'It's a good thing I have thick skin': School nurses bear brunt of COVID-19 responsibilities

York Suburban school nurse Karla Coffman always considered her office her "second home."

But since the start of the COVID-19 pandemic, her front door has been closed.

"It is a very difficult place right now," she said. 

Coffman, along with other school nurses across the county, preferred to keep her office doors open as a welcoming space for students to come for physical or mental health needs. When the pandemic hit, it changed multiple aspects of her job. 

School nurses suddenly became the point person for managing COVID-19 spread in their respective buildings. At the start of the 2020-21 school year, nurses were in charge of identifying and recording cases as well as contact tracing, sometimes for multiple schools at once. Not much has changed since then. 

While virtually all school nurses had to make adjustments, the specifics of those adjustments varied among districts. Coffman's closed office at York Suburban High School has a doorbell that rings every few minutes with a new student who needs her attention. 

South Western nurse Janet Frerichs' door also is closed, but she is notified of incoming students by a phone call from the student's teacher. The intent is the same: to limit the  crowding in each office. 

COVID-19 is spreading among Pennsylvania's school-aged children faster than ever before, at least double the rate it was in York County school's last year, according to available data. Coffman said she is seeing more young students come to her with COVID-19 symptoms this school year. 

School nurses are responsible for identifying possible COVID-19 cases and sending students home if they suspect infection. Warring with that responsibility is the high priority most districts have put on keeping students in school. 

More:As COVID-19 cases increase, even fewer schools are closing their doors

With fewer state regulations, it's easier for schools to remain open and keep students in the classroom, but Spring Grove nurse Lisa Bahn described this as "a blessing and a curse." While last year was more restrictive, this year has more gray areas that make it difficult to discern the best choice for each student. 

"It's a balancing act," Bahn said. 

Adding to the pressure is the challenge of identifying a COVID-19 case versus a more common ailment, such as the flu or even allergies. If Coffman sent home every student who exhibited one or more COVID-19 symptoms, she said she would likely have to quarantine her entire school. 

In difficult cases, Coffman said she uses her best judgment as a nurse. Bahn said she typically sends home any student who is ill, regardless of whether she suspects COVID-19. 

Contact tracing: One of the most time-consuming new responsibilities school nurses took on was contact tracing, which Coffman said would often extend her work hours late into the evening, tracking spread and contacting families. 

"This is a job where you do take it home with you," Coffman said. 

Contact tracing can get incredibly complicated because it incorporates every part of a suspected case's time in the school, from the classes they attended, the activities they were involved in and the buses they took.

Coffman said she worked through her Labor Day weekend because there were five reported cases, each with dozens of potential contacts for her to investigate. 

During peak levels of transmission, contact tracing  has involved hundreds of students and staff that nurses  investigated on a daily basis. At one point last school year, Frerichs said she quarantined so many students in a single day, she had to quarantine some of them outside the building. 

Good to have 'thick skin': Nurses also were responsible for contacting the families of students who had to quarantine, not all of whom have responded well to the news. Coffman, Bahn and Frerichs said they've dealt with their fair share of upset parents, and Frerichs said the irritation seems to have increased this year as COVID-19 fatigue has  grown. 

Frerichs said she's had parents refuse to even look at her when they picked their child up from school. Coffman said parents have told her they don't believe in COVID-19, and some have refused to share their child's vaccination status, even if it would make a difference in whether that child would be allowed back in the classroom.

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The three nurses all deal with difficult parents the same way — a combination of patience and empathy. Coffman said when she allows parents an opportunity to voice their frustrations to her, they often would be more willing to collaborate later in their conversation. 

"It's a good thing I have thick skin," Coffman said. 

A recent change in state regulations has eased the responsibility of contact tracing for many nurses. Now, when a student is a close contact of a reported COVID-19 case, they don't have to quarantine or get tested unless they exhibit symptoms. 

Following this change, Coffman and Frerichs said their district administrators have taken on much of the responsibilities in contacting families of close contacts to notify them of their options. Spring Grove spokeswoman Stephanie Kennedy said their district doesn't do contact tracing anymore, but instead notifies a classroom or bus when a positive case has been identified among their group. 

More:Closer Look: A year into COVID pandemic, York County teachers face exhaustion

Pandemic taking a toll: Though their workloads have lessened somewhat, school nurses are still feeling the toll of working through a global pandemic and have turned to different coping mechanisms along the way. 

Coffman splits her free time spending time with her family, binge-watching reality television and crafting. Frerichs tries to get outside three to four times a week and walk or bike along a trail with her best friend. 

For Bahn, she and her husband love to travel, particularly internationally. The pandemic took that off the table, so instead Bahn focuses on cycling. She bikes with a group in Hanover and tries to get out multiple times a week. This year alone, she said she has biked more than 1,800 miles. 

"If I didn't have those two wheels," Bahn said, "I think I would be crazy right now."

— Reach Erin Bamer at ebamer@yorkdispatch.com or on Twitter @ErinBamer.