Impact of the COVID-19 Pandemic on Pennsylvania School Nurse Management of Student Immunization Requirements

Abstract

School nurses play a significant role in the coordination of school-entry immunization requirements across the United States. The COVID-19 pandemic changed the school landscape and introduced additional responsibilities to a school nurse's workload. We conducted a cross-sectional survey with n = 110 Pennsylvania school nurses to explore the impact of the COVID-19 pandemic on school-entry immunization compliance management. Qualitative and quantitative data indicated increased difficulty obtaining school-entry immunization data (n = 52) and reduced school-level enforcement of immunization compliance (n = 30). We also observed increases in the percentage of students enrolled with an immunization exemption in Kindergarten, 7th, and 12th grades between the 2019–2020 and 2020–2021 school years. However, few respondents (15%) offered school-located immunization clinics (SLIC) for school-entry-required immunizations. While the benefits of SLICs are documented, the capacity required to execute recommended actions may be limited among school nurses—particularly post-COVID-19 pandemic. School nurses may need additional support to address these gaps.

Keywords

immunizations school nurse knowledge/perceptions/self-efficacy policies/procedures documentation

Get full access to this article

View all access options for this article.

References

Centers for Disease Control and Prevention. (2017, October 12). SchoolVaxView. Centers for Disease Control and Prevention. https://www.cdc.gov/vaccines/imz-managers/coverage/schoolvaxview/index.html

Centers for Disease Control and Prevention. (2020). Preparing K-12 school administrators for a safe return to school in fall 2020. https://www.cdc.gov/coronavirus/2019-ncov/community/schools-childcare/prepare-safe-return.html

Centers for Disease Control and Prevention. (2023). Resources to encourage routine childhood vaccinations. https://www.cdc.gov/vaccines/partners/childhood/stayingontrack.html

The Community Guide (n.d.). Vaccination programs: Schools and organized child care centers. https://www.thecommunityguide.org/findings/vaccination-programs-schools-and-organized-child-care-centers.html

Gormley

J. M.

Poirier

Hassey

K. A.

Van Pelt

(2023). School nurses’ reports on reopening roles, practices, and concerns during the COVID-19 pandemic at the start of the 2020–2021 school year. Journal of School Nursing, 39(2), 143–149. https://doi.org/10.1177/10598405211054805

Gostin

L. O.

Salmon

D. A.

Larson

H. J.

(2021). Mandating COVID-19 vaccines. JAMA, 325(6), 532–533. https://doi.org/10.1001/jama.2020.26553

Guglielmi

(2022). Pandemic drives largest drop in childhood vaccinations in 30 years. Nature, 608(7922), 253. https://doi.org/10.1038/d41586-022-02051-w

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

Hoke

A. M.

Keller

C. M.

Calo

W. A.

Sekhar

D. L.

Lehman

E. B.

Kraschnewski

J. L.

(2021). School nurse perspectives on COVID-19. Journal of School Nursing, 37(4), 292–297. https://doi.org/10.1177/1059840521992054

10.

Hoke

A. M.

Pattison

K. L.

Molinari

Allen

Sekhar

D. L.

(2022). Insights on COVID-19, school reopening procedures, and mental wellness: Pilot interviews with school employees. Journal of School Health, 92(11), 1040–1044. https://doi.org/10.1111/josh.13241

11.

Hoke

A. M.

Stuckey

H. L.

Keller

C. M.

Hivner

E. A.

Calo

W. A.

Strick

J. M.

Kraschnewski

J. L.

(2021). In their own words: Resources needed by school nurses to facilitate student immunization compliance. Journal of School Health, 91(3), 218–226. https://doi.org/10.1111/josh.12993

12.

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

13.

Limper

H. M.

Burns

J. L.

Lloyd

L. M.

Atilano

Alexander

K. A.

Caskey

R. N.

(2014). Challenges to school-located vaccination: Lessons learned. Pediatrics, 134(4), 803–808. https://doi.org/10.1542/peds.2014-1339

14.

Long

(2023). Why are school nurses leaving? NEAToday. https://www.nea.org/nea-today/all-news-articles/why-are-school-nurses-leaving

15.

Mazyck

(2010). School-located vaccination clinics: Then and now. Journal of School Nursing, 26(4 Suppl), 3S–6S. https://doi.org/10.1177/1059840510369231

16.

National Association of School Nurses, Tanner

Griffin

Stanislo

K. J.

Hinkley

Walsh

C. A.

Clark

Graf

La Point

D’Souza-Vazirani

(2024). A contemporary Framework update for today’s school nursing landscape: Introducing the School Nursing Practice Framework^TM. NASN School Nurse, 39(3), 140–147. https://doi.org/10.1177/1942602X241241092

17.

Pennsylvania Department of Health. (2021a). School immunization survey summary for PA 2019-2020 Version February 17.

18.

Pennsylvania Department of Health. (2021b). School immunization survey summary for PA 2020-2021 Version November 10.

19.

Pennsylvania Department of Health. (2024). School immunization frequently asked questions. https://www.health.pa.gov/topics/programs/immunizations/Pages/School-FAQ.aspx

20.

Wang

Clymer

Davis-Hayes

Buttenheim

(2014). Nonmedical exemptions from school immunization requirements: A systematic review. American Journal of Public Health, 104, e62–e84. https://doi.org/10.2105/ajph.2014.302190

21.

Willgerodt

M. A.

Brock

D. M.

Maughan

E. D.

(2018). Public school nursing practice in the United States. Journal of School Nursing, 34(3), 232–244. https://doi.org/10.1177/1059840517752456

22.

Willgerodt

Brock

Tanner

(2023). National School Nurse Workforce Study 2.0. https://doi.org/10.1177/10598405241253565