Posted on July 29th, 2022.

“It was the most exhaustive, exhilarating, creative, awful, collaborative work I’ve ever done.” So says the lead nurse consultant in Aurora Public Schools Health Services after two years of a global pandemic in one of the largest school districts in the state.

Nurses had to pivot. And pivot again and again to deal with changing guidelines from the Centers for Disease Control and Prevention, Colorado health officials and their own cities and counties.

“We were building the plane as it was taking off,” said Marnie McKercher, DNP, MPH, RN, NCSN, adjunct clinical faculty at the University of Colorado College of Nursing and the Lead School Nurse Consultant at Aurora Public Schools Health Services.

On any normal day, school nurses are responsible for the health and safety of your kids, the teachers, the staff and their own families. Today, they are also dealing with infectious disease and mental health.

Are school nurses better prepared now for the next wave of disease? We asked Dr. McKercher, who led the effort in Aurora Public Schools to take something complicated and make it understandable by peers, staff, families and students. It was not easy in a district where people speak 160 languages.

Dr. McKercher, thank you for joining us. The public has heard a lot about how stress and pressure impacted nurses in hospitals. But we haven’t heard a lot about our school nurses. They actually played a big part in helping contain COVID-19.

How has the job of a school nurse changed since the pandemic?

In terms of what school nurses do, how much time they spend on infectious disease on a typical year is usually about 10%, looking at infectious disease prevention, and intervention. That got turned completely upside down.

The obstacles got harder as COVID spread. Can you please take us through the phases of your efforts?

Phase 1 was in the spring of 2020 and we learned about COVID.

We went remote very quickly. We had two weeks to plan and execute full-time remote nursing work for 45 nurses. We thought it was stressful. But we didn't know what was coming. We wanted nurses engaged even though they were working at home. We also had to keep people abreast of everything COVID. We wanted to make sure that whenever a parent, a staff member, or somebody else called for COVID information, they had the most up-to-date information.

Phase 2 was in the summer and fall of 2020.

Schools began to get public health guidance from CDPHE, and LPH but it lacked details and was not specific to schools. We were talking and trying to combine information to move forward, even though we didn't know what public health and public education were going to look like a few weeks from that time. So, we were doing a ton of writing, bringing in, and collaborating with other departments. We were basically building the plane while it was taking off. This is the time when we were getting told what to do by public health, but they weren’t saying “how” to do it. So, we had to build the “how”.

This is also when we built the first generation of COVID algorithm and linked letters, which gave the school administration definitions and actions to take for staff and students who tested positive, who were exposed, who got sick with COVID-like symptoms, and to trace exposures.

Phase 3 in the spring of 2021 was about finalizing the algorithm.

We had to take COVID information from multiple sources; the CDC, the state, the Tri-County Health Department and combine them into a document that could be used by school nurses, school administration, and district administration to better understand what to do in different scenarios.

The building of the algorithm had multiple iterations. Then we had to attach staff letters that went to students in ten languages.

As we were going through the fall, the nurses were saying to us “What you have is not sustainable, we cannot continue to work with the tools that you have presented to us. Please invent something else, something electronic.” So, we embarked on what I think was one of the most innovative work I've done with another nurse and the IT department. We call it the COVID app. It's really a computer application of where we're going to report the positive, exposed, or sick individual students or staff. And it's going to notify those who need to be notified without having to come up with who needs to be on this email. That was one of the most challenging developments. What we learned is the app not only worked, but it's continuing today.

Then we learned we had to work on this great intervention that had arrived for humanity, which is the COVID vaccine. I can tell you today we have completed about 150 school-located vaccine events with more than 11,000 vaccines given on site.

Phase 4 was in the fall of 2021 to today.

In the summer of ’21, people started going to the grocery store with their masks off, and we all start feeling like maybe we were on the decline. And guess who arrived – Delta - just as school began. The nurses didn't feel like they could muster more. Well, they did muster more. Now we have the highest number of cases we've ever seen in Colorado, and we're bringing everybody back to school with the responsibility to try to reduce the spread in the building. But cheers to APS school nurses, not one nurse left and said, “I can't do this.”

What happened next was Omicron, which came harder and faster than Delta ever had. Luckily for us, Omicron was up and down very quickly. Otherwise, I don't know that it would have been sustainable.

Through this entire two-year process, I wondered what would break school nurses as you always think they can't do more. Well, they did. And they continue to do more.

I'm very grateful that vaccines came and the community really embraced them, and that school nurses stood the test of time and worked hard until the end to keep kids in their seats and continue learning.

What lessons did you learn from the pandemic response?

I think that we couldn't have done anything at all if we hadn't had all the different disciplines in the district come together saying, “How can I help?” This was an all-out war against COVID, and a war to get kids in school and staff in school. And it really took an entire district to come together to do that. So, I think the lessons are, don't do it alone. This is unique to nursing; we don't typically collaborate with facilities. We don't typically collaborate with a nutrition department or a communications department. We collaborate with other medical providers. But this was a really unique opportunity to do this collaboration outside of the health experts because we needed a ton of other guidance and support.

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