For school nurse Donna Jordan, the moment she had been preparing for all summer and fall finally arrived on a Friday afternoon in early November.

It was a remote learning day and Jordan, like other staff at Bonny Eagle Middle School in Buxton, was working from home. The school day had just ended and she was getting ready to head to the gym when she got a text from her principal, Ben Harris, about a potential positive case of the coronavirus – the first one at their school.

Quickly, Jordan put aside her plans and contacted the infected individual to get details and obtain a copy of their test results. She confirmed the positive case with Harris, who then contacted the superintendent.

They identified students and staff who were close contacts, reported the case to the state, met with the superintendent, reached all the close contacts by phone and email and sent out a community letter – a process that finally wrapped up around noon Saturday, not counting for follow-up calls and emails from people with questions throughout the weekend.

“Talk about nurses’ jobs changing,” Harris said. “Usually administrators are the ones getting those kinds of calls on the weekend and having to deal with it. Now nurses are part of that.”

In Maine and around the country, school nurses are being tested by the pandemic. They’re working longer hours on nights, weekends and holidays in response to the coronavirus pandemic. They’re on the phone much more between contact tracing and answering questions from staff and families. They’re administering COVID-19 tests and responding to possible positive cases during the school day. And they’ve become resources for their communities on COVID protocols, where to get tested and how to stay safe.

“They have been putting in so many hours,” said Emily Poland, school nurse consultant for the Maine Department of Education. “They (always) work hard, but school nurses were working all summer long on how they were going to make school happen and how are we going to take care of kids that show symptoms at school? What is that process going to be?”

Maine law requires that every school district have a school nurse who is registered to practice professional nursing in the state. Only 62 percent of individual schools are staffed with school nurses, however, and there are 493 school nurses currently working in Maine. That’s up from 461 last year and 444 the year before. The average salary is $56,829.

In the past, school nurses haven’t always been a priority for districts, especially in tight budget years, said Melinda Nadeau, president of the Maine Association of School Nurses and a nurse in the Brunswick School Department. The coronavirus might be changing that.

“I feel like this has kind of heightened that awareness,” Nadeau said. “If there’s anything this pandemic has done, (it’s that) they have hired more school nurses which I think most districts will continue to keep, and I hope they do.”

Tina Veilleux, a nurse at Reiche Elementary School and school nurse coordinator for Portland Public Schools, said the district added one school nurse position that’s not quite full-time, increased another part-time position to full-time and added two part-time floating substitutes this year. Through a grant the district also created two health aides who speak Portuguese and Spanish.

“The year – it’s hard to describe,” said Veilleux, 54. “It’s a lot of time tracking and calling and following up with doctors, with testing, with families. We’ve always done stuff like that, but the volume of it with COVID is just huge. That’s one of the biggest changes, and then also how it’s all the time. We have the scheduled school day but anything could happen anytime. We’re kind of 24/7.”

It’s not unusual for Veilleux to get a call or text before 7 a.m. from a staff member who has a headache or isn’t feeling well and is wondering if they should stay home. As students arrive at school each morning she keeps a thermometer in her pocket, checks to make sure they’re wearing masks and keeps an eye out for any possible signs of illness.

Most of the day is spent on phone calls and emails from students, families and staff. A student’s uncle has tested positive for the virus, and the family was at his house last weekend. What should they do? A parent has tested positive. How long should their child stay out of school?

There’s also contact tracing – the complicated investigative process of tracking down and notifying anyone who has come in contact with an infected person to let them know about the exposure and next steps. A positive case can be reported at any time, including school vacations and snow days, and school administrators and nurses must respond right away with outreach to close contacts.

At Brunswick High School, school nurse Jennifer Strout starts by looking at a student’s schedule to determine every class the student has been in and what teachers and students they may have come in contact with. Then she looks at whether the student rides the bus and whether they play sports or are involved in extracurriculars. She also interviews the patient themselves to see if there’s anywhere else they went during their infectious period. The list of contacts can easily grow to 20 or 30 people.

At the same time, Strout is trying to preserve the confidentiality of the infected person, so she’s limited on how much help she can recruit for contact tracing. “It’s a lot,” she said of the process.

At Bonny Eagle Middle School, Jordan said contact tracing is one of the biggest ways her job has changed. It involves a lot of time and detective work, with the school even utilizing security camera footage to verify close contacts. “I’m on the phone probably half the day,” said Jordan, 55. “I like being in person and talking with people, but I’m having more contact with parents than I ever had before.”

With almost 800 students, Bonny Eagle is one of Maine’s largest schools. The day-to-day is sometimes less busy, as there are fewer students in the school during hybrid learning and students also must now make appointments to come to the nurse’s office. But Jordan and fellow school nurse Katie West still have regular pre-pandemic responsibilities to tend to: distributing medication, monitoring students with chronic conditions, conducting vision and hearing screenings and responding to any injury or illness that pops up.

In years past if a student called in sick there typically wasn’t a follow-up call home. Now Jordan said she might spend hours in the morning making phone calls to check on absent students and screen for COVID symptoms.

Many parents also have questions about testing and where they or their children can get tested. In a rural district like SAD 6, where Bonny Eagle is located and where testing options are more limited, Jordan said she may have to direct them to sites in Portland, which though not far away, can be time-consuming for families to access. In Portland, the school district is partnering with Greater Portland Health to offer testing to students and staff, but Veilleux, the nurse at Reiche school, said she also gets lots of questions about testing, including how family members can access tests.

“It’s not super easy if you’re not good on a computer or English isn’t your first language or you don’t have transportation,” she said. “So that’s something all nurses are doing is helping people find testing.”

Most school districts in Maine aren’t offering COVID testing at schools, although a growing number are starting to utilize rapid antigen tests being made available through the state. In Gray-based School Administrative District 15, school nurse Tonia Gilley-Pratt recently administered her first COVID test to a student. While some schools are reserving the tests for students who show symptoms during the school day, Gilley-Pratt said she invited a student who had been out of school to come in after their family was having trouble finding testing.

The student came to school and Gilley-Pratt met the family outdoors in their vehicle to do the test. After the test came back positive, the school reported it to the state and immediately started contact tracing. “It worked out really great,” said Gilley-Pratt, 46, a former ER and ICU nurse who made the switch to school nursing about three years ago.

“There was a lot of concern from the state school nurses with bringing testing into the schools for the reasons of, ‘What if we get parents who send their kids to school sick as a way to get a test?’ But I think if there’s any way we can be part of the solution to keep kids in school and keep the state open, I’m happy to do whatever. It’s a really good thing for contact tracing to know immediately.”

The additional phone calls, questions, contact tracing and testing can take a toll. “Sometimes we’re not the best at taking care of ourselves,” Jordan said. “We’ve all had our moments and usually it’s the fatigue. It’s not just COVID fatigue. It’s ‘When is the other shoe going to drop?’ Things happen when you least expect it. You had a great day and then boom, it’s 2:45 and you get that call.”

The state is lending a hand in providing support and updates on the latest CDC policies and how schools should be responding. This fall the Department of Education brought on two part-time nurse consultants in addition to Poland, the nursing consultant, and operationalized a team of retired school nurses to help with school-based contact tracing. Still, Poland said there is a lot of stress. “Any of the stories you are hearing about mental health and burnout in a lot of professions, school nurses are feeling it too,” she said.

For some school nurses, working more closely with staff and administrators as well as each other has provided a silver lining. “I don’t feel like I’m stressed, but I feel like a lot of people in our community are stressed,” said Janet Rivard, a school nurse at Kate Furbish Elementary School in Brunswick. Going for walks twice a day, staying educated and keeping in close touch with other Brunswick nurses helps, Rivard said.

“We definitely all have different areas of strengths and we know that about each other,” said Rivard, 57. “We have group texts and we text each other nights, weekends, whenever. We call if there’s a question, ‘Hey, what do you think?’ We’re very much a team.”

There’s also some comfort in knowing what they’re doing is working. As of Friday, the rate of new cases in Maine schools over the last 30 days was 27 per 10,000 staff and students, compared to 113 per 10,000 people statewide. That puts the rate of new cases in schools at 24 percent of the statewide rate for the general population, according to the DOE.

“What I’m seeing is these kids are doing great,” Gilley-Pratt said. “It’s important for them to be around other people and in school, even if they’re wearing masks and keeping social distance. They’re still super happy to be there and I know the teachers are happy to be there. So as the numbers go up in the community, I’m hoping we can maintain that safe structure in school. I’m just going to stay optimistic.”

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