EDITOR’S NOTE: This article is being localized with photographs of school nurses in west central Arkansas.


WIMBERLEY, Texas — Jacob's Well Elementary School nurse Annie Wood bends slightly to take the temperature of a fourth grade student. And then another. And then another.


Wood performs temperature checks with touchless thermometers of all students once a week, part of a new campus effort to keep the coronavirus away.


The Wimberley district is one of the few in Central Texas to have launched in-person classes for the fall semester, and so far, officials have reported no cases.


As school districts across the country reopen their doors to students for the first time since the pandemic abruptly shuttered schools last spring, school nurses will be critical in the fight against the spread of the virus among students and teachers. They helped craft school pandemic actions and will evaluate whether students should be pulled out of school because of coronavirus-like symptoms.


But the country faces a shortage of school nurses. About a third of all schools employ a nurse only part time, and 1 in 4 have no school nurse, according to the National Association of School Nurses.


"It's going to be school nurses who are on the front lines and that's a place where we have systematically underinvested for a really, really long time," said Sara Johnson, an associate professor of pediatrics at the Johns Hopkins University School of Medicine. "How we support school nursing and school-based health services in general is really an important next step because this is going to be with us for a while. It's not going to go away this winter."


School nursing is more than affixing Band-Aids to skinned knees and doling out cough drops. The profession, often filled by nurses who previously worked in hospitals, has grown more complex over the years, as campus nurses see more medically fragile students. In any given day, a school nurse may perform a urinary catheterization, help a diabetic student inject insulin or attend to a child who is having a seizure. For some children, particularly students from low income families, it is the only source of health care they may receive, and many high poverty schools don't employ them. COVID-19 now adds another layer of complexity to the job.


"People don't realize that real health care goes on in a school," said Laurie Combe, president of the National Association of School Nurses. "School nurses are delivering health care in schools that sustains students' ability to learn. Without that care there are many children who could not come to school."


"In this period of COVID, we really have been leading pandemic planning in so many schools," Combe said. "When school administrators recognize the public health and infection control expertise that school nurses bring to the table, then they are working as collaborative teams to develop their return-to-school plans, the messaging and all of the decision trees that need to be made along the way."