Beating the Odds Faced by Rural Communities

Greenfield, MA:

Greenfield is a small city in Franklin County, with a population of just over 17,000. Like many rural communities in western Massachusetts, Greenfield faces many challenges. These communities have experienced a decline in population, a decrease in economic growth resulting from falling income levels and housing values, and aging infrastructure. Additionally, residents of these western Massachusetts communities have less access to workforce support services, higher public education, public transit, and broadband infrastructure.

Start of the Pandemic:

Due to the inadequacy of health and social services in Greenfield, they had difficulty fighting the unforgiving spread of SARS-CoV-2. With nearly 18% of their population school-aged children, Greenfield’s utmost concern was for the students’ health and safety. Rural schools often struggle with increased costs, decreased enrolment, and limited availability of health and social services. The school nurses in Greenfield knew their role would be vital to ensuring the safety of the school population moving forward. When the pandemic hit the region in March 2020, it was clear that these challenges faced by rural communities would be compounded.

The Rural Policy Plan, put forward by the state of Massachusetts in 2019, had hoped to address many of the challenges through sustained implementation strategies. However, rural communities hadn’t made enough progress in addressing existing healthcare infrastructure gaps when the COVID-19 pandemic hit, which affected their ability to respond to the emergency.

Shifting to Remote:

As COVID-19 spread relentlessly through Franklin County, Greenfield made the tough, yet necessary, decision to transition to remote learning. Greenfield School nurses saw a major shift in their responsibilities. However, since school nursing practice is founded in population and public health, without hesitation, the Greenfield school nursing team began to focus on promoting a healthy home learning environment for their students and surrounding community. Health promotion efforts included:

  • increasing their connections to the school community and to families,
  • keeping track of student health and wellbeing, and
  • providing the public with accurate information.

In order to efficiently adjust their focus, school nurses strengthened their collective communication systems, which enabled them to effectively advocate for improving the physical environment of their school buildings and to stay positive during a time of dismay.

Collective Communication:

Maintaining the same level of collaborative communication that they had prior to the pandemic was a hurdle the Greenfield school nurses overcame in stride. They quickly adjusted to virtual meetings and began working toward the creation of a robust communication stream. Their goal was to stay connected with the school community and keep families updated and informed. To meet this goal, they used the relationships they already had in place to efficiently disseminate information. Along with maintaining continuous communication, the school nurses ensured that families had access to appropriate resources, from food to health services.

Promoting Health in the Physical Environment:

The Greenfield school nurses took every necessary action and opportunity to ensure the school safety guidelines outlined by the Massachusetts Department of Public Health (MA-DPH) and the Centers for Disease Control and Prevention (CDC) could be met. They made it a priority to obtain the appropriate supplies and equipment, and to advocate for their necessity.

As the school nurses worked tirelessly to keep their community healthy, they were met with rural challenges and barriers. First, the processing time for healthcare purchases in rural communities takes much longer. Second, the school nurses struggled to obtain HVAC filtration systems for the schools that would help ensure a safe physical environment for students and staff. Despite being met with resistance, the school nurses’ desire to reach meaningful health and academic outcomes spurred them to continue to advocate for the importance of the new filtration systems. Through their perseverance, they successfully convinced the administration that HVAC systems, while costly, were necessary to protect the health and safety of Greenfield’s students and staff, and the systems were installed.

Back to School:

Greenfield students are finally beginning to return to school, and school nurses are excited to have them back. Their current initiatives are focusing on disease prevention. As a means of disease prevention, the school nursing team is working towards being trained in BinaxNOW™ COVID-19 antigen testing and pooled testing for the city. The district will use these tests to identify positive cases and intervene quickly to prevent SARS-CoV-2 spread within schools. They are also focusing on employee and student wellness, by providing teachers with information on how to maintain safety in the classroom.

Rural communities often face physical barriers to accessing vital disease prevention tools, like vaccination clinics. Even though Greenfield has four vaccination clinics, the rural nature of the city poses an accessibility challenge for residents. All of the clinics are centrally located, within 5 square miles of each other, but the town is spread over 21.87 square miles. This means many people have to drive a significant distance to reach them. There are two more clinics in surrounding communities, however, driving to those locations could take between 30-60 minutes.

Remaining Uplifted:

Maintaining a positive outlook throughout this pandemic has been challenging for everyone. Thankfully, Greenfield school nurses found a way to strengthen relationships and create a dependable support system for their community and families. They hold weekly virtual debrief and update meetings. These meetings are run without any hierarchy. Greenfield school nurses operate entirely side-by-side as a team, working together to check items off their collective to-do list. Continual quality improvement assessment of their roles and responsibilities has allowed the school nurses of Greenfield to persevere and continue their crucial work.

Despite facing rural challenges and isolation, these school nurses are grateful for each other and for being able to virtually collaborate with colleagues across the state throughout this past year.

School Nurse, a Professional:

When explaining the resilience of school nurses, one said, “There is something about the nursing profession that draws in incredibly hardworking individuals who are tremendously passionate about healthcare. Their philosophy to provide service allows them to prevail every day.” The school nurses of Greenfield have persistently applied their unique training and skills to ensure access to care, promote health, and reduce risk in their schools and community. They have been leaders in advocating for and creating a safer physical environment. Their efforts to educate themselves, their colleagues, and their administrators led to improved air quality, COVID-19 antigen testing, and safer classrooms, and has helped reduce the risk of SARS-CoV-2 spread through their school population.


Written by Hannah Burgess