Florida's Hillsborough County Public Schools have had students in classrooms for only two weeks, and yet Katherine Burdge, a school nurse for the district, said she's more stressed out than at any other point during the coronavirus pandemic.
The district, the eighth largest in the U.S., has had to isolate or quarantine more than 13,485 students and employees since the start of August, and more than 2,650 of them have tested positive for Covid-19. In response, the Hillsborough County school board ordered a more restrictive mask mandate Wednesday after hours of debate, defying Gov. Ron DeSantis' order that masking decisions be made by parents.
"It's frustrating and overwhelming just to be in the position that we are in," Burdge said. "We have so many children as well as teachers that are either isolated or quarantined right now. It's really tough for nurses.
"At least we have this," she added, referring to the new mask mandate. "It's a safeguard. Nothing is 100 percent, but this will hopefully help get the numbers down."
With fewer tools at their disposal, school nurses nationwide are expressing frustration and exhaustion even as the academic year is only just beginning.
It is especially difficult in states like Florida, where political leaders are refusing to allow schools to create mask mandates and other policies that could act as basic safeguards against the coronavirus' delta variant, which is surging and has been shown to increasingly infect children just as they are returning to school.
"School nurses here are facing a moral dilemma, because the protocols that are in place and coming from the state don't align with their values, their training, general scientific opinion, CDC guidance or the position of the American Academy of Pediatrics," said Lisa Kern, the director of the Florida Association of School Nurses. "It's unsettling."
This cognitive dissonance is particularly tough because many school nurses have taken on huge responsibilities during the public health crisis.
At many schools across the country, school nurses often develop mitigation strategies, contact tracing and case management protocols. They conduct Covid testing and even help with vaccine administration. They also are operating as public health educators for students, parents and staff members and often take point on communicating and explaining masking, vaccinations and public health guidance.
They must work as front-line health care workers and as sounding boards for parents who seem to be divided between outraged opposition to mask mandates and real fear that their children could be exposed to the coronavirus.
"It's impossible," said Karen Schwind, the president of the Texas School Nurses Organization, who works as the health services coordinator at the New Braunfels Independent School District.
"I'm receiving calls and hearing from parents who absolutely want to keep their kids in masks, would like their child to be in a classroom with only masks and do not want the child in the classroom where there are no masks," Schwind said. "Unfortunately, that's just not something we have the capability of doing at this point. But then there's the flip side of it where the parents are absolutely tired of the masks, they didn't want them even last year and they are not sending their child to school in a mask."
In Schwind's district e-learning is no longer an option, and it is difficult to know what to do with kids who have been exposed to the virus or have tested positive when they could miss 10 to 14 days of school. Other districts are just now restoring e-learning as an option because of spikes in their student populations.
The stress is taking its toll, especially as thousands of kids in states with outbreaks are having to quarantine in response to the quickly spreading delta variant. It has all come to a head as schools reopen and state political leaders remain opposed to mask mandates and other safety precautions.
Many school nurse groups are advocating that their members do what it takes to protect their mental health, especially as many express frustration that they don't have basic safeguards at their disposal. The concern is that those circumstances may accelerate the type of pandemic burnout that has caused nurses across the country to resign or find other work.
Hospitals have reported growing shortages of nurses and other health care workers during the pandemic. School nursing, often overlooked, was already facing labor shortages that had left schools without medical professionals on their campuses, but experts warn that that could grow worse — if it hasn't already.
There is no clear count of school nurses. National Association of School Nurses President Linda Medonca said the last workforce study it conducted five years ago showed that about a quarter of schools in the U.S. operated without a dedicated school nurse.
Medonca said the situation has most likely become only bleaker during the pandemic. She and other school nurse leaders have heard of colleagues retiring or moving to other jobs at the end of the 2020 and 2021 school years because of the stress and the increasing demands of the job during the public health emergency.
"It's become really challenging because of the politics involved," Medonca said. "School nurses practice public health, and that's what they're going to do in their school communities to keep people healthy and safe, and they've been going above and beyond what their normal roles and responsibilities are, but it can be really difficult."
It's particularly difficult in states like Florida and Texas, where the governors, DeSantis and Greg Abbott, both Republicans, have refused to allow school districts to require masks — even after Abbott recently tested positive for Covid. They are the most notable states to have done so; the Republicans governors and state leaders in Arizona, Iowa, Utah, Georgia, Mississippi, Tennessee, South Carolina and other states have put up roadblocks, as well.
Many have also limited schools' ability to manage Covid cases, and it is having an effect.
More than 20,000 students in Mississippi, who haven't yet completed the first month of the new school year, have had to quarantine because of exposure to the coronavirus. That's about 5 percent of the state's student population, but Gov. Tate Reeves, a Republican, remains opposed to mask mandates.
Experts say those states' opposition to basic precautions will only aggravate the public health emergency.
"It's a real challenging spot to be in if you are a school administrator or a school nurse and you don't have options available to you that we know work in terms of reducing transmission in schools," said Dr. David Dowdy, an epidemiologist at the Johns Hopkins Bloomberg School of Public Health. "That means testing frequently, requiring kids and staff who test positive to stay home and quarantine, requiring masks and increasing ventilation.
"We know these things work," he added, "but without those tools at their disposal, school officials are really in a bind."
Some school districts, like Hillsborough's, are standing firm against their state leaders, however.
In Texas, one school has made masks part of its dress code to circumvent Abbott's executive order. Larger districts, such as the ones that serve Dallas, Austin and most recently Houston, have enacted mandates despite Abbott's requirements.
Three school nurses who work in the Dallas Independent School District said they were relieved that the policy was in place and they could focus on serving their students.
"Masking works, and we saw that over the past year," said Dawn Wilcox, a nurse at Lipscomb Elementary School in East Dallas. "We're at ground zero here, so I was very pleased that the district took this bold step, brought masks back and put student and staff safety first."
Veronica De La Torres, who is the school nurse at an all-girls middle school in Dallas, said she is very relieved that masks — "our first line of defense" — are back. The spread of the virus is personal to her as a nurse who also works at the local hospital, where she has helped open and close the Covid ward. She again helped to reopen the ward because of recent surges.
"I don't want anyone to lose hope," she said. "I've been at this battle now for too long, and I'm hopeful we're going to be successful. We just need to band together and really overcome this — and I need more parents and their kids to wear their masks and get vaccinated."