As the COVID-19 pandemic continues to evolve, so has the work of school nurses.

Since the statewide school closures last spring, school nurses have remained vigilant in monitoring student and staff health.

If the position hadn’t been a priority in school districts before because of tight budgets, the pandemic has changed that. Through federal and state coronavirus relief funding, many local school districts have hired additional nurses who have become essential to assisting schools in the added tasks of keeping the doors open during a pandemic.

In Montana, school nurses are not mandated by law. The American Academy of Pediatrics and National Association of School Nurses, however, share the stance that students have access to a full-time professional registered school nurse in each building.

According to a Montana Association of School Nurses 2018 survey, the registered professional school nurse-to-student ratio in Flathead County was one to 1,633. It is not uncommon that school nurses are responsible for more than one building.

Things have changed, at least in the county’s largest school districts, as a direct result of the pandemic where full-time/part-time nurses and health aides were hired to fill all the needs.

“We have four school buildings,” Columbia Falls High School Nurse Cathy Dragonfly said. “We had three nurses prior, we now have five nurses and three aides on our staff this year. I’m kind of hoping we’ll be able to continue that extra staff into next year depending on how the pandemic looks.”

Whitefish School District added a full-time school nurse, which meant a nurse in each building.

“That has really, really been important to have during all of this rather than having to run between buildings and be screening students,” Whitefish Middle School Nurse Deanne Sramek said. Sramek also serves as the Whitefish School District coordinator of COVID-19 mitigation practices.

Kalispell Public Schools hired three full-time and a part-time contract nurse to serve grades K-8, for a total of six nurses working in the six elementary schools and middle school. One full-time and a part-time contract nurse were hired to serve grades 9 through 12 for a total of two nurses, “which has been amazing,” said Flathead High School and Glacier High School Nurse Molly Denman.

THE PANDEMIC has changed how school nurses triage and treat symptoms of illness versus chronic diseases. Dragonfly, Sramek, Denman and Bigfork School District Nurse Jennifer Knopik and Glacier Gateway Elementary School Nurse Casey O’Neil talked about how their role has changed in a recent interview with the Daily Inter Lake.

“We do have to triage students in a different way. I meet them outside, kind of prescreen them. If I’m concerned about them then I immediately move them into our isolation room,” Sramek said, until parents pick them up.

Dragonfly added, “We’re trying to keep sick children separate from immunocompromised children who may come to our office for their daily medication, or who we see routinely.”

With many overlapping symptoms of COVID-19, the common cold, flu and strep throat, schools aren’t taking chances. More often than not, students exhibiting these symptoms are sent home out of an abundance of caution, which is a big change, Denman and Sramek pointed out.

“I kind of felt like originally the role of the school nurse was to help students and staff be healthy to stay in school. Now, it seems like we are trying to identify students and staff that are symptomatic, that we need to exclude from school — to keep those that are here, healthy and safe, which is kind of a complete turnaround from what our roles were a year ago,” Sramek said, with other nurses nodding in agreement.

SINCE THE start of the school year, nurses have stressed to families that students who have symptoms should stay home and monitor symptoms — even if they think it’s only the common cold, or feel better after taking fever-reducing medication. Staying home has been a culture shift.

“I think that it took a while to get the message to parents where students really could not be in school this year having any symptoms,” Sramek said.

Contact tracing is now a regular part of the day-to-day work for school nurses.

“I also spend a lot of time, as I’m sure the rest do, tracking students,” Sramek said. “Why aren’t they here in school? Are they sick? Are they symptomatic? How long have they had the symptoms for? Do we need to recommend they see their medical provider? And if tested, we have to follow up on test results and exclude them if they’re positive and then start contact tracing with the health department … or, if they have siblings, identifying them in other buildings.”

This has meant a lot of interactions with more parents than in past years.

In Columbia Falls and Whitefish, health screenings conducted by staff are a morning routine when students arrive at school.

Additional staff, touchless thermometers, and apps have aided in how quickly the process goes.

DESPITE ALL the precautions, cases of coronavirus in schools have been unavoidable as community caseloads rose, leading to grade levels or entire school buildings to temporarily move to remote learning when enough people are quarantining and classrooms become understaffed.

School nurses, including Sramek and Denman, have both experienced being in quarantine.

“I ended up getting COVID and was pretty sick, but I’m pregnant so I was really down-and-out sick. I definitely respect the virus more,” Denman said. “But the rest of my family members had very short, minor symptoms, like my 3-year-old had a fever for a couple hours and my 6-year-old had a headache for a day, but yeah, we were in quarantine for quite awhile.”

In Sramek’s case, she was identified as a close contact.

“I was in quarantine for over three weeks, which was challenging in November into December,” Sramek said. “My daughter, who is a senior at the high school, got sick really fast and was diagnosed with COVID. My husband and I got tested and he tested positive. He was asymptomatic. So I was in quarantine for a really long time thinking I would get it and I had three negative tests.”

AS ESSENTIAL workers, nurses have access to the vaccine, which Dragonfly said she took advantage of as soon as possible.

The school nurses believe buildings remain a safe place for children to be and the doors have stayed open because of adherence to wearing masks; hand washing/sanitizing; physical distancing when possible; reducing the number of people students come into contact and disinfecting buildings.

As the pandemic drags on, Denman and Knopik said it’s important not to forget how the pandemic is affecting people’s mental health. School nurses are another resource for students and parents to get connected with mental-health support if they are struggling to cope with the feelings of isolation, depression or anxiety.

“One overarching theme moving forward into the long stretch of this pandemic is keeping our students’ mental health as a top priority in how we manage things going forward,” Knopik said. “What exactly that means will be an evolving thing up for discussion.”

Denman said in a school environment there is always a certain level of teamwork required to educate students, but the pandemic revealed just how necessary it is.

“I think in the context of uncharted territory of living through a pandemic and trying to do school you’ve really had to work more as a team because there are all sorts of opinions and views on how to navigate it, and what’s the best solution for how we are going to manage the school day,” Denman said. “We’ve really had to work together and find common ground for the benefit of our students.”

Reporter Hilary Matheson may be reached at 758-4431 or hmatheson@dailyinterlake.com.