A qualitative study of school nurses’ moral distress related to COVID‐19

Abstract

ObjectiveTo understand school nurses' perceptions and experiences of moral distress related to COVID‐19 case management in the school systems.DesignA descriptive qualitative study guided by Braun and Clarke's reflexive thematic analysis.SampleTwelve school nurses practicing in Colorado from December 2021 to January 2022.MeasurementsSemi‐structured interviews about school nurses’ experiences of COVID‐19. Investigators utilized an iterative reflexive thematic analysis process engaging the participants' and researchers' subjective experiences.ResultsFour themes were created: (1) keeping kids and the community safe, (2) caught in the middle of the “tug of war” between health and politics, (3) distress amid an ocean of COVID‐19 uncertainty, and (4) visibility as a bright spot shining through the COVID‐19 cloud.ConclusionsTwo research questions examined school nurses’ experiences of moral distress and their role and scope of practice that affected their relationships in the educational and public health systems. The results of this study confirm the important role of school nurses and interprofessional case management in school environments in the fight against infectious diseases and pandemics. Building stronger relationships between school nurses and public health is imperative for future collaborative and cohesive public health responses to pandemics.

The impact of COVID‐19 on school nursing: A qualitative survey of stressors faced by school nurses

“…In addition, school nurses experienced conditional resource loss when they felt unable to fulfill the responsibilities of their role, and school decision-makers disregarded their expertise. In the setting of these losses, school nurses most commonly sought social and informational support from informal networks of school nurses and school administrators (Baker et al, 2023;Best et al, 2023;Kim & Bae, 2023;Lee et al, 2021;Um & Choi, 2022). Resource loss may have also been reduced or stymied in some places by added pay, extra staff, collaboration with health departments and community organizations, and boundary setting (Baker et al, 2023;Barbee-Lee et al, 2021;Best et al, 2023;Kunz et al, 2022).…”

“…School nurses provide vital access to healthcare for students and communities that may not otherwise receive care due to poverty or geographic location (Wakefield et al, 2021). During the pandemic, school nurses were more visible than ever as communities recognized their expertise and more families reached out for support (Baker et al, 2023;Kim & Bae, 2023;Wilson et al, 2023). Many parents and families relied on school nurses during the COVID-19 pandemic as a trusted source of information regarding vaccination and prevention of illness (Rose et al, 2023).…”

“…The COVID-19 pandemic threatened to further erode the school nursing workforce through new challenges and the amplification of existing demands. School nurses experienced overwhelming demands from added COVID-19 responsibilities that were prioritized above chronic disease management, health screenings, and other school nurse duties (Baker et al, 2023;Best et al, 2023;Cook et al, 2023;Hale et al, 2023;Lowe et al, 2023;Seo et al, 2023;Um & Choi, 2022;Wilson et al, 2023). The added COVID-19 workload was even too much to complete during work hours, leading nurses to work after the school day, on weekends, and holidays with little or no added pay (Merkle et al, 2023;Morse et al, 2023;Wilson et al, 2023).…”

“…The added COVID-19 workload was even too much to complete during work hours, leading nurses to work after the school day, on weekends, and holidays with little or no added pay (Merkle et al, 2023;Morse et al, 2023;Wilson et al, 2023). School nurses were concerned by their exclusion from school COVID-19 planning and management and the absence of health experts (Baker et al, 2023;Best et al, 2023;Cook et al, 2023;Morse et al, 2023;Wilson et al, 2023).…”

“…As the pandemic continued, school nurses and other healthcare workers also contended with opposition, distrust, and violence rather than the gratitude and recognition that characterized the first few months of 2020 (Baker et al, 2023;Best et al, 2023;Cook et al, 2023;Morse et al, 2023;Ravenelle et al, 2021;Tribby & Isaacson, 2023;Wilson et al, 2023).…”