School nurses are on New York's COVID-19 frontlines. Here's what it's like.
Sue Repetti’s job these days is one part student disease detective, one part parent crisis counselor.
Charlie Davis, meanwhile, drew on decades spent working at IBM to tackle the complex problem-solving involved in reopening schools safely during the coronavirus pandemic.
And Mimi Buerkle has found herself swapping a little tough love for a lot of scrutiny over kids' coughs and sniffles.
For Repetti, Davis, Buerkle and thousands of their fellow school nurses, returning to class buildings this fall amidst the COVID-19 pandemic was just the start of a daily learning curve.
They balance tense moments explaining COVID-19 risks and precautions to parents with daunting workloads that come with handling each student coronavirus case that crops up. Many schools require negative COVID tests before a student who has any type of respiratory problems to return to school.
Now nurses are anxiously watching as COVID-19 surges nationally, despite early signs K-12 classrooms had a limited role in spreading the respiratory disease so far.
“They’re facing many challenges and frustrations around the work they have to do to ensure that their school community stays safe,” said Linda Mendonca, president-elect of the National Association of School Nurses.
It is all unfolding as new research shows severe COVID-19 illnesses among children are rare, despite at least 853,000 child coronavirus cases across the U.S., accounting for 11% of the total number of infections, according to the American Academy of Pediatrics.
In New York, schools have reported more than 8,700 positive tests for coronavirus infections among students and staff since Sept. 8.
Each case triggered a far-reaching response that involved school nurses, and several of them on the frontlines shared their experiences with USA TODAY Network New York.
School year demands special skill sets
When the coronavirus pandemic hit, Charlie Davis knew he could count on his skills not only as a school nurse, but from his 50 years at IBM to solve the "complex" problems the district was facing.
Davis, a nurse at Webutuck High School in Amenia, Dutchess County, used the skills he learned as a senior technical staff member to find creative solutions to prepare the district for in-person instruction.
He created a PowerPoint presentation with recommendations for district leaders with applications for health screenings, ways to carry out effect social distancing with young students and effective cleaning methods.
"That's why my previous career kicked in a little bit, I reached out and said there is expertise and knowledge I can share, so I put together some suggestions and recommendations for the district leaders for their consideration," Davis said.
Davis worked with school leaders and staff in the Hudson Valley district to create a plan in which students could return to school safely.
Aspects of the school day like cleaning, transportation and food service were things he never had to consider until schools began planning to re-open. He said he started reviewing and drafting a list of recommendations based on CDC, state and local health department guidelines so that the district could make informed decisions when it came to re-opening.
Webutuck began welcoming students back to a hybrid model of learning on Oct. 5.
Davis said he pored over information online to find the best way to carry out social distancing, how to do health screenings in a quick yet effective manner and the best ways to transport students to and from school safely.
One worry: Finding ways to socially distance students who might move around the classroom.
"Nurses don't typically develop the healthcare procedures; we look to the experts in the field, and for me the North Star was the CDC," Davis said. "It's a challenge to balance the need to meet the educational needs of the student population...with the safety and health aspect of it."
While Davis said the responsibilities have changed, the day-to-day workload has remained the same, with only half the amount of students coming in and out of the building each day.
"There are some new things the health office is doing," Davis said. "If a student gets flagged for presenting COVID-19 symptoms, we have to decide if that student has to go into isolation. We use our clinical judgement, based on the history of the student, and I will contact the county department of health if that student has a positive diagnosis."
When asked about the risks he takes to care for his students, Davis said, "That's what nurses do, that's our job, our responsibility."
"In my case, for my students and their families, I care about them," Davis said. "I deeply, deeply care about them. I want to see them be well, be safe and succeed in school. That's why I became a nurse."
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A new kind of busy
In a school with over 2,000 students and more than 200 staff, Sue Repetti was used to busy days.
She supervised daily care for students at White Plains High School with diabetes, asthma and various disabilities. The nurses were responsible for staying on top of immunizations, health screenings and sports physicals — all that before the illnesses and injuries that popped up during the day.
All those responsibilities are still on her plate, though now there are only about 600 students in the building a day, four days out of the week.
But the nursing staff still has plenty to do.
They are responsible for contacting every student and staff member who marked “yes” to experiencing COVID symptoms on their daily health screening.
“We do that first thing in the morning to see who is sick and why they're sick and advise them as to what they have to do,” Repetti said. “Then we do follow up, depending on what it is we've told them or what their illness is.”
The calls take up an enormous amount of time, and they’re essential to making sure no one comes to the building with COVID symptoms unless a test has confirmed they don’t have the virus.
“I say we've become detectives, and we're doing investigative work,” Repetti said.
Sue Repetti has been a nurse at White Plains High School for 17 years. She made the transition into school nursing after more than a decade in the emergency department at United Hospital in Port Chester.
“I never thought that I would work in a school,” Repetti said. “One of my neighbors was working in the White Plains district, and she said ‘Sue, the school district is wonderful, you need to start subbing and get a feel for how it is,’ and that's what I did.”
After a year of substituting in the school district in between 12-hour hospital shifts, she heard that one of the high school’s nurses wanted to retire. Repetti interviewed, got the job and never looked back, even when schools became the front lines of reopening.
“I love what I do,” she said. “I still plan on working for a good bit of time. It's just a matter of being smart and being safe. I really believe in PPE.”
The most important part of her job these days is education, Repetti said. If she tells a parent their child needs a COVID test, she also has to assure them that it’s not about panic, it’s about caution.
If a staff member is feeling a little under the weather, she has to impress upon them the importance of staying home. If there are cases reported, she has to make the community understand that they might not get as much information about the case as they desire.
“It's a different type of year, but our number one priority is taking care of the kids and the staff,” she said. “Some of this investigative work is new, but we're doing what we have to do. I think we're hoping for some normalcy in the future...and we'll do whatever we have to do until that time comes.”
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An added layer of caution
It used to be tough to convince Mimi Buerkle to send you home from school.
As mom of four who's been a nurse at Iroquois Middle School in West Irondequoit, Monroe County, for the last seven years, Buerkle's become pretty adept at nurse judgment — identifying reasons a student says they aren't feeling well and determining if they actually need to go home.
But with COVID-19, the game has changed for the district outside Rochester.
"When a kid comes in with a runny nose and a cough, normally I would say, 'Cover your cough, wash your hands.' But now, we can't," Buerkle said.
"We have to send those kids home because I don't want to be the nurse in the district who sends a kid back to class and they test positive for COVID."
A child with a fever over 100 degrees Fahrenheit will automatically get sent home, Buerkle said. Other symptoms, like a headache or sore throat, now warrant a closer look, too.
"I've probably sent 60 kids to be tested, and I feel like it's the best way to keep the rest of the kids safe," Buerkle said.
Having students back in school is largely positive, she said. They're happier, they benefit from seeing and interacting with their peers, and life feels significantly more normal having them back in school — even with masks and social distancing in play.
The risk of exposure to COVID-19 doesn't make Buerkle feel uneasy at all. Rather, it's more challenging to be the one in charge of making the call to send a kid home or back to class when the stakes are so high.
"I've been a pediatric nurse for 35 years, and this doesn't bother me," Buerkle said. "It is a little bit more stressful...(but) I'm not afraid to be vigilant because I know the consequences."
Mary Piston, the district's nurse coordinator and the nurse at Irondequoit High School, said in her 22 years with the district, she's never seen anything like this.
One of her biggest concerns is balancing the safety of the school community with the delicate situations each student's family might be enduring.
"It's difficult for some families and parents — working, taking care of the kids, having them home, financially to get them tested, financially to get a doctor's appointment," Piston said.
"That is a worry for a lot of parents. And sometimes you get those minute, little symptoms that we have to grab on to and that sometimes is questioned by parents."
Like many districts across the state, West Irondequoit has put a variety of rules and regulations in place to keep students safe: Students have to abide by social distancing guidelines, temperatures are taken by an infrared camera when they arrive and, of course, masks are required at almost all times.
Piston said she truly adores her job. She loves being in the school environment, loves the students she gets to interact with and loves the community they have together.
But with COVID-19, there's new worries and responsibilities — and her heart aches for what students are going through.
"This is rough. This is a rough time for us to be living, and it's a rough time for them to be growing up," Piston said.
"We don't know what the next day is going to bring...But yes, we are pretty much at the same place we were in March as far as anticipating and not quite knowing what's going to come next and just being very cautious."
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