Patient checked for scoliosis. / Photoshop imageIn image blurred for privacy, nurse checks for scoliosis in pandemic. 

A closer look
at these 'invisible' public servants
in Arlington

As the overall severity of Covid lessens, students are among many finding ways to endure after nearly three years of a global pandemic.

So are school nurses, who face a myriad of issues – from staffing shortages to increased responsibilities. YourArlington homed in on these often-unseen servants and reported some of their concerns.

Is scoliosis test needed?

Doreen Crowe

Doreen Crowe, Arlington nursing director, cites 'efficiency.'

Massachusetts school nurses are busy, and, their leaders say, scoliosis testing is an unnecessary part of their workload. They are trying to do something about it.

Currently in Massachusetts, school nurses must perform postural exams once a year for grades fifth through nine. The nurses are pushing for a change in the legislation so that they are required only to conduct the exams once during that five-year period. It is both a workload issue and a question of efficacy, according to Doreen Crowe, Arlington nursing director.

Cathryn HampsonCathryn Hampson, state nursing organization president, sees a better use of time.

The Massachusetts School Nurse Organization (MSNO) has been lobbying to change the legislation. MSNO President Cathryn Hampson said that the organization put a bill forward last session, in informal session until Dec. 31. The House Bill was filed by state Rep. Kay Khan, who says on her website that she is “extremely proud to be a nurse” at Boston Children’s Hospital before becoming a professor of nursing at Boston University and earning her master's degree in psychiatric mental health nursing. The Senate Bill was filed by state Sen. Julian Cyr.

“School nurses spend a lot of time doing postural screening when there are other screenings that we know are best practice and evidence based, and we could be spending more time doing those screening as opposed to postural screening,” Hampson said.

Cara Dalton is the nurse at Gibbs, a school in Arlington only for sixth graders. She says that the screenings are not only an increased workload, but also a stressful thing for her students.

“It's hard to be 11 and 12 [years old], . . . It's uncomfortable, I don't mind doing it, but they feel odd, they have to take off their shirt in school, and someone has to stand there and look at them,” Dalton said. “That is something that not only is it not an evidence-based practice, but it bothers my students, and so it bothers me.”

DaltonCara Dalton, Gibbs nurse, notes student stress.

Nurses perform the Adam’s Forward Bend Test, wherein students remove their shirt so that the spine is visible and lean forward with their palms and feet together. The nurse looks for any curvature of the spine, unlevel shoulders, asymmetry or uneven hips.

The U.S. Preventive Services Task Force, an independent volunteer panel of national experts in prevention and evidence-based medicine created in 1984, determined that there is insufficient evidence to judge the efficacy of youth postural screening.

Crowe, the nursing director in Arlington and a former president of MSNO, agrees that the yearly testing is redundant, and so she supports the bills. She says that a lot of parents opt out each year anyway, because pediatricians generally do postural screenings during annual check-ups.

“It's time on learning. There are five grades that we're screening for postural screening, and it's just, it's not evidence-based practice anymore,” Crowe said. “Our time could be better used on doing other things like SBIRT [screening, brief intervention and referral to treatment] screenings and just seeing kids in our office and working on other health-promotion things and supporting our students.” 

Covid and workload

Crowe supervises the 11 public schools in Arlington, each with one nurse. In addition, she is in charge of implementing protocols to protect the approximately 6,000 students. Crowe’s office is in Ottoson Middle School, yet she frequently travels to the other campuses to help out and oversee programs.

“It’s never the same day twice; [it’s] always very busy,” Crowe said.

Currently, the nurses are focused on symptomatic individuals and getting students and families vaccinated. Arlington offers a flu shot clinic to all students and their families, which Crowe helps organize. The schools are no longer contract-tracing as this is no longer required by the state Department of Elementary and Secondary Education, but they are instead tracking patterns in the schools to help detect future outbreaks.

“The workload definitely has increased for school nurses, but it’s also highlighted the work of school nurses in terms of what a school nurse does and what a school nurse is capable of adding on to her plate,” Crowe said.

Despite working in a supervisor position and not being responsible for direct care, she still values her connection with students and families.

“I love seeing our students, not only in school, but thriving in school. There's nothing more rewarding than working with our students and our families, especially for our students that have special health-care needs,” Crowe said. “I love the setting, and I love the connection between academics and health.”

Joseph RyanJoseph Ryan, at Lesley Ellis, faces many of the same issues.

A private-school perspective

At Lesley Ellis, a private school in East Arlington with about 200 students in preschool through eighth grade, nurse Joseph Ryan faces many of the same issues. He has been a nurse for about 30 years, working in physical therapy, hospitals and with adults with special needs; he switched to the school-nurse role about seven years ago.

What he sees at Lesley Ellis “runs the gamut.” From dealing with young children with typical viruses to eighth graders asking questions about sex, his job is dynamic. Next month, he will start his work in the classrooms doing seminars on different health topics.

“You get to know the families, you get to know the kids and you have more of a chance of a relationship than you would if you’re working in a hospital and you see somebody for three days,” Ryan said.

Ryan feels grateful that so many families practice good “Covid hygiene” and the school has a high vaccination rate. Now he is seeing more common viruses on the rise, especially among younger students whose entire lives have been overshadowed by Covid. He said that while people were masking, they were not exposed to the same germs they would have been otherwise and now that they are in school, they are dealing with weakened immune systems on top of the typical spread of germs.

The importance of school nurses has increased not only because of Covid, but also because of the school's growing responsibilities for children.

“The needs can be so great because schools are being called upon to be social-service agencies, to be health-care providers, to be educational specialists,” Ryan said. “Not just the standard education, the percentage of kids on [individual education plans] and 504s.” 

Staffing shortages 

Sara LeeSara Lee, at Arlington High: '... as a school nurse, we have a chance to really connect with kids ....'

At Arlington High School, Sara Lee is a self-described “school nurse by design.” Her current job was what she always wanted and intended to do. Instead of starting as a nurse at a hospital, she intentionally became a school nurse. She says that as a nurse at a hospital, there is little real connection with the patients, which among other factors, can lead to burnout in the nursing industry.

“I think [connection with patients is] why a lot of nurses go into it, and probably why the burnout rate is so high is that you're just, it's work, work work,” Lee said. “I knew that, as a school nurse, we have a chance to really connect with kids, we have a chance to connect with families in a meaningful way.”

Despite the increased connection in schools, burnout still plagues employees at schools everywhere, including in Arlington.

During the height of Covid-19, many nurses and other health-care professionals accelerated their retirement or have switched careers completely.

Crowe similarly has been facing a staffing crisis and is currently working to fill some positions in the public schools.

Hampson, president of the state school nurses' organization, also spoke about the staffing shortage. She said it was expected, but sped up by Covid. The decrease in young people pursuing nursing as a career, coupled with the Covid burnout, has contributed to nursing shortages everywhere.

Value of career

Hampson said that the solution is to educate more students about the value of a nursing career. Additionally, working in a school requires a degree of responsibility and independence that hospitals do not. In a school, many nurses are the only providers for hundreds of students and must be confident in their own diagnostic skills, whereas at a hospital, it is easier to get second opinions, which may make people weary of pursuing the school role.

Finally, a person working as a school nurse typically will make significantly less money than working in a hospital, which  deters some people from choosing this career path.Ultimately, though, she says she loves it because she loves the children and hopes that other people will feel the same and will be inspired to become school nurses.

Hampson is the supervisor of health services in North Middlesex Regional School District, comprising the rural towns of Townsend, Pepperell and Ashby. She supervises the district and also provides direct care for the preschoolers. In the past, she provided care at locations in South America and worked in a variety of hospitals and schools, including at a Navajo reservation in New Mexico. 

The state school-nurses' organization, which Hampson emphatically pointed out is not a union, advocates for and supports school nurses throughout the state. In the past, they had worked to ensure that school nurses were included in the planning and response teams.

As the president, Hampson works with the president elect and the immediate past president, who is Arlington's Crowe.

“She is wonderful to work with, she’s very very knowledgeable, and loves working as part of a team and is very encouraging to work with,” Hampson said of Crowe. 

The rise in mental health issues is a concern, but stigma is still there, and I think that society needs to look at that and understand that someone with a mental health issue should be treated the same as anybody with a broken bone.”                                 -- Doreen Crowe, nursing director, Arlington Public Schools 

Crowe, Ryan and Hampson all pointed out mental health struggles of students. Crowe is grateful for the Arlington director of social-emotional learning and counseling and emphasizes the importance of social-emotional learning for all ages.

“The rise in mental health issues is a concern, but stigma is still there, and I think that society needs to look at that and understand that someone with a mental-health issue should be treated the same as anybody with a broken bone,” Crowe said. “It happens to people; it’s a normal thing we should all be aware of. People tend to not seek help if they have mental health issues because there’s so much stigma attached to it. But there’s help out there, and I think we need to change our ways.”

Ryan said that the mental-health struggles predated Covid, especially the increase of anxiety. While the school has emotional support staff, he is educated in psycholog­ical first-aid and does his best to help kids when they are dealing with that anxiety.

Hampton spoke about the increased workload because of Covid but also due to the increased needs of students. From allergies to advanced diseases, students with health issues are taking up an increased amount of nursing time. Additionally, very young children whose entire childhoods were during the pandemic often were unable to get the proper early intervention they needed.

At Arlington High School, nurse Lee said that because of Covid restrictions, employees had to turn away students who needed emotional help.

“We were so busy managing Covid and testing and [coping with] positive cases that we didn't see the kids who needed the TLC, we just physically we couldn't have them in our office because we had other sick kids,” Lee said. “So that part was really hard, to sort of feel like you were shutting the door a little bit on the kid that needed that emotional support.”

Overall, Lee and other nurses are grateful for the support they have.

“I think Arlington Public Schools is amazing,” Lee said. “We have so much support in the way we collaborate, and I think we [will] just continue to support our kids, and get them back and be resilient and educate them.” 

This news feature by YourArlington intern Renee Abbott, a journalism student at Northeastern University, was published Saturday, Dec. 17, 2022.

Donate button, 300pxThis explanatory reporting is supported by a $15,000 federal grant provided to YourArlington as part of $860,000 aiding 22 local nonprofits and businesses.

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