Throughout the pandemic, district nurses and health room specialists have been at the forefront of all efforts to keep students and staff healthy and safe. Filling the role of building medical experts, caring for students and staff who don’t feel well and answering questions are just a few of their many responsibilities.
On most recent mornings, Cougar Ridge Elementary Nurse Danielle Kolesnikov starts her day administering “test-to-stay” COVID-19 tests, for students who were confirmed close contacts while they were at school or on the bus. In this program, students test on the first day and the fifth day (prior health guidance called for a series of three tests). After those tests are complete, she tackles other daily tasks and cares for students who are medically fragile or have complex health conditions.
“I love the kids, and I absolutely love working as a team with the health room specialist. We both bring different aspects to the care of the student,” said Kolesnikov, who started as a school nurse last year, but had worked as a nurse in wound care for 10 years before that. She has a bachelor of science in nursing degree, and is a registered nurse. “It’s just really satisfying being a part of the health and safety of the school.”
Like other building nurses, Kolesnikov also assesses any major incidents that occur during the school day, such as head injuries or other serious accidents and illnesses. Meanwhile, her coworker, Health Room Specialist Erica Wood, takes care of students who have bumps, bruises, or other relatively minor ailments such as stomach aches. Quite a few students also visit who are upset or just need a few moments to collect themselves before returning to class.
“I love talking to the kids and making them feel heard,” Wood said. “Half the time they come in here, they really just need a listening ear. … They have a lot of feelings. It’s cozy in here and safe.” At Cougar Ridge, the health room lights are often kept low. Kolesnikov and Wood have added other touches to make the space feel welcoming, such as colorful student artwork, felted colorful ties that hold back the privacy curtains, apothecary jars, and posters about inclusiveness.
The pair sees between 30 and 40 students per day, or about 440 over the course of a month in fall and winter during cold and flu season. That number has held steady since before the pandemic.
“Our nurses have been rock stars!” said Dr. Karen Thies, Health Services Supervisor for the district. All of the health rooms across the district are very busy, and particularly at the elementary level due to playground injuries as our staff work to help students relearn safe playground behaviors. At all levels, many students are sent home with COVID-19 symptoms, which often turn out to be from colds.
“It’s doing the COVID testing and all the following up that is keeping us really slammed,” Kolesnikov said.
The pandemic has made students and families more conscious of any symptoms they may have. “A lot of the kids right now are hyper-aware of their bodies and not wanting to get others sick. It’s really incredible. It’s going to change our culture, I think,” Kolesnikov said.
Thies agreed that managing COVID-like symptoms is extremely time-consuming for the district’s nurses and health room specialists.
“One of the biggest challenges our nurses face now are having to manage students who come to school sick with symptoms of COVID-19. It is very time consuming to place the student in the isolation room, ask all the questions about symptoms, then try to contact parents and possibly do a COVID test,” Thies said. Nurses and school staff are also seeing a number of students with elevated levels of anxiety about COVID. “It takes more encouragement and counseling to get kids to return to class,” she noted.
Since the pandemic, Thies said her team has noticed some students having more difficulty navigating social conflicts, which creates more anxiety. Some of the time, that anxiety and stress results in unacceptable behaviors. Thanks to the Educational Programs & Operations Levy that voters approved in 2020, the district has added more mental health supports in recent years. The pandemic has further heightened the need to increase access to mental health assistance for students.
Having a nurse in the building helps families know that their students are safe and in good hands while at school, Cougar Ridge Principal Drew Terry said. “It just makes people feel more confident, and puts them at ease,” Terry said, noting that many Cougar Ridge families live in multigenerational homes and have been quite concerned throughout the pandemic.
For many students, having a nurse in the building makes the difference between being able to attend school or needing to stay home.
Parent Lesli Sager said having a full-time nurse on site is critical in order for her daughter to be able to attend school at Cougar Ridge. Brynn, who was diagnosed with Type 1 Diabetes at age 2, is now in fourth grade and can now check her own blood sugar and calculate how much insulin to take fairly independently. When she was younger, though, her parents relied on Brynn’s teachers and the school nurse to help keep her safe while she was at school. “Definitely, the nurses are key for us,” Sager said.
Even though Brynn can now manage some of her own diabetic care, anytime her blood sugar unexpectedly drops too low or soars too high, having a nurse available to help her is vital because of the unpredictable nature of the condition, Sager said. “Just because she eats the same thing from day to day doesn’t mean that her blood sugar will respond the same way. It fluctuates all the time.” Extremely low blood sugar, or hypoglycemia, can be very dangerous; sustained periods of high blood sugar are also unsafe.
Throughout the district, there are 28 health room specialists, and one nurse assigned to each building, although 15 of the district’s nurses work part-time.
“It’s really important that staff and students have a licensed healthcare professional they can rely on,” Kolesnikov said. “For my students who are medically fragile, I talk with the parents frequently. I send updates to my families and they know they can reach out to me at any time, too.”
District nurses have many responsibilities, including:
Writing health plans for any student with a health need, and updating those plans annually.
Caring for students with rare genetic diseases, asthma, diabetes, cardiac diseases, scoliosis and more.
Participating in multi-disciplinary teams that help provide for students with IEPs.
Helping students with injuries such as dislocations or fractures.
Helping students with catheterization and tube feeding.
Staying up to date on COVID-19 requirements, protocols and procedures when they are updated by the district, county and state.
Providing education about development and other health topics for students and families.
Coding health conditions so that accurate reports can be generated.
Serving on the safety patrol and safety committees at their buildings (can vary by school).
Helping to plan and monitor the contents of the on-site emergency containers to ensure that necessary medical supplies would be available if an emergency occurred.
Completing vision checks
Ensuring compliance with vaccines that were mandatory before the pandemic.
Working together to stay up to date on laws and health advisories, to ensure they are using best practices, as well as continuing their own education via pediatric conferences and other means.
This article originally appeared in the December issue of the FOCUS newsletter. Note: The information about Test to Stay Program was updated on Jan. 11 to reflect current health guidance.