staple on their agenda going forward. In addition to boundaries on their time, participants planned to set emotional boundaries, practice self-kindness, and be more vocal about what they needed in the workplace to achieve better personal-professional balance.
“Come to the Health Professionals Next Time”. If faced with another pandemic situation, participants strongly suggested that school or district leaders meaningfully involve school nurses in decision-making and support school nurses in their public health efforts. Nearly all participants wished for more support from administrators on topics such as following and interpreting guidelines, masking, vaccination, and school exclusion. Many participants noted that in preparation for the return from fully remote schooling to in-person programming, nurses were not consulted nor involved in planning efforts or meetings about the pandemic. Some participants attempted to advocate for a seat at the decision-making table but were excluded. Other participants were pleased to be involved in planning efforts at first but felt left out or forgotten as the pandemic progressed beyond the first year.
School nurses did not feel supported in their efforts to enforce health policy and honest practices. Participants affirmed that going forward, consistent, strong, and supportive messaging from district leaders on health guidelines and behavior expectations are needed. Participants also thought that consequences were needed for families providing false documentation or sending children to activities (e.g., sports) when knowingly ill. Before starting the next school year, participants were hopeful for a chance to debrief on COVID experiences and procedure changes.
Participants felt that school nursing unity was a practice to foster now and in the future. Participants highlighted the negative aspects of not having a cohesive school health services team. Some participants gave examples of different guidelines across school buildings, which led to confusion among families. Beyond family confusion, participants thought this could cast the school nursing team in an unprofessional light. Participants also wished for more communication regarding positive cases in the district when multiple students were involved in one household. Alternatively, other participants worked with school health teams that held regular meetings, sought input from each other, and were sources of great support, although some of this waned with a return to in-person schooling. Beyond their district colleagues, some participants found unity online in video-chat support groups or on social media pages. Participants who did join the online groups felt a strong sense of solidarity and less alone. Participants who either read the stories of other school nurses or actively engaged on social pages felt they had found nursing camaraderie like they had previously experienced in other specialties, but not school nursing.
The purpose of this study was to describe the perspectives of school nurses regarding changes to their professional role during the COVID-19 pandemic. The study aims of describing school nurse experiences, identifying barriers and facilitators of nursing practice, and eliciting suggestions for strategies to support school nursing practice were achieved through conducting virtual individual and small group interviews with 13 school nurses from the United States.
School nurse participants described a workload that grew to become unrealistic, unmanageable, and in some cases traumatic. Experiences working through the pandemic led some participants to consider leaving nursing, school health, or their current positions. Given the commonalities between COVID-19 symptoms and presentations of other common school-day ailments, participants described a renewed thoroughness of their assessment practices and documentation. Counseling families on social and physical distancing best practices to reduce the spread of the virus in the home as well as sharing information on required testing for returning to the school building unearthed disparities in family living arrangements and resources.
A major barrier to nursing practice was the evolving nature of public health guidelines that were not always supported with common sense or evidence. Confusion surrounding guidelines and the need to enforce rules for the safety of the school community contributed to unexpected behavior from parents, and a lack of respect for the school nurse and at times a disregard for reliable health information. Participants spoke of students fondly and were proud of their resilience and willingness to employ safe behaviors at school. Opportunities to highlight school nursing accomplishments and contributions were also a facilitator of practice during a difficult time.
Participants consistently affirmed that in the next school year, they would set boundaries on their time and efforts to support their own health, hoped to advocate for nursing voices at decision-making tables, and would seek camaraderie with school nursing colleagues locally and online to combat feelings of isolation and facilitate therapeutic debriefing.
Experiences that participants generously shared inform several implications for professional school nursing practice. Table 3 displays a pairing of implications with Framework for twenty-first Century School Nursing Practice components (Maughan et al., 2016).
Prioritizing School Nurse Health and Well-Being. Despite the pandemic starting only a few years ago, thoughts of leaving nursing entirely or a specific specialty during COVID have already been well documented as an international phenomenon that crosses nursing areas (Cornish et al., 2021; George et al., 2021; Kaya & İşler Dalgıç, 2022; Lee et al., 2022; Levi & Moss, 2022; Raso et al., 2021). In a pandemic situation, school nursesfeel a strong sense ofduty to protect theircommunity from diseases and experienced loneliness related to taking full responsibility for an outbreak (Um & Choi, 2022). The strong sense of duty and responsibility coupled with our participants’ experiences of a workload that was evolving to a state of unmanageability precipitated trauma responses and thoughts of leaving a job they otherwise greatly enjoyed. In response to all forms of trauma, trauma responses may be consistent with positive coping strategies (e.g., seeking social support or increased volunteerism) or may be harmful and include emotional dysregulation, somatic symptoms, difficulty sleeping, flashbacks, dissociation, anger, aggression, and among others (Center for Substance Abuse Treatment, 2014). This is especially concerning in light of the findings of Tanner & Merkle (2022) regarding PTSD, suicidal ideation, and other mental illness observed in a national sample of school nurses during the pandemic.
Research regarding resilience, self-care, and work–life balance has been conducted for over a decade in nursing. Such work generally focuses on the individual nurse as being deficient in select emotional skills, although resilience is influenced by organizational, and situational factors as well (Cooper et al., 2020). School nurse researchers recently called for an exploration of school nurse self-advocacy methods, outcomes, and skills needed (Morse et al., 2022). The strong advocacy attempts of our participants that were not adequately addressed point to systems-level issues regarding the productivity, degree of burnout, and level of moral suffering school nurses are expected to tolerate. Participants planned to limit their working hours and intended to set boundaries in the coming school year, but adherence to such plans may depend on the support of others. To protect the health and well-being of school nurses, leaders, colleagues, and districts must support boundary setting, including appropriate work hours, contact guidelines, time off, fair compensation, and manageable workloads.
Awareness of Our Communities. School nurses play a significant role of school nurses in responding to and preventing infection in schools, especially in communities impacted by social and economic disparities. School nurses in a study conducted during an influenza pandemic described their ability to address the diverse needs of their school community, especially via clear communication (Faherty et al., 2019). Participants of this study described varying methods of communication with families with access to different tech tools. Participants also described disparities in access to health resources in the home and city/town. In fact, participants reported becoming newly aware of the scope and severity of the economic impact and financial realities of family households during the pandemic in relation to expenses such as virus testing, time off work, and child care.
For school nurses who reside a distance away from their school or who have not attempted to access services proximal to the school, we suggest visiting the pharmacies, clinics, urgent care centers, and other places of resource or referral. Doing so will help school nurses determine accessibility and describe to students and families specifics about such centers. Further, attempting to visit local health centers may illuminate access barriers, such as cost or long waits, that school nurses may either work to ameliorate or find an alternative referral site. A negative financial impact imposed on families is an unintended consequence of policies meant to support health in schools. School nurses are encouraged to involve families in policy planning and review so that such unintended consequences may be avoided or proactively addressed.
Guideline Development. The National Association of School Nurses notes school nurses as essential developers of strategies and interventions to comprehensively address school safety (Allsbrook et al., 2019). As professionals with keen insight and knowledge about the work of both public health and educational systems, school nurses can drive integral discussions regarding COVID safety. Participants of the present study reported varying invitations or involvement in COVID planning. A school nursing research team recently identified that collaborations between educational and public health institutions can help schools safely navigate the pandemic (Galemore et al., 2022). To support school nurse involvement in planning as well as the availability of resources for future pandemics, school nurses should take a leadership role in the development of a guidebook for providing comprehensive school health services during a pandemic situation.
Throughout the pandemic, there was considerable confusion about changing public health guidelines, cited by participants of this study as a major barrier to professional practice. Developing a guidebook for the steps utilized to safely keep schools open would be an asset during future pandemics. Keeping schools open is not just an action of convenience; school nurses know that schools being open support overall health outcomes for children and families (Um & Choi, 2022). School nurses have shown resilience, autonomy, and importantly creativity throughout the pandemic in managing their ever-changing nursing practices. For example, innovative school nurses of Illinois collaborated with their local health department to create a virtual COVID toolkit (Kunz et al., 2022). School nurses also developed virtual health offices using open-source technologies to stay in touch with students (Williams et al., 2021) and partnered with technology specialists to increase efficiencies in COVID data collection (Hardiman & Sonnenberg, 2022). We encourage sharing of any school nurse innovations or tools developed out of necessity at conferences, on discussion boards, as scholarly articles, and in a guidebook so that all school nurses may learn and build on the ingenuity of their peers.
Highlighting the Work of School Nurses. As school nurses have led communities in health and safety initiatives, there has been a sudden spotlight on school nursing in the media over the course of the pandemic (Grano et al., 2021). Despite personal and professional hardships, some participants leveraged attention on public health to promote school nursing contributions, value, resiliency, creativity, and specific practices to local and national news outlets. Such sharing is supported by an expert call for school nurses to shine a light on each other to highlight the flexibility and creativity in navigating the barriers encountered within the pandemic (Bergren, 2022). Nurses of other specialties, reporters, and public health professionals highlighted nursing contributions, innovations, and dedication to patients throughout the pandemic and encouraged greater nurse involvement in policy and research (Begnini et al., 2021; Castro-Sánchez et al., 2021; McDonald, 2022; Morone et al., 2022). School nurses need to tell their stories and support the work they do to keep the children and community healthy.
The results represent only the experiences of the participants. Experiences across the United States and globe varied greatly depending on the incidence, policies, and community response to the virus. Our sample may not be representative of the cadre of school nurses across the United States. Our sample included more white nurses and nurses with preparation at the master’s level compared to the recent national sample of the school nursing workforce (Willgerodt et al., 2018). Our sample did not include any male nurses or Black nurses. Finally, while school nurses who left the specialty since the start of the pandemic or intended to leave at the conclusion of the 2021–2022 school year enrolled in the study, they did not appear for interviews. Their experiences may have differed from those of our participants, who either did not leave or intend to leave in the months following study participation.
There is a critical need to ensure school nurses are supported in their important work. This study has illuminated school nursing pandemic experiences, silver linings found, barriers and facilitators of practice, and actions that may support individual nurses and the specialty going forward. The trauma responses shared by participants that indicate a risk for PTSD or mental health risk, coupled with the findings of a national survey regarding school nurse mental health is a top concern and should underscore the importance of urgently addressing school nurse workload, respect in the workplace, and value. Such change is beyond individual action; School nurses unifying to support each other and demand change is needed. Although prioritizing their own health and boundaries, school nurse readers are encouraged to share professional contributions and successes on as broad of a scale as they are comfortable and ensure they are up to date with the availability and accessibility of community health and social resources for district families. School nurses have shown their dedication to supporting the school community. School nurses have also proven themselves as an integral resource and asset to keeping members of a community safe. Their expertise and knowledge should be seen as the conduit to support the educational goals of students and health of the entire community.
The research team would like to thank Erin Maughan for facilitating a professional introduction of Drs. Morse, Meoli, and Samuel.
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
The author(s) received no financial support for the research, authorship, and/or publication of this article.
Brenna L. Morse https://orcid.org/0000-0001-9876-4700
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Brenna L. Morse, PhD, FNP-BC, NCSN, CNE, PMGT-BC, FNASN, is a associate professor at MGH Institute of Health Professions, Boston, MA.
Anne Meoli, PhD, MPH, RN, is a director of health initiatives at Jack and Jill Center, Fort Lauderdale, FL.
Cynthia Samuel, PhD, RN, CSN-NJ, is a school nurse at Irvington Board of Education, Irvington, NJ.
Amanda Carmichael, MSN, MBA, RN, is a PhD student at University of Massachusetts Lowell, Lowell, MA.
1 MGH Institute of Health Professions, Boston, MA, USA
2 Jack and Jill Center, Fort Lauderdale, FL, USA
3 Irvington Board of Education, Irvington, NJ, USA
4 University of Massachusetts Lowell, Lowell, MA, USA
Corresponding Author:Brenna L. Morse, Associate Professor, MGH Institute of Health Professions, 36 1st Avenue, Boston, MA 02129, USA.Email: drbrennamorse@gmail.com
