O’Brien: We base it on census and acuity. All students are important and need a nurse, but when adjustments need to be made, it’s prioritized around the highest need and sometimes the high school is more self-sufficient. It’s about prioritizing the needs of the students. Students getting sent home more regularly comes up in research in schools that routinely don’t have a nurse and our job is partly to make sure students are in school when possible. But sometimes a building is left without a nurse, which does happen.

Griel: Those in the student office or our secretaries fill in. At the elementary school, it’s also secretaries from the main office, however we are also available. A certified school nurse is available at least by phone and can drive to a school if needed, so we can leave one building to cover another – either Alex or I – and we can also do phone consultations to help sort out the problem. But it almost always falls on the secretaries. It sometimes falls back on the teacher, too. When we send an email about the shortage, we encourage staff to only send emergency (cases) to the nurse’s office, but then the teacher has to administer Band-Aids and icepacks and things like that. So, it truly affects everyone in the building because it will trickle down to them, but a student who gets sent to the nurse’s office who is acutely ill will fall on the secretaries. All those other things, the teacher – if they’re comfortable – will take care of.

O’Brien: We haven’t got any pushback. That’s why the email is written, “If you’re comfortable,” because in the past there have been people who have said, “this isn’t my area of expertise; I do not feel comfortable,” which is fine because that’s why we’re there when we can be. If they’re not comfortable, then call and consult with one of us.

Griel: I think it (has) always been a problem, but it’s definitely become more of a problem since the pandemic. I did have at least one district sub say that they couldn’t work at all during the pandemic because they were caring for an elderly parent. Since we also use Bayada (Home and Health Care), the nursing agency, they’re trying to staff the community and we’re pulling from them at the same time, so since there is a whole country worth of nursing shortages, it trickles down to everybody because we’re pulling from agency nurses.

O’Brien: Right now, we don’t have a heath room assistant at Benner (Elementary School). We do have a sub, but things like that add to our workload or fall on someone else that would normally be in the hands of the health room assistant, in addition to not gaining the trust of students who we’d normally see every day.

Griel: The school nurses and health room assistants definitely build relationships with the students, but since there can be voids, there is a lot of relationship building that is sacrificed because there isn’t a constant person there. We have the luxury at Benner right now of having a constant sub, but if she wasn’t there for us, it would be someone different every day. If kids don’t have that relationship and trust with the school nurse, or the parents or principal or staff don’t have that relationship, then it can be detrimental. Trust is huge, because then they might not feel comfortable sending their child to school if they have a chronic health condition.

Griel: It’s one of the most important things. Because we have built good relationships, those parents trust the nurse and then don’t feel the need to have multiple updates throughout the day. Because we have built relationships and they trust us, they are comfortable sending their kids to school and then they can go about their day without worrying.

O’Brien: Well, we’re all nurses, but the certified school nurse is the one who makes the plan of care for students, and the health room assistant can help gather data. That’s the main thing. In our daily practice, that means the health room assistant does a lot of direct patient care, and when there are more complex health needs, then data is collected by the health room assistant and is used by the school nurses to make the care plan for the students.

O’Brien: The relationship with the kids is really rewarding and helps make this feel like a safe place for them. The group of nurses I work with – the six of us – are an awesome team. It would be very different if we didn’t have the team we have.

Griel: I personally love working here at Bellefonte. I love the students, I love the community and I honestly love the administration, which is so supportive. Plus, there is flexibility in the schedule unlike other typical nursing positions. In nursing, you don’t always have weekends and holidays and the summers off, so that’s an added benefit. And I also love the work. We’ve done a lot of work to keep kids in school when possible because we know the learning happens when they’re in the building and not always on the computer, so it’s rewarding to be a part of helping build our kids. People just think the school nurse is just giving pills and putting on Band-Aids, but it’s so much more than that.