‘A wild year’: School nurses greatly expand role with Covid-19 vaccinations, contact tracing

Last September, as Covid-19 vaccine candidates were rapidly advancing, Katherine Park and six of her fellow school nurses in St. Louis County, Mo., envisioned school-based vaccination sites as an extension of the district’s pandemic response plan, which they had been working on for months. They reached out to the local health department, letting it know the district had buildings for use and more than 30 school nurses who could jump in on administering shots.

“Honestly, our health department here was kind of surprised that we even reached out to them,” said Park, who is also the interim director of health services at Parkway Schools, a public school district in western St. Louis County. “It’s almost like they had never really considered they could utilize us.”

Park said that many people don’t realize how much school nurses do to manage student health care on a daily basis, from administering insulin injections to giving seasonal flu vaccinations. 

“School nurses don’t just hand out Band-Aids,” she said. 

Now during the Covid-19 pandemic, school nurses have taken on unprecedented responsibilities, including contact tracing and symptom screening. Their role in the pandemic response has only increased as the U.S. vaccine rollout picks up, from sketching out the logistics of school-based sites to immunizing teachers and their communities at large. 

Historically, schools have been instrumental in administering vaccines to students, going back to New York City schools delivering the smallpox vaccine in 1875. The three Covid-19 vaccines authorized for emergency use in the U.S. are not yet approved for use in children (though the Pfizer-BioNTech vaccine has been cleared for those 16 and up), but teachers are already eligible to receive the vaccine in all but six states. President Biden also directed states earlier this month to offer all educators and school staff at least a first vaccine dose by the end of March. Many school nurses have also given vaccinations before, making them well-positioned to administer Covid-19 vaccine doses. 

School nurses in Park’s district had given H1N1 flu shots to students to combat the 2009 outbreak. But that effort, they remembered, had been disorganized and chaotic, pulled together last-minute after the school unexpectedly received doses of the vaccine. 

“When that happened, we had no plan,” said Park. “It was very difficult.” 

With Covid-19, they started preparing for school-based vaccinations as soon as they could, a process detailed in a recent paper in the journal of the National Association of School Nurses. Among the nurses’ other considerations: planning an efficient yet socially distanced vaccination process, something they’d never had to consider with the flu, and which school buildings would be the most centrally located.

Parkway school district nurses haven’t yet begun administering vaccines, Park said, but other school nurses across the country have, said Linda Mendonca, the president-elect of the National Association of School Nurses. 

One of those school nurses is Mirna Caro, who works at the F. Donald Myers Education Center in Saratoga Springs, N.Y., which is part of the area Board of Cooperative Educational Services (BOCES). The organization provides supplementary services like special education to area schools. These schools sent groups of teachers to a central BOCES building, where they were vaccinated by school nurses. The nurses all underwent training on how to administer the vaccine, and many, including Caro, had given other vaccines before. 

Caro said she is thrilled to be able to help administer the vaccines after watching other health care workers tirelessly treat patients during the pandemic. 

“Now I feel like I can really do my part,” she said. 

In Anchorage, Alaska, the local school district is running a mass-vaccination site. In December, after a small team of school nurses vaccinated first responders in the city, they were asked to vaccinate 2,000 community residents over two weeks, said Jennifer Patronas, the director of health care services for the Anchorage school district. In the end, 8,000 people signed up, and with some adjustments, school nurses in the district were able to vaccinate all of them at a school office building. They haven’t stopped since.  

“We’ve given 20,000 vaccines total since January, and now it is very apparent that our system is very efficient,” Patronas said. 

Cynthia Booher, a school nurse in Anchorage, said that utilizing individual schools instead of solely administrative buildings was even more convenient. Teachers were able to get the shots without having to leave work. 

“The teachers were happy because then they just drove to the school parking lot in the morning, got their vaccine, waited in their car for 15 or 30 minutes, and then were able to go straight into their job,” said Booher. (The waiting period is required to monitor people for a rare allergic reaction to the vaccine.) 

In addition to Covid vaccinations, school nurses’ jobs have drastically shifted in the past year to now include screening students for potential Covid-19 symptoms and ensuring that pre-pandemic duties, like administering a child’s routine medication, happen safely. Park and other school nurses in her district are also helping out a full-time school contact-tracer by enforcing quarantine regulations for students who are out sick, calling the families of students who might have been exposed, and quarantining classrooms when necessary. 

“It’s been a wild year,” said Park.