As millions of students and teachers return to school amid the coronavirus pandemic, so too will tens of thousands of school nurses who suddenly find themselves on the COVID-19 front lines.
School nurses -- often the sole providers of medical care for dozens to thousands of students -- this year will be executing schools' coronavirus response plans, disseminating information to parents and staff and taking care of students with COVID-19 symptoms, on top of their usual duties.
"We really are sentinels in the school system for students' health and are always looking for trends in symptom presentation for both physical health and mental health needs," said Laurie G. Combe, a registered nurse and president of the National Association of School Nurses. "Being a school nurse is a role that is much more than people perceive it to be."
MORE: Don't skip vaccinations: 8 things pediatricians want parents to know during the coronavirus pandemicPrior to the pandemic, as many as a quarter of U.S. schools did not have a nurse on site, and fewer than 40% of schools employ a full-time nurse, according to the NASN. Guidelines from the American Academy of Pediatrics recommend that every school have a nurse on site.
Gail M. Smith, a registered nurse and director of health services for the Pickens County School System in Jasper, Georgia, compared being a school nurse in regular times to operating a one-person "mini urgent care clinic." In the time of coronavirus, that is multiplied.
"I don't think the community knows in general that we've all been tirelessly working all summer to prepare for students' return," she said. "A lot of work is being done behind the scenes with students' health in mind."
Here are five things school nurses want parents to know as they embark on an unprecedented school year.
Parents should be prepared for the fact a child's sniffle or complaint of feeling hot may send them to the nurse's office faster than those symptoms may have in the past, according to both Smith and Combe.
In many schools, students should expect to be seated at a social distance outside the nurse's clinic while waiting for an assessment. Students with COVID-19 symptoms will be isolated from others seeking more routine medical care.
Students with chronic conditions such as diabetes still will have access to school nurses' care, according to Smith and Combe.
Smith added that school nurses in her district will be repeating what they call the "three Ws": Wear a mask, watch your distance, wash your hands.
In Smith's district, school officials are asking parents to screen their children on their own at home.
"We recognize that everyone has a part to play, and the part that parents play is to screen their child before they come to school," she said. "When parents send their child to school or put them on a school bus, they are attesting that their child does not have any symptoms."
MORE: Teacher has more than 700 entries on a spreadsheet tracking COVID-19 in schoolsIn addition to monitoring for COVID-19 symptoms at home, Combe said it's important for parents to practice healthy safety measures with their kids, like wearing masks and washing their hands.
"I'm asking parents to put their face coverings on at home when they're asking their children to do so, and increasing that time each day so kids become accustomed to that," she said. "And that they practice things like how they keep their mask clean when they take it off to eat."
"And practice washing hands for 20 seconds with soap and water," Combe added. "We're asking children to be doing that more frequently at school, so it's good to practice at home."
Combe's organization, NASN, has launched the Safer Return to Schools Coalition that's advocating for $208 billion in federal funding to help provide for everything from more school nurses and mental health staff to material needs like personal protective equipment and cleaning supplies, as well as new HVAC systems to increase ventilation indoors.
"What we're asking for is for the federal government to invest in children," Combe said. "When we keep schools safe, then children can learn in a robust, safe environment."
School nurses, who are typically compensated far less than peers who work in clinics and hospitals, are fearful about their own health, the health of their students and staff and keeping up with the normal pace of the job, according to both Combe and Smith.
Hospitals experiencing a shortage of PPE throughout the pandemic has many school nurses bracing for the worst.
In Smith's district, they are relying on support from local clubs and community partners like hospitals and companies to make sure schools have enough PPE.
"It has been a challenge to get the supplies, but we rely on various sources ... so then if one falls through, we have other avenues," Smith said.
Both Smith and Combe stressed that parents, educators and school nurses alike will need to show patience in the weeks and months ahead.
"What I'm telling everyone is, it's like we're building a ship as we sail because no one has ever been here before," Smith said. "There are going to be mistakes and changes because [the situation with] COVID-19 changes every day."
"When you're in that phase of life, you've got to give grace and receive grace," she said.
"Schools need to recognize that this is such a challenging time for parents who have worked to provide their children's education during school closures," Combe added. "It's been a stressful time for everyone and we need to show a little kindness all around the table."
On a regular basis, school nurses monitor students' mental health and special needs in addition to their physical health.
"School nurses are visiting teachers' virtual classrooms to check in with students, see which students aren't engaged in education and then reaching out to those families," she said. "And they're reaching out to students who may fall in the special education umbrella and receive support at schools like occupational therapy and physical therapy and making sure those connections and therapies are still being made."