Credit: Courtesy of the Centers for Disease Control and Prevention

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D.C. school nurses are being told to serve in the District’s response efforts to combat the coronavirus pandemic or they will face temporarily layoffs effective April 2, according to a work notice provided by District of Columbia Nurses Association to City Paper.

Registered nurses or licensed practical nurses in 110 traditional and 68 charter schools report to Children’s National Hospital under a partnership between the hospital’s Children’s School Services (CSS) program and the Department of Health (DOH). The nurses’ union, the District of Columbia Nurses Association, says CSS notified leadership earlier this week about the new job responsibilities. The union informed its nurses about the possibility of layoffs on Friday, with the expectation that CSS was also going to issue employees a work notice. 

With schools closed until at least April 27, CSS told the union that DOH requests school nurses assist with needs resulting from the pandemic. According to a “layoff and option to work notice to DCNA-represented RNS and LPNS” provided to City Paper, DOH will tell school nurses where they will be working for as long as schools are closed and what they will be tasked with doing. School nurses will be compensated at current wages and benefits.     

“We intend to lay off all nurses effective April 2, 2020 subject to recall when D.C. schools reopen. Nurses who are laid off will need to continue health insurance at their expense through COBRA,” says the work notice.

The notice says school nurses will have until Tuesday, no later than 5 p.m., to make a decision on whether they will participate in the COVID-19 emergency response or be laid off. The notice was sent on Friday evening.  

The pandemic has strained resources and manpower in the D.C. and elsewhere. Across the country, states have been forced to get creative about identifying and deploying more health care workers, including asking retired physicians to volunteer. In D.C., the mayor has been calling on volunteers to support public health tasks. Already, thousands have volunteered to join the Medical Reserves Corps, where they would help staff D.C.’s drive-through testing sites. If the city wants to screen and test more patients, it’ll need the workers to do it. 

“During this unprecedented public health crisis, trained public health and health care professionals are in demand,” says a joint statement from DC Health and Children’s School Services sent to City Paper on Friday. “To mitigate community spread and to ensure our residents receive the care they need, health professionals in various organizations are being asked to take on new or expanded responsibilities. School nurses are leaders in their field with specialized experience in public health nursing.” 

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The joint statement makes no mention of layoffs, although City Paper inquired about this. Instead, the statement outlines what non-direct patient care and patient care activities include. D.C. needs help performing contact tracing for COVID-19 patients that is done by phone; case management and remote monitoring of individuals under strict quarantine; supporting the COVID-19 call center; and working at testing sites. These testing sites are developed by D.C. government and volunteers, including nurses, assigned are going to be provided with the “appropriate” personal protective equipment.  

DCNA told City Paper the union was not given any assurances during a conference call with CSS on Wednesday that school nurses who cannot do screening and testing would be able to do other work if they sign up to join DOH’s COVID-19 team. No representative from DOH was on the call. The union does not believe school nurses should be forced to volunteer, especially if that means they’ll have to work in testing sites where they would put themselves at risk. An overwhelming majority of the nurses are at a high risk for severe illness if they become infected with COVID-19 due to their age or underlying medical conditions. Of its 157 nurses, DCNA says only about 20 nurses expressed willingness to volunteer. The rest could face layoffs. 

“The school nurses have been given an ultimatum to accept an assignment that will be harmful to their lives or face job loss,” says Walakewon Blegay, a staff attorney with DCNA. “Most of the school nurses have underlying health conditions that would be at higher risk for severe illness from COVID-19. Our nurses need information on these COVID-19 assignments and need guarantees that nurses will be accommodated and protected. This is a callous act of the District and Children’s.” 

“We’re talking about people that have little kids, that are putting their whole family at risk and they’re the caretakers of their family,” she adds. 

On Friday, DOH told City Paper by email they are appreciative of the nurses and that there is “a process” to seek an accommodation for those that believe some of the COVID-19 work could jeopardize their health. “The health and safety of all our essential personnel and the school nurses who assist DC Health in addressing this public health emergency is paramount,” the joint statement reads. “We will comply with applicable laws and guidelines and provide accommodations, as appropriate, to ensure the safety of these workers.” 

When asked about the accommodation offered by DOH in a follow-up interview, Blegay says it was the first she’d heard of this. “When we ask for specifics, CSS said they did not have any and that would be up to DOH,” she tells City Paper

Jocelyn Esposito, 68, is a school nurse who could not volunteer if that means she’ll have to screen and test patients for COVID-19. She has a chronic respiratory condition. Esposito is a school nurse at John Eaton Elementary School in Woodley Park and has been with the school for two academic years. She’s been a school nurse since 2006. 

She is happy to perform other tasks, like surveillance, for example. But she does not want and cannot be a frontline worker who is being exposed to patients who potentially have COVID-19. 

“I am totally in respect and humbled by the nurses that are in clinical situations right now on the front lines. But it would be too risky for myself and the majority of nurses that are employed by Children’s School Services,” says Esposito. “It’s too risky for them, for their own personal health. At some point, health care providers have to look at themselves, because we’re not the ones that look at ourselves during times when care is needed.”

“But in this particular case, because of the lethality, our age, our health condition, it is not the right type of nursing,” she adds.  

Generally, school nurses have not worked in a clinical setting or with adults for years. Some go into this profession because it’s not as physically demanding. The work of a school nurse typically involves data collection, like making sure students have all their vaccinations, or care coordination for students with chronic health conditions. 

“The workload is much different. You find a much older population of nurses doing school health,” says Esposito, who is also her union’s shop steward and secretary. “We’re at the end of our active careers and we’re in school nursing for a reason.”

She says she’s been working remotely since March 13, in self quarantine, and has spent her days making sure health data is accurate. Eventually, she and other nurses were working towards checking in with parents. But if she has to pivot to COVID-19 screening and testing, she’ll be forced to retire early. This will be a financial burden for her. It is upsetting for her because she likes her employer-based health insurance with the school. If she retires, she’ll have to get a Medicare plan. This is not an option for all school nurses who do not want to participate in DOH’s emergency response. Some might have to get COBRA.   

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