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School Nurses: The Best Defense Against the Spread of H1N1

NEA’s Health Information Network asked a panel of school nurses about the challenges we face as we go back-to-school and prepare for a possible H1N1 epidemic.

Beth Mattey (R.N., M.S.N., N.C.S.N.) is a 22-year NEA member and a school nurse at Mt. Pleasant High School in Wilmington, Delaware. Robin Wallin (R.N., M.S.N., N.C.S.N., C.P.N.P.) is the nurse coordinator for Alexandria Public Schools in Virginia and has been an NEA member and school nurse since 1997. Mary Paradise has been a school nurse for 12 years in Seattle and is now on staff at NEA.

What is the biggest obstacle to meeting the challenges that H1N1 presents?

Paradise: One of the main barriers to effectively treating students is a lack of reliable emergency contact information. The forms that parents or guardians are required to provide must be verified and re-verified to make sure that families can be contacted when their student isn’t feeling well.

Mattey: On top of that, the challenges of not having a full-time nurse on staff are immense, and many schools in the U.S. don’t have a full-time school nurse. School nurses are the health care expert in schools—they have the education and expertise to quickly recognize serious symptoms and recommend appropriate care.

Wallin: There are definitely logistical issues to overcome. Communication and information are certainly at the top, but there are resources and workload issues to be considered too, specifically, isolating and supervising students if they are sick.

What should you do about staff and students who exhibit symptoms while they are at school?

Paradise: If a student or staff exhibits flu symptoms or is diagnosed with the flu—H1N1 or seasonal—make sure you can isolate them to prevent the spread of the virus and then send them home.

What do schools need to be aware of when isolating sick students and staff?

Wallin: The first thing you should do is determine what local policies already exist. We plan ahead to find space for and maintain a working sick room. Then, make sure you’re logistically covered: Is someone available to supervise sick people? Are there proper hydration and nutrition plans in place? How will you keep students occupied while they’re in the sick room? 

How can you do this effectively?

Mattey: It’s best to create very clear and detailed roles within your school—in other words, an emergency plan. A team of school staff that includes administrators, teachers, support staff, and the school nurse should meet early in the year to plan for possible scenarios like those mentioned previously. The team should continue to meet during the school year to update the plan. Keep in mind that we don’t know how the H1N1 virus will impact schools this year. We might have to change our plan mid-year. In an emergency, one nurse I know “deputized” support staff and security into service so they could supervise the sick kids.

Wallin: You will also need to allocate resources to occupy and supervise students—movies, videos, lessons, and books to read. And there are staffing resources to be cognizant of, especially if you don’t have a full-time nurse.

Who else needs to be involved?

Paradise: It’s important that we foster partnerships with public health care departments and providers outside of schools. Oftentimes a sick child will leave school and be taken directly to the emergency room. This can be costly, time-consuming, and may overwhelm hospitals. In some cases, the public health department might be more suitable to meet the needs of the student and parents/guardians and help them find the alternatives to the emergency room so those who need emergency care can have access to it.

Wallin: As soon as possible, get together with your local health departments and discuss the options.

Mattey: Local public health departments will be an invaluable resource on the local impact of H1N1. What may be happening in California may not be happening in Delaware. School nurses and others will need to communicate with the public health department to determine the best course of action in your community.

We’ve discussed planning as a school, what about personally. What advice do you have for educators?

Wallin: First and foremost, if you are sick you must stay home! If you have enough sick leave, use it appropriately. If you have a fever, stay home until you are fever-free for 24 hours.

Mattey: Practice proper hygiene and infection control. Hand washing and respiratory etiquette (coughing into your sleeve) and staying home when you’re sick is paramount to protecting yourself and others from the flu. Staff should also get the seasonal flu vaccine in the fall and the H1N1 vaccine when it’s available.

Wallin: If you have a sink, use warm water and wash your hands properly. Ensure that you have an appropriate supply of soap and paper towels. A lot of schools overlook that, but they are necessary tools to washing hands properly. 

Paradise: I’d add that warm water is the most helpful but cold or lukewarm water is the next best thing. If you don’t have a sink, alcohol-based (with at least 60 percent alcohol) hand sanitizers are your best option. Review your state’s guidance on hand sanitizers before you distribute them. Kids should never use hand sanitizer un-supervised.

So the message is that prevention comes from being prepared. How should an educator embrace that?

Mattey: Staying up-to-date is key. Take advantage of available information.

Paradise: Seek out your school nurse—if you are lucky enough to have one!

Mattey: Exactly! In the case of H1N1, you don’t need to reinvent the wheel. Your school nurse may have access to information and handouts for staff and parents from the National Association of School Nurse’s Web site. Also check out and for more great resources to review before school starts--they are updated regularly.

Wallin: The best resource for planning is early immunization for regular seasonal flu. While the H1N1 vaccine may not currently be available, you should monitor the CDC for updates on your access to it. If you have sick kids in your school or class, review social distancing practices. I recommend that desks are pushed apart (at least 3 feet from each other on all sides) rather than in groups or pods.

Paradise: I can’t speak more highly of appointing a “classroom health officer.” Each day, I would assign a different student a health-related task to teach the class. Kids learn every day from other kids, so they can certainly teach other good habits, too. With H1N1, they could do some research and inform the class. Hygiene contracts to be signed by parents are also powerful.

That’s a lot of information, how do you make it sound so easy?

Mattey: You have to Stay Calm. Nurses and educators have so much in common. We are the type of people that are wired to handle situations like this. It’s in our DNA.

Wallin: There is a teachable moment here. Yes, H1N1 is scary, but we are more prepared for this pandemic than ever in the history of the world. We are capable of staying in front of it and there’s a lesson for our students there.

Mattey: The most important lesson is that the best way to avoid getting sick and stay healthy is to practice proper hygiene, eat well, get enough rest. You have to realize and respect that the silver lining of H1N1 is the opportunity to teach, instill, and practice proper hygiene and flu prevention etiquette. 


  • anc_dyn_linksWhere Have all the Nurses Gone?
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  • anc_dyn_linksA Nurse's Tale
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  • NEA Health Information Network Flu Resources
  • The National Association of School Nurses

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