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What school nurses have seen during the COVID-19 pandemic

"Mental health has been huge this year," school nurse Melody Heath said. "There are a lot of students who are really struggling."

AUGUSTA, Maine — In recognition of school nurses week May 6-12, NEWS CENTER Maine sat down with three nurses who work in Maine schools and a representative from the Maine Department of Education

We wanted to highlight some of the challenges they faced over the last two years, and what they've seen in their students as the pandemic has progressed.  

In a normal year, on a normal day, school nurses actually do a lot of overall health care, which often stems beyond the child. 

"Some misconception may be, 'Oh, you just put on Band-Aids.' And really, it’s a lot of case management and coordination. You know, just helping the whole child, the whole family," Brock Major, a school nurse at an elementary school in Standish, said. 

"We also do a lot of care management making sure families who are having difficulty navigating the healthcare system can get through," Melody Heath, a new district nurse in Westbrook added. 

Band-Aids aside, what Heath said she has really been treating lately in all grades in her district is anxiety.

"Mental health has been huge this year. There are a lot of students who are really struggling," Heath said. "I think there’s a difficulty with connection with others after so much distance." 

Heath said she has been working more with parents and social workers to get kids more access to mental health resources. 

"Even students who didn’t have needs before the pandemic, there are new students who have needs now," Angie Buker, a nurse at Dexter Regional High School and the president-elect of Maine Association of School Nurses, said, agreeing with Heath about the upswing in student cases of stress or anxiety. 

Major also agreed but admitted it can be difficult to pinpoint in the elementary school. 

"You can see it. Certain kids feel isolated, don’t have that way to communicate with their peers anymore," Major said. "For parents, sometimes it is hard to communicate with them. Unfortunately substance abuse has increased, it seems, during the pandemic, so that can be a barrier. We will have [Department of Health and Human Services] come in and tell us parental rights have changed, and we just have to run with that and figure that out who to communicate with."

Emily Poland, school nurse consultant for Maine's Department of Education, nodded her head while listening to the school nurses speak, because she's heard all of it in her weekly meetings held through Zoom with nurses all over the state. 

"Before the pandemic and even now part of the school nurse's role is to identify, 'Is this bellyache or headache,' you know, doing this assessment on this student. What is the real issue going on? Is there a physical health problem? Is there a belly virus? Is there something going on, or is it anxiety? Is it depression?" Poland said.

The Department of Education worked with nurses to create toolkits to help them navigate parts of the pandemic. 

"When we were all home at the very beginning, I had school nurses who were saying, 'What are we supposed to be doing? All of our kids are at home. I’m supposed to be taking care of these kids, but they’re in their homes. What does that look like?'" Poland said. "It was a lot of discussion, like what can you do to support the families." 

Poland said the DOE quickly figured it out. 

"A lot of school nurses would do either physical drop-bys of their kids with chronic conditions," Poland said. "So maybe there was a student with diabetes. They would go to their house make sure they had everything they needed, because normally a lot of the care that was happening during the school day was being done by the school nurse. Now that they’re home all day, do they have a parent that is home who is there to make sure they are doing what they’re supposed to be doing?" 

Others, like Buker, kept their Zoom line open. Some students dropped in to talk, and others scheduled appointments to ask questions. Once classes returned to in-person learning, nurses were a part of the conversation of how to do that safely. 

"A lot of administrators, and even myself going into the summer, we thought things were looking a little better, and we might have a different year than what we had," Heath said. "Then, right before school started, it started picking up in the numbers again, and a lot of the changes came out really close to the start of the school year. So me being new and trying to make all those changes and communicate all of those changes or research them, it was intense. It was a lot of time spent searching through all the documents and making sure we were doing everything right."

One of the hardest parts of returning to school was the way students seemed to view their nurses. 

"The impression of the school nurse kind of changed for the pandemic," Buker said. "We had been helpers, and students would seek us out, then we kind of had this dark era where they avoided us and at all costs, didn’t want to see the school nurse because you were likely to get sent home." 

The others agreed, saying the kids were frustrated, their parents were frustrated, and they were frustrated. 

"My own children go to a different district, and their district did do a pause and my district decided not to," Major said. "It was tough to have that extra time off, because we didn’t have a plan for it. We didn’t have a good day care for it. There were days where I took a day off, then my wife took a day off just to split it. So as much as it made safety sense, it also made it difficult for planning."

"I helped the high school in our district make some of the phone calls about quarantine and things like that, and I certainly heard the frustration in those voices," Heard said. "Sometimes I would call, and it was their third or fourth time they had gotten a call in a few months. Their kids are missing a month of school in two months, so there’s a lot to be said about that situation."

Poland said the frustrations came from all over, as state guidelines changed, because federal guidelines changed, and it all happened so quickly. 

"The Department of Education works very closely with staff from Maine [Center for Disease Control], and trying to make it as easy as possible for schools, understandable as much as we could."

"On several occasions we had something planned to go out to schools, and then the federal government would issue some sort of change, and we would have to change. And it was, 'OK, what we thought we were going to say we can’t say anymore,'" Poland said. "It would happen that day."

Poland said she fielded a lot of those frustrations, including parents or staff asking why the DOE was making guidelines so confusing for schools to follow. "We are all on the same team, and we are all trying to work our best toward the same goal."

"I think the hardest part is still keeping protocols and safety in the forefront but also absolutely allowing the freedoms to be there," Heath said. "But also, just recognizing the damage that’s done ... mental health wise, coordination wise, for these kids who are just trying to figure it out. I’m in a fourth-fifth grade, and it’s a very interesting year to kind of transition and grow, and they are not as far ahead as he would want them to be to become middle schoolers yet, just because of the time they have missed."

"There’s so much that has not been done because the pandemic has been all consuming," Heath said. "A lot of the students haven’t had vision or hearing screenings in a couple of years, and just catching up with students and meeting with them and interacting with them. So it’s just a lot of catchup."

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