DOI: 10.1177/1942602X20935612 For reprints and permission queries visit SAGE’s Web site, © 2020 The Author(s) September 2020 | NASN School Nurse 269

Ask the E.R. Pediatrician

In response to the novel coronavirus disease 2019 (COVID-19) pandemic, most states in the United States enacted statewide school closures, ranging in duration from 1 month to the remainder of the academic year. The extended durations of these closures present unique challenges, as many families rely on the school as a source of physical activity, mental health services, psychosocial support, child care, and food security. While the school doors may be closed, the school nurse can still play a vital role in emergency management. This article discusses challenges and proposes solutions to maintaining student health and wellness during extended school closures due to the COVID-19 pandemic. Furthermore, it is inevitable that until a vaccine for coronavirus is developed and readily available, many schools will continue to see future closures, though likely for shorter periods of time, as they respond to local outbreaks.

Keywords: coronavirus; COVID-19; pandemic; social distancing; school closures

Who Is the ER Pediatrician?

Dr. Robert Olympia, MD, is a pediatric emergency medicine physician with more than 20 years of experience, currently working in an emergency department in the “sweetest place” on Earth (Hershey, PA). He is a professor in the Departments of Emergency Medicine and Pediatrics at the Penn State University College of Medicine. His research interests include emergency and disaster preparedness for children in the setting of schools and school-based athletics, as well as in sports-related illnesses and injuries. He has presented his research both regionally and nationally and has lectured on a variety of topics pertaining to pediatric emergency medicine, such as fever and infectious diseases, trauma, sports-related injuries, and disaster preparedness.

Who Is Dr. Olympia’s Coauthor?

Rachel Rothstein is a fourth-year medical student at the Penn State University College of Medicine and a recent graduate of Tufts University School of Medicine Master of Public Health

Program. Her interests include pediatrics, pediatric surgery, and public health.

What Is the Purpose of the “School Nurses on the Front Lines of Healthcare” Series?

The “School Nurses on the Front Lines of Healthcare” series will present cases reflecting emergencies commonly encountered in the school setting, focusing on an evidence-based approach to the initial management, stabilization, and disposition of the ill or injured child.

Special features unique to each article are Extra Credit Points and Report Cards. Extra Credit Points are trivia questions or clinical pearls scattered throughout the article related to the topic at hand. Report Cards are concise tables summarizing key points in each article that you can photocopy and laminate or photograph and keep on your smart device for easy access.


During an otherwise normal afternoon in early March, your superintendent urgently assembles the school nurses,

935612NASXXX10.1177/1942602X20935612NASN School NurseNASN School Nurse research-article2020

School Nurses on the Front Lines of Healthcare The Approach to Maintaining Student Health and Wellness During COVID-19 School Closures

Rachel Rothstein, BS, MPH

Robert P. Olympia, MD



270 NASN School Nurse | September 2020

principals, and other key faculty members, as well as local public health officials, to discuss the growing threat of COVID-19. Your team ultimately decides to close the schools for the next 2 weeks, effective immediately. Shortly thereafter, your state governor declares a state of emergency and announces statewide closure of schools for a minimum of 6 weeks.

Parents in the community begin contacting your team with concerns. Many parents are essential workers and cannot obtain child care. Others are concerned about food security, in the absence of school meal programs. The list of student health and wellness concerns continues. Your school district is fortunate to have an emergency procedure in place for infectious disease outbreaks, and the school closure provides you and the school staff time to review and update your emergency and disaster plan, addressing many aspects of wellness for your students and their families.

School Closures During Historical Infectious Disease Outbreaks

While the term social distancing is likely new to many, the concept of school closures as a tool for reducing spread of infectious diseases originated long before the COVID-19 pandemic. During the 2009-2010 influenza H1N1 pandemic, over 720 schools, housing nearly 368,300 students, closed across the United States (Klaiman et al., 2011). While the current durations of school closures exceed those of other infectious disease outbreaks in recent history, consistent are the challenges to maintaining student health and wellness in light of closures.

The Role of the School Nurse During School Closures

The National Association of School Nurses (NASN) recognizes the school nurse as a “vital member of the school team, who collaborates with community agencies to develop comprehensive emergency response procedures” (NASN,

2019, para. 1). Likewise, the school nurse provides expertise in school health as a “leader and integral partner with school staff and outside agencies in developing comprehensive school plans/procedures” (NASN, 2019, para. 3). NASN is continually providing up-to-date resources on COVID-19 for school nurses, which incorporate emerging information from the Centers for Disease Control and Prevention (CDC) and other groups (CDC, 2020b; NASN, 2020). Furthermore, the uncertainty surrounding future “peaks” of COVID-19 or other infectious disease outbreaks emphasizes the importance of emergency and disaster planning.

emergency management

As school districts enter this unfamiliar phase of emergency management, the school nurse plays a critical role in addressing student health and wellness during school closures. The document, “Considerations for School Nurses When Providing Virtual Care,” highlights the role of virtual care in addressing student needs, continuing case management, providing resources to families, and mitigating health disparities (NASN, 2020). NASN also provides, “Guidance for School Nurses to Safely Send and Receive Resources Between School and Home During COVID-19,” to ensure safe transfer of both student and school property, including backpacks, student medication, school supplies, electronic devices, and ongoing food services to socially and medically disadvantaged families (NASN, 2020). Finally, “Ideas for School Nurse Activities during the COVID-19 Pandemic” provides a list of activities that school nurses can complete in light of closures (NASN, 2020).

school nurses in planning processes

Regarding school reopenings, NASN provides template letters, addressing state leaders, local leaders, and school superintendents, advocating for the inclusion of school nurses in planning processes (NASN, 2020). In the article, “Interim Guidance: Role of the School Nurse in Return to School Planning,” NASN outlines school nurse roles according to the five major principles of the Framework for 21st Century School Nursing Practice™ (Care Coordination, Community/Public Health, Leadership, Quality Improvement, and Standards of Practice). For school

nurses practicing in schools that are open, NASN offers “Considerations for School Nurses Regarding Care of Student and Staff that Become Ill at School or Arrive Sick” and “Facemask Considerations for Healthcare Professionals in Schools” (NASN, 2020).

Challenges to Obtaining Child Care Coverage

Currently, 16 sectors of the workforce qualify as “critical infrastructures” and are essential to the country’s continued functioning, potentially leaving 45.9 million children, who otherwise would be in school, without adequate supervision (Bayham et al., 2020). While there is no definitive age at which it is appropriate to leave a child home alone, many resources are available to guide parents in this decision. Leaving children home alone may present risks to both physical health and mental well-being.

Families First Coronavirus Response Act

On the national level, the Families First Coronavirus Response Act includes a provision that expands protection for employees that during a public health emergency are unable to work due to a need for leave to care for their child because the school or day care has been closed or the child care provider is unavailable (Moss et al., 2020). Similarly, the Coronavirus Aid, Relief and Economic Security Act includes a $3.5 billion expansion in funding of the Child Care and Development Block Grant, to help states establish child care assistance for essential workers ( Johnson-Staub, 2020).

Examples of such interventions include temporary pandemic child care centers in Ohio and regional enrichment centers in New York City. To assist your community’s essential workers in obtaining child care coverage, view your state’s emergency child care provisions and actions in response to COVID-19 on the Hunt Institute website in Table 1. Also, the Khan Academy websites listed in Table 1 offer free online video classes, including music, games, crafts, and educational materials, for children to follow along while parents work or accomplish tasks in the home.