As a result of decreasing immunization rates, outbreaks of vaccine-preventable diseases have become more common in the past 5 years. Many countries, including the United States, Canada, Australia, and many European countries, require immunizations to attend school or incentivize immunizations in some way, yet increasing vaccination exemption rates have resulted in an increase in disease outbreaks (Scutti, 2017.) This is especially problematic for immunocompromised children because they are no longer protected by the herd effect.
School nurses make an enormous impact when managing illness, thus the school nurse’s response to outbreaks should be a priority. School nurses have proven to be very helpful in improving the health of students (Best, Oppewal, & Travers, 2017). In cost-benefit analyses, school nurses are found to be effective advocates of health and result in a net benefit for schools and communities (Wang, Vernon-Smiley, & Gapinski, 2014; Rodriguez E., Rivera, Perlroth, Becker, Wang & Landau, 2013). Many studies illustrate that school nurses effectively promote immunization compliance in schools (Lineberry & Ickes, 2015), but few have explored the role of school nurses in managing an outbreak (Chrysanthy, Rios & Pannaraj, 2012). An effective school nurse can be of great benefit in a disease outbreak, however in most school districts, the role of the school nurse is unclear.
The purpose of this study is to explore the role of the school nurse during a disease outbreak. Increasing rates of vaccine-preventable disease outbreaks have made the response of the school nurse a priority. However, the role of the school nurse in a disease outbreak is unclear and varies between school districts and regions.
Methods:
After receiving IRB approval, a convenience sample of nurses was established through the Utah School Nurses Association (USNA). Focus groups were conducted at the 2017 USNA Conference. Three 45-minute focus groups with eight participants each were conducted following a semi-structured interview guide. Focus groups were audio recorded for transcription. All findings were combined and analyzed.
Results:
Current Response Algorithm
Currently, outbreak response follows a seedy pattern and varies by school. Generally, the local health department declares a disease outbreak after a health provider reports diagnosing a communicable disease. The health department contacts school administration and the school nurse. The school nurse must identify the students and staff that are not vaccinated, non-immune, or medically fragile and exclude them from school.
Barriers to Response
In Utah and in most of the United States, school nurses are assigned several schools to oversee. As school nurses cannot be onsite at all times, they are often left out of communication between schools and the health department. Additionally, the child’s healthcare provider may give parents information that conflicts with the school nurse and social media messages can cause community panic. School nurses report unclear guidelines for managing medically fragile children and frustration for lack of immunization records of teachers and staff. All of which nurses are not trained to handle.
Conclusion:
The findings of this study indicate that training for school nurses should be improved. Nurses expressed a desire to receive training upon hire and periodically afterward, and be involved in the development of the training. Training should include a general outline of what to do in an outbreak and how to deal with social media issues.
The findings of the study had several other implications for school systems and healthcare providers. A lower nurse-to-student ratio would allow nurses to work more quickly and effectively, and improves student’s health and safety (NASN School Nurse, 2015). Managing disease outbreaks would also be more effective if school systems had a reporting system for school staff members to report their immunization status, as determining the immunization status of staff members often takes a lot of the school nurse’s time during an outbreak. Finally, the school nurses presented a need for some healthcare providers to be trained regarding local outbreak statutes and guidelines, to ensure they are on the same page as the nurse.
In summary, many of the barriers school nurses in Utah face in managing disease outbreaks are due to increased workload, lack of communication, and training deficiency. School nurses could more effectively manage disease outbreaks if the nurse to student ratio decreased. Additionally, an improvement in communication through more thorough training may help to better manage disease outbreaks.
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