Relying on Brockton School Nurses: A Story of Leadership
With a population of just over 95,000, Brockton is the most populated city in Plymouth County in southeastern Massachusetts. The city has had over 14,000 positive COVID-19 cases and 434 deaths since March 14th, 2020. They currently sit in the yellow zone of the MA COVID risk color-coding system, as they regularly experience more than 10 new cases a day and a positivity rate of 3.06% (https://brockton.ma.us/covid19/).
Since almost 15% of Brockton residents live in poverty and roughly 25% of their population is under the age of 18, the Brockton school community was tremendously impacted by severity of the COVID-19 spread in their area.
Brockton Public Schools experienced difficulty adjusting to the transition to remote learning because of lack of technology, food accessibility, and mental health concerns. Their school nursing staff rose to the challenge and exemplified exceptional leadership skills.
In March 2020, when schools closed and students shifted to remote learning, Brockton began contact tracing. The Brockton Board of Health turned to the school nurses and asked them to build a robust contact tracing program. Trained in infectious disease, surveillance, and risk reduction, contact tracing was a natural fit for school nurses. While the effort started with only one public health nurse and two school nurses, the program quickly grew to include 11 school nurses from across the city.
In May, the Brockton Board of Health faced a new challenge with the passing of a health officer, and they were in need of a replacement. The Board of Health appointed Linda Cahill as the Interim Executive Health Officer. Linda Cahill, DNP, RN, has worked as a school nurse in the Brockton Public Schools for the past 18 years, and has been the school district’s Nursing Supervisor for 9 years. Although excited for the opportunity, Linda remarked that she did not feel entirely ready to assume this incredibly involved leadership position, while also continuing to serve as the school district’s Nursing Supervisor. Despite her apprehension, her knowledge of public health and her years directing Brockton’s school health program made her the perfect person to fill the role temporarily until a permanent Health Officer could be hired.
Linda’s devotion to lifelong learning, as well as the generous help of her colleagues at the Board of Health, aided her transition into her new role. When Linda was appointed to this interim position, she gained a lot more responsibility. Realizing she didn’t have a full understanding of the duties of the Board of Health, she asked coworkers for a summary of their job responsibilities, so she could better understand how the Board of Health operated. Responsible for new policy development and implementation of COVID-19 regulations citywide, Linda regularly researched guidelines and code enforcement for housing, restaurants, gyms, sports, and pools. She admits that this task was challenging, in part because the protocols were constantly changing.
Linda continued to work as the Interim Executive Health Officer through August, when the Board of Health hired someone permanent to fill the role, allowing her to resume her responsibilities as a school nurse and Nursing Supervisor.
Grounded in Community Health: Whole School, Whole Child, Whole Community (WSCC):
The work being done by Brockton’s school nurses exemplifies the Frameworks for the 21st Century School Nursing PracticeTM model, where nurses focus on children as members of a family and community. Linda and the school nurses are focusing not only on promoting community health by tackling the spread of COVID-19 with contact tracing, but also assisting many impoverished families with food and rental assistance. They hope that these efforts create a ripple effect and improve the health of Brockton students, linking back to CDC’s WSCC student-centered model that emphasizes the community’s role in supporting schools, health, and academic achievement.
School nurses in Brockton have also engaged in other important community health initiatives throughout the past year. In January, Brockton school nurses assisted the board of health with scheduling the city’s vaccination clinics. Linda also highlights a special project some school nurses undertook. The nurses were making phone calls to multilingual families and creating videos about COVID-19 in multiple languages for non-English speaking families.
By focusing on and building a collaborative communication approach, these school nurses have gone above and beyond to increase access to COVID-19 care and resources. Linda is proud of the professionalism and dedication the Brockton school nurses have shown in assisting families in need and promoting the overall health of the community.
Meaningful Academic Outcomes:
Ensuring students are ready and able to learn is paramount to school nursing. During this pandemic, not only have Brockton school nurses focused on building a healthy community through contact tracing and vaccination, but they also helped mitigate acute problems that were interfering with student learning and health.
Technology: Adequate access to technology was a major obstacle to learning when schools closed. The school department had to purchase thousands of laptops for students to learn remotely and for staff to teach remotely. The school nurses assisted with distributing the technology and keeping track of which students borrowed the equipment.
Food: Another critical concern was making sure students were still fed. The school nurses implemented a “Grab-and-Go” food program that allows families to pick up meals at 17 different locations across the city, with the goal of maintaining health equity during the pandemic. Some of the sites now offer breakfast as well, which families can pick up the afternoon or night before. Some sites are also running over the weekend.
Mental Health: The community is also experiencing an increase in mental health concerns. Many children and families are struggling with isolation. School nurses made it a priority to reach out to students and assist them in any way they could, focusing primarily on students with learning disabilities or a history of depression before the pandemic. School nurses collaborated with school counselors, making check-up calls every day to these students. This student-centered coordinated care approach aims to empower students, reduce risks, and improve overall health.
Collectively, these interventions are aimed at ensuring students are safe, healthy, and ready to learn, whether at home or in the classroom.
Back to a “New Normal”:
On April 11, 2021, Brockton students returned to school full time. Linda describes it as, “feeling like the first day of school again.” Having students back in the classroom has created new challenges for school nurses. Everyone – teachers, staff, and students – need ongoing education and reminders about COVID-19 safety protocols (e.g., mask wearing, handwashing). Linda and the school nurses have established medical waiting rooms within the schools, continue to contact trace as much as possible, and begun pooled testing on May 10th. They are juggling many tasks critical to school safety and are conducting continuous quality improvement on the safety measures in place.
School nurses focus primarily on student health, however, as they are often the only health professional in the school building, staff members frequently rely on them as well for information and support. School nurses often are the ones called upon to calm and allay the fears and anxiety of staff members who are nervous about returning to school and unsure as to when they would receive the vaccine. School nurses have been educating teachers on ways to protect themselves, and ways to keep health and safety a priority in their classrooms.
The Brockton school nurses, Linda included, have all applied their unique skill sets far beyond the school to address the challenges posed by the SARS-CoV-2 pandemic. They continue to go above their call of duty to support their community and school district. Their undivided attention to community health has allowed Brockton Public Schools to safely return to in-person learning and improved the ability for students to reach their full academic potential. The Brockton school nursing team deserves recognition for their depth of expertise and devotion to population health.
Written by Hannah Burgess