Listening to School Nurses' Voices: A Mixed Methods Study on the Continued Impact of COVID-19 on School Nursing Practice

Abstract

School closures in March 2020 due to the COVID-19 pandemic precipitated losses of critical student resources as physical, mental, emotional, and social needs escalated. Identifying the challenges, strategies, and changes in school nurse (SN) practice in Massachusetts during this pandemic is fundamental to understanding how to manage future anticipated pandemics while protecting children, communities, and SNs. The purpose of this mixed-methods descriptive study in the second year of the global pandemic was to (a) listen to SN voices through a novel online survey including the prompts of challenges, strategies, and practice changes and (b) describe the SN experience of COVID-19 response in Massachusetts schools, including identification of intent to leave school nursing. Responses were analyzed using descriptive qualitative analysis (n = 73). The prompts each elicited subthemes that coalesced to a cohesive theme: Finding one's way required the support of others to pave untraversed roads.

Keywords

school nurses school nurse voices COVID-19 challenges strategies changes in practice research network attrition mixed-methods research

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References

Banerjee

S. C.

Manna

Coyle

Shen

M. J.

Pehrson

Zaider

Hammonds

Krueger

C. A.

Parker

P. A.

Bylund

C. L.

(2016). Oncology nurses’ communication challenges with patients and families: A qualitative study. Nurse Education in Practice, 16(1), 193–201. https://doi.org/10.1016/j.nepr.2015.07.007

Bergren

M. D.

(2021). School nurses’ moral distress amid COVID-19. The Journal of School Nursing, 37(6), 419–420. https://doi.org/10.1177/10598405211056570

Berlin

Lapointe

Murphy

(2022). Assessing the lingering impact of COVID-19 on the nursing workforce. McKinsey & Company: Healthcare. https://www.mckinsey.com/industries/healthcare/our-insights/assessing-the-lingering-impact-of-covid-19-on-the-nursing-workforce#/

Braun

Clarke

Boulton

Davey

McEvoy

(2021). The online survey as a qualitative research tool. International Journal of Social Research Methodology, 24(6), 641–654. https://doi.org/10.1080/13645579.2020.1805550

Broussard

Myers

(2010). School nurse resilience: Experiences after multiple natural disasters. The Journal of School Nursing, 26(3), 203–211. https://doi.org/10.1177/1059840509358412

Cohen

S. S.

Toly

V. B.

Lerrer

S. M.

Sawin

K. J.

(2023). The impact of COVID-19 on systems of care for children and youth with special health care needs. Journal of Pediatric Health Care, 37(2), 106–116. https://doi.org/10.1016/j.pedhc.2022.09.009

Combe

L. G.

(2020). School nurses: Living the framework during COVID-19. NASN School Nurse (Print), 35(4), 183–187. https://doi.org/10.1177/1942602X20929533

Dickson

Crawford

Sparks

Ciblis

(2023). “This has changed everything”: The impact of the COVID-19 pandemic on school nursing practice in New Mexico. The Journal of School Nursing, 41(2), 201–212. https://doi.org/10.1177/10598405231218532

Doyle

McCabe

Keogh

Brady

McCann

(2020). An overview of the qualitative descriptive design within nursing research. Journal of Research in Nursing, 25(5), 443–455. https://doi.org/10.1177/1744987119880234

10.

Esposito

Principi

(2020). School closure during the coronavirus disease 2019 (COVID-19) pandemic: An effective intervention at the global level? JAMA Pediatrics, 174(10), 921–922. https://doi.org/10.1001/jamapediatrics.2020.1892

11.

Flaherty

E. A.

(2020). School nursing and public health: The case for school nurse investigators and contact tracing monitors of COVID-19 patients in Massachusetts. NASN School Nurse, 35(6), 327–331. https://doi.org/10.1177/1942602X20950670

12.

Gormley, J. M., Poirier, V., Hassey, K. A., Van Pelt, M., & Ye, L. (2023). School nurses’ reports on reopening roles, practices, and concerns during the COVID-19 pandemic at the start of the 2020–2021 school year. The Journal of School Nursing, 39(2), 143–149. https://doi.org/10.1177/10598405211054805

13.

Graneheim

U. H.

Lundman

(2004). Qualitative content analysis in nursing research: Concepts, procedures, and measures to achieve trustworthiness. Nurse Education Today, 24(2), 105–112. https://doi.org/10.1016/j.nedt.2003.10.001

14.

Halcomb

Williams

Ashley

McInnes

Stephen

Calma

James

(2020). The support needs of Australian primary health care nurses during the COVID-19 pandemic. Journal of Nursing Management, 28(7), 1553–1560. https://doi.org/10.1111/jonm.13108

15.

Harris

P. A.

Taylor

Minor

B. L.

Elliott

Fernandez

O’Neal

McLeod

Delacqua

Kirby

Duda

S. N.

, & REDCap Consortium (2019). The REDCap consortium: Building an international community of software platform partners. Journal of Biomedical Informatics, 95, Article 103208. https://doi.org/10.1016/j.jbi.2019.103208

16.

Harris

P. A.

Taylor

Thielke

Payne

Gonzalez

Conde

J. G.

(2009). Research electronic data capture (REDCap)–a metadata-driven methodology and workflow process for providing translational research informatics support. Journal of Biomedical Informatics, 42(2), 377–381. https://doi.org/10.1016/j.jbi.2008.08.010

17.

Hill

R. M.

Rufino

Kurian

Saxena

Williams

(2021). Suicide ideation and attempts in a pediatric emergency department before and during COVID-19. Pediatrics, 147(3), e2020029280. https://doi.org/10.1542/peds.2020-029280

18.

Hsieh

H. F.

Shannon

S. E.

(2005). Three approaches to qualitative content analysis. Qualitative Health Research, 15(9), 1277–1288. https://doi.org/10.1177/1049732305276687

19.

Jameson

B. E.

Bowen

(2020). Use of the worklife and levels of burnout surveys to assess the school nurse work environment. The Journal of School Nursing, 36(4), 272–282. https://doi.org/10.1177/1059840518813697

20.

Lee

R. L. T.

West

Tang

A. C. Y.

Cheng

H. Y.

Chong

C. Y. Y.

Chien

W. T.

Chan

S. W. C.

(2021). A qualitative exploration of the experiences of school nurses during COVID-19 pandemic as the frontline primary health care professionals. Nursing Outlook, 69(3), 399–408. https://doi.org/10.1016/j.outlook.2020.12.003

21.

Lopez

Anderson

West

Cleary

(2022). Does the COVID-19 pandemic further impact nursing shortages? Issues in Mental Health Nursing, 43(3), 293–295. https://doi.org/10.1080/01612840.2021.1977875

22.

Macyko

S. J.

(2022). The impact of the COVID-19 pandemic on children/youth with special health care needs: A school nurse’s perspective. Journal of Pediatric Health Care, 37(2), 117–121. https://doi.org/10.1016/j.pedhc.2022.12.001

23.

Martin

Kaminski-Ozturk

O'Hara

Smiley

(2023). Examining the impact of the COVID-19 pandemic on burnout and stress among U.S. nurses. Journal of Nursing Regulation, 14(1), 4–12. https://doi.org/10.1016/S2155-8256(23)00063-7

24.

Martinsson

Garmy

Einberg

E. L.

(2021). School nurses’ experience of working in school health service during the COVID-19 pandemic in Sweden. International Journal of Environmental Research and Public Health, 18(13), 6713-6725. https://doi.org/10.3390/ijerph18136713

25.

Massachusetts Department of Education. (2015). Information services: Redefining low income – A new metric for K-12 education . https://www.doe.mass.edu/infoservices/data/ed.html

26.

Maughan

E. D.

Bergren

M. D.

(2020). School nursing data collection during COVID-19. NASN School Nurse, 35(6), 319–320. https://doi.org/10.1177/1942602X20960214

27.

McDonald

C. C.

(2020). Reopening schools in the time of pandemic: Look to the school nurses. The Journal of School Nursing, 36(4), 239–240. https://doi.org/10.1177/1059840520937853

28.

Ravindran

(2019). Data analysis in qualitative research. Indian Journal of Continuing Nursing Education, 20(1), 40. https://doi.org/10.4103/IJCN.IJCN_1_19

29.

Rebmann

Elliott

M. B.

Reddick

Swick

Z. D.

(2012). US school/academic institution disaster and pandemic preparedness and seasonal influenza vaccination among school nurses. American Journal of Infection Control, 40(7), 584–589. https://doi.org/10.1016/j.ajic.2012.02.027

30.

Rothstein

Olympia

R. P.

(2020). School nurses on the front lines of healthcare: The approach to maintaining student health and wellness during COVID-19 school closures. NASN School Nurse, 35(5), 269–275. https://doi.org/10.1177/1942602X20935612

31.

Smiley

R. A.

Allgeyer

R. L.

Shobo

Lyons

K. C.

Letourneau

Zhong

, . Kaminski-Ozturk

Alexander

(2023). The 2022 national nursing workforce survey. Journal of Nursing Regulation, 14(1), S1–S90. https://doi.org/10.1016/S2155-8256(23)00047-9

32.

Theberath

Bauer

Chen

Salinas

Mohabbat

A. B.

Yang

Chon

T. Y.

Bauer

B. A.

Wahner-Roedler

D. L.

(2022). Effects of COVID-19 pandemic on mental health of children and adolescents: A systematic review of survey studies. SAGE Open Medicine, 10, 1–14. https://doi.org:10.1177/20503121221086712

33.

Y. J.

Choi

Y. J.

(2022). A grounded theory on school nursing experiences with major pandemic diseases. Inquiry: A Journal of Health Care Organization, Provision, and Financing, 59, Article 469580221090405. https://doi.org/10.1177/00469580221090405

34.

Van Lancker

Parolin

(2020). COVID-19, school closures, and child poverty: A social crisis in the making. The Lancet Public Health, 5(5), e243–e244. https://doi.org/10.1016/S2468-2667(20)30084-0