School nurses have become crucial in battling the pandemic, but Texas doesn't require districts to have them

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Working as a school nurse is “not just ice and boo-boos.”

That’s how Marisa Thomison, a nurse at a Hutto Independent School District elementary school, explains her profession, which has become a crucial component of public health during the pandemic. At Veterans’ Hill Elementary School, she manages students’ medical histories, administers medications, provides health education and tries to keep COVID-19 from spreading widely among students and staff.

Among her tasks: keeping parents and teachers calm when she calls to tell them they were in contact with someone who tested positive for COVID-19. Thomison said she and her colleagues have been “cussed out” and even physically threatened by parents who are scared and frustrated at having to keep their children home for weeks.

“It’s the immediate, ‘Oh my God, I have a job. How can I have someone watch my kid? What am I going to do?’” Thomison said.

Unlike their peers in hospital COVID-19 units, school nurses have not had to care for dying patients. They are serving on the front lines of the pandemic in a different way: tracking who has been exposed to the virus, testing staff and students who experience symptoms and diagnosing signs of anxiety in traumatized students.

Thomison is one of 13 nurses in her school district, which makes her lucky. Texas law doesn't require public schools to have full-time nurses, and many don't. In 2019-2020, more than 8,000 Texas public schools employed about 6,100 full-time school nurses, according to state data.

State Rep. Shawn Thierry, D-Houston, has filed a bill this legislative session to require all districts to employ at least one full-time nurse per school and keep a ratio of at least one full-time nurse for every 750 students enrolled. Hiring more nurses would cost districts or the state money, and Thierry said she wasn’t yet sure exactly how much.

“These are essential workers, so it is a cost that we can’t afford to cut any longer. Even one child’s life lost would be tragic,” she said.

Similar bills have failed in previous sessions, but the coronavirus pandemic has shown the scope and importance of school nurses’ jobs. Without a trained health professional to track how the virus has spread on campuses, schools are less able to avoid major outbreaks, said Becca Harkleroad, advocacy chair for the Texas School Nurses Organization and a nurse in Lake Travis ISD.

“I can’t imagine what it’s like during this time to not have a nurse. A lot of times it falls to the front office staff to take care of the kids and send kids home who may be sick,” she said. The advocacy group is also asking the state to track how many schools have nurses and whether they are covering more than one campus, a current hole in available state data. And it is championing a bill filed by state Sen. Beverly Powell, D-Burleson, which would allow schools to use money previously allocated for school safety to pay for additional nurses.

The sole school nurse for 320-student Marfa ISD, Beverly Dutchover, springs into action after a parent or teacher reports a positive COVID-19 case. She asks who they ate lunch with, tracks down class schedules and calls dozens of parents. Sometimes, if more than one person in a small classroom tests positive, she closes down the entire room and demands everyone stay home and quarantine for two weeks.

In the fall and early winter, tourists flocking to Marfa and Big Bend National Park fueled a surge in COVID-19 cases and overwhelmed local hospital capacity. Cases among Marfa ISD students and teachers spiked to about 15 in October before dropping again. Now that Gov. Greg Abbott has repealed the state’s mask mandate, Dutchover worries cases will spike again.

“It upset me. It made me sad to think that especially with all these nurses and doctors who work so hard to keep people alive in the hospitals, and then he went and did this,” Dutchover said of the governor’s decision.

This spring, the state gave school boards the power to opt out of requiring masks on their campuses, which could make some school nurses’ jobs even more challenging.

Debates over which safety policies are necessary for in-person learning have fractured some school communities, with 56% of students learning in person as of January. Marfa ISD will continue to require masks, but some school districts have already opted out. Dutchover knows that even if students and teachers wear masks on campus, they may not wear them while hanging out with friends or running errands, heightening the risk of transmission.

Masks indoors are crucial in preventing the virus from spreading, experts say, and school nurses know from experience. Tracy Ayers, district nurse in rural Caldwell ISD, recalled the time about five players on the girls soccer team tested positive for COVID-19. Upon contact tracing, she learned the outbreak stemmed from close contact on a school bus: The girls were eating with no masks. By contrast, the football coaches were adamant about having their players wear masks and sit far apart on the bus, and the season netted few cases.

“When I see lax behavior in mask wearing in particular is where I tend to see cases that will rise,” she said.

At the beginning of the school year, about half of Caldwell ISD’s students were learning in person. Now, nearly all are. The district’s school board will likely hear public comments after spring break from community members advocating to drop the mask order.

“Even taking a trip to one of the local grocery stores, some will wear masks and others don’t,” Ayers said. “I understand where parents are coming from in that they want normalcy for their kids. From where I’m coming from as a health provider and seeing how much masks are working, I want their kids in school and I want them healthy.”

The symptoms of the pandemic go beyond the purely physical. Thomison has noticed an increase in anxiety among staff members and students. Recently a student came into her office for the second day in a row, concerned about their symptoms. Before the pandemic, Thomison would have sat on the cot next to the student, met them at eye level and convinced them to open up. Now, she had to sit six feet away in a chair, fully outfitted in goggles and a mask. The student eventually confessed to being terrified of getting COVID-19 because a relative had it, and Thomison calmed them down.

She felt the strain of the distance between her and the student. “We can’t do for our students like we normally would. Our work can only provide so much comfort but it’s not going to allay anybody’s true fears,” she said. “I can’t nurse the way I’m used to because we do have safety restrictions. ...It takes a big toll. We’re trying, but we’re also feeling the effects.”