The Journal of School Nursing
School nurses have been working to protect the lives of students, faculty, and school staff since the onset of the COVID-19 pandemic. They served the public in high-risk environments that threatened their health and the health of their families. Nurses across the country are working triple duty—helping their school districts interpret ever changing guidelines, conducting contract tracing, and COVID-19 testing—all while attending to the responsibilities of their pre-pandemic roles. Frequent news articles and photos of school nurses at the forefront of the COVID-19 battle demonstrates the public, media, and local officials respect and understand the expertise, commitment and leadership of their community‘s school nurses.
Despite the accolades and the appreciation showered on school nurses over the last two years, they are now often targets for abuse in their efforts to enforce Centers for Disease Control and Prevention guidelines. In the past, national crises have brought the country and communities together to fight a common foe. To our collective dismay, COVID-19 has driven the country and communities, and sometimes families, apart. School nurses, bound by their conscience, their license, and the Code of Ethics (ANA, 2021), are caught in the middle of the debates over student and staff safety.
Nurses experience moral distress in their role when they identify ethically appropriate actions but are unable to take those actions (Silverman et al., 2021). Even before the pandemic, school nurses suffered from moral distress (Savage, 2017). A team of researchers found 97.2% of school nurses experienced moral distress in ethical dilemmas and compromising situations inherent in their role (Powell et al., 2018). The pandemic exponentially increased moral distress among school nurses. In communities divided by disinformation and competing political agendas, parents, nurses, public health officials, health care providers and health care systems are undermined in their efforts to protect students’ and school employees’ health. Many school nurses have exhibited moral courage by making impassioned and reasoned arguments in public forums defending mitigation, masking, and quarantine practices. When speaking to those audiences, school nurses and other health authorities have been belittled, insulted, and harassed. Long held beliefs that government officials, school district leaders and local citizens, friends, and neighbors would do the right thing to protect others in a crisis have been shaken. Many school nurses are being asked to work in an environment that could, but will not, do everything possible to keep children safe.
The effects of the disruption to our belief systems, our trust of authority, and our faith in the goodwill of our neighbors will not be resolved when the worst of the pandemic has passed. Some relationships will be permanently altered. It is essential that school nurses support each other and encourage our colleagues to seek professional support when needed. We can build resilience and moral courage by finding opportunities to share and to recognize our achievements and successes and by reinforcing that there is a community of professionals who will stand together during this most challenging time (Hossain & Clatty, 2021). Support from our state and national professional associations will be needed for many years. Silverman et al. (2021) reported that nurses benefited from regular, formal debriefing. Many state school nurse associations have held town hall meetings to provide connection and recalibration for nurses. Creating stronger alliances with local pediatricians, nurse practitioners, emergency room providers and public health officials who champion science and can share strategies will leave us stronger. Grunin and Malone (2021) recommend supporting school nurses with access to ethics committees. Stronger and more formal school health specific ethics training in the use of ethical decision-making models is recommended to navigate daily dilemmas and to prepare for future disasters and pandemics (ANA, 2021; Grunin & Malone, 2021; Powell et al., 2018; Savage, 2017; Silverman et al., 2021).
School nurses are being told how school campuses need us in the aftermath of the pandemic. The community has suffered trauma and needs trauma-informed policies and practices to transcend the collective insult of the last two years (Bergren, 2021). School nurses can only be resources to students, families, and the school community if we acknowledge the toll the pandemic has taken and take advantage of every resource to heal ourselves and each other (Hossain & Clatty, 2021).
Martha Dewey Bergren, PhD RN NCSN PHNA-BC FNASN FASHA FAAN
Martha Dewey Bergren, PhD RN NCSN PHNA-BC FNASN FASHA FAAN https://orcid.org/0000-0001-8655-5418
American Nurses Association (2021). ANA center for ethics and human rights. https://www.nursingworld.org/practice-policy/nursing-excellence/ethics/
Bergren, M.D. (2021). Post-Covid-19: Trauma informed care for the school community. Journal of School Nursing, 37, 145. https://doi.org/10.1177/10598405211004709
Grunin, L., & Malone, S. (2021). Best interest standard in school health: A concept analysis. The Journal of School Nursing, [Online First]. https://doi.org/10.1177/10598405211001459
Hossain, F., & Clatty, A. (2021). Self-care strategies in response to nurses’ moral injury during COVID-19 pandemic. Nursing Ethics 28,(1), 23–32. https://doi-org.proxy.cc.uic.edu/10.1177/0969733020961825 https://doi.org/10.1177/0969733020961825
Powell, S. B., Engelke, M. K., & Swanson, M. S. (2018). Moral distress among school nurses. The Journal of School Nursing, 34(5), 390–397. https://doi.org/10.1177/1059840517704965
Savage, T. A. (2017). Ethical issues in school nursing. OJIN: The Online Journal of Issues in Nursing, 22(3). https://doi.org/10.3912/OJIN.Vol22No03Man04 https://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-22-2017/No3-Sep-2017/Ethical-Issues-in-School-Nursing.html
Silverman, H. J., Kheirbek, R. E., Moscou-Jackson, G., & Day, J. (2021). Moral distress in nurses caring for patients with Covid-19. Nursing Ethics, 9697330211003217. Advance online publication. https://doi-org.proxy.cc.uic.edu/10.1177/09697330211003217
