This article is part of State of Health, a series about how Michigan communities are rising to address health challenges. It is made possible with funding from the Michigan Health Endowment Fund.

While school nurses have long played a role on TV shows and movies, they haven't played a huge part in most Michigan schools. As recently as 2014, less than half of Michigan school districts employed at least one school nurse – despite research showing that school nurses lower absenteeism, help identify children with mental health issues, and support students with chronic health issues like asthma.

And like all frontline workers, school nurses' jobs changed dramatically in March 2020. When COVID-19 shut schools down, they found themselves with even more work to do. In the face of a pandemic, the state's health departments were thrown into uncharted territory. In regions where school nurses already had boots on the ground, health officials turned to them for help in managing the crisis.
Rachel VanDenBrink.
"School nurses have simply been stretched very thin, especially those of us in place in schools. We're not being able to do that which we feel called to do and being turned into contact tracers, quarantine enforcers, and all of that COVID stuff. There's no bones about it. We're exhausted," says Rachel VanDenBrink, Kent Intermediate School District Center Programs nurse coordinator. "You hear about health care workers in the hospital leaving their jobs. We're just as tired from tracking students, tracking families, and living the political battles of masks or no masks. We're doing our best to maintain the physical and mental health of our students and school staff."

COVID throws a curveball

According to Hendrina Cupery, Holland Public Schools district nurse, Michigan's school nurses continue to play an essential role in public health efforts to reopen schools and keep students in school. They support local health departments with COVID-19 preparedness and response, triage cases and outbreaks, and coordinate COVID-19 testing programs. 
 Hendrina Cupery.
"Because this was so new, the health departments didn't know how to navigate, and that put a lot of strain and stress on school nurses, more on school nurses than anyone would have anticipated," Cupery says. "No one foresaw that. It was no one's fault."
 
VanDenBrink also serves as president, and Cupery as president-elect, of the Michigan Association of School Nurses (MASN). They have advocated and created support mechanisms for school nurses throughout the pandemic.

"Health assessment has fallen on the back burner. We don't get to promote health and work on continuum of care and all the things that school nurses love to do," VanDenBrink says. "Instead, we're stuck tracking down students, asking who they sat by in the lunchroom so we can quarantine them. It's no fun."

When COVID-19 vaccines came out and cases dropped, Michigan's school nurses heaved a collective sigh of relief. Then the Delta variant came along, mostly infecting the unvaccinated. However, those who have decided not to get the COVID-19 vaccine are not their main concern. Many of the students they care for, from the littles through grade five, have not been cleared to receive the vaccine.

"We were hopeful this summer until the variant hit," VanDenBrink says. "We're still excited to see our kids in person for sure, but it's going to be a lot more of the same. When you add that layer of 'Are they vaccinated or not?' it becomes detective work. It is a lot."
Anna Whitaker.
MASN Emerging Issues and Advocacy Chair Anna Whitaker works as Oakland County Health Division's school nurse consultant. She, too, has serious concerns about COVID-19's dangers for students this fall.  

"People think COVID-19 is done. It's going to be challenging and very reactionary this year, especially with the Delta variant. We are seeing it every day in the news. It's here, and there are breakthrough cases [in vaccinated people]," Whitaker says. "Some districts are starting school without implementing mitigation strategies like masks and COVID screenings. Even though other districts are doing these, students intermingle with activities and friends from outside of their own districts."

Cindy Brummette, MASN Legislative Committee chair and a school nurse in Grand Ledge Public Schools, agrees.

"[Add] in the fact that students 11 and under cannot be vaccinated [against COVID-19]," she says. "That's the challenge if we're going to provide a safe learning environment. Keeping kids safe is going to be a challenge."

While some state lawmakers are working to prevent schools from requiring masks and some local officials seek to prevent their health departments from promoting vaccinations against COVID-19, school nurses may find themselves pitted against parents and school districts as they work to keep their kids safe from the virus.

"Wearing a mask is about keeping them safe. It's so hard to get that message across when it has turned into such a huge political battle," VanDenBrink says. "How many children are there age 12 and under that can't even get vaccinated and are left very vulnerable? By the nature of this virus, it's going to seek out those who are most vulnerable and we are going to put them back into the classroom. Two of my own kids are in that age group, so it really hits home."

On the bright side

Michigan's school nurses look forward to the time when the pandemic truly is history. As it has done with many other issues, COVID-19 has shown school districts and state leaders how important school nurses are – not only to students' mental and physical health, but also their academic performance.

"We are excited to see kids back in person. So many school districts have chosen to make that pledge to in-person learning," VanDenBrink says. "Seeing students and having them back is a huge lift to the spirits."

School nurses are also optimistic because the Michigan Department of Education budget recently added $240 million for hiring school nurses and counselors. With more money in school budgets to cover school nurse salaries, more Michigan schools and students will have access to the benefits that a school nurse can bring.

"Now, school administrators can't tell me they don't have money," VanDenBrink says. "Schools without a nurse don't realize what they're missing – not only physical health, but also the mental health of our kids and the safety piece."
Cindy Brummette.
During the pandemic, Brummette says school nurses have "missed out" on classroom education opportunities, ranging from teaching kids how to take care of their teeth to mental health education.

"We're all looking forward to doing these again, once this pandemic is behind us," she says.

A freelance writer and editor, Estelle Slootmaker is happiest writing about social justice, wellness, and the arts. She is development news editor for Rapid Growth Media and chairs The Tree Amigos, City of Wyoming Tree Commission. Her finest accomplishment is her five amazing adult children. You can contact Estelle at Estelle.Slootmaker@gmail.com or www.constellations.biz.

Cindy Brummette photos by Roxanne Frith. All other photos courtesy of the subjects.