Meadow Village Elementary School nurse Kathryn Cruz works behind her desk in the school clinic.
Meadow Village Elementary School nurse Kathryn Cruz works behind her desk in the school clinic. Credit: Bonnie Arbittier / San Antonio Report

Kathryn Cruz loves her job as a school nurse at Meadow Village Elementary School, where she’s been doling out sympathy and health care to kids for the past three years. One of the big reasons Cruz said she left her pediatric nursing job at a hospital to work in schools is the opportunity to build long-term relationships with her young patients.

“Being a school nurse I’m able to see them every day, and some of them I saw them from when they were in kinder until fifth grade,” Cruz said. “And I always call them my little ones. They’re all my little ones.”

Cruz said before the coronavirus pandemic her nursing duties ran the gamut, from helping children take their medication to dealing with broken bones and sometimes just providing comfort and support.

“Sometimes I have students who come in and they just need a little TLC – somebody to talk to, someone to share their day with, and it makes me happy to be that person,” Cruz said. “We never really know what’s going to come through the door, but we are always ready and prepared for what may come.”

This year her job has become more complicated as the question of what’s coming through the door every day becomes a vital matter of public health. Now Cruz’s day starts with helping screen and temperature-check every staff member and student being before they enter the campus. The task requires all hands on deck, so even the school’s principal, vice principal, and other staff members are outside every morning with quick-scan thermometers, Cruz said.

Meadow Village Elementary is in Northside Independent School District, where district spokesman Barry Perez said currently about half the students have returned to classrooms. The district will continue to bring more students back as long as the COVID-19 indicators for San Antonio continue to remain low.

Not every Texas school has the full-time services of a nurse like Cruz. The state does not require school districts to provide a nurse for every campus, and according to a recent report by ABC13 in Houston, dozens of schools in the Houston area do not have a school nurse, even as they begin bringing kids back for in-person instruction. 

Funding shortages have caused similar problems at Austin schools, where Austin Independent School District is sharing 76 nurses among 130 schools.

In comparison, San Antonio area school districts are well-staffed. Of nine local school districts contacted by the San Antonio Report, all reported having at least one school nurse position for each campus, and some had either multiple nurses or an additional nurse aide position.

Northside Independent School District had the most nurses, with a total of 148 registered nurses (RNs) and licensed vocational nurses (LVNs) for the district’s 120 campuses. Northeast ISD also had more than one nurse per campus with a total of 90 nurses spread among 68 campuses.

Laura Short, spokeswoman for San Antonio ISD, said her district has 88 RNs, six LVNs, and three flex nurses for its 90 schools, with at least one nurse on every campus.

Even smaller districts around the area, such as Harlandale and Edgewood ISDs, have a nurse on every campus, according to data provided by the districts. 

At Meadow Village Elementary, Cruz said nobody has showed up to school with a fever so far, but the arrival of allergy season is further complicating her ability to diagnose. During the school day, any student who coughs or sneezes more than normal or displays COVID-19-like symptoms is removed from the classroom and put into one of the school’s new isolation rooms until a parent can take them home, Cruz said. As a precaution, the student’s entire classroom is then cleaned and sanitized. 

With the district continuing to bring more students back to campus, Cruz said the increased workload of screening and monitoring will still be manageable as long as staff, students, and parents all continue to follow the district’s guidelines.

“I’m confident in everything that we have put in place and all of the protocols,” Cruz said. “I’m just hopeful that parents will continue to be vigilant and if they see something out of the ordinary they’ll keep them home.”

Although school nurses may be busier than ever during the pandemic, they have always played a crucial role, said Cruz. School nurses make it possible for children with severe issues such as asthma, diabetes, or epilepsy to attend school safely knowing a licensed medical professional is on campus. Many disabled children, some of whom have to be tube fed, would not be able to go to school at all without the assistance of a registered nurse, she said.

“A nurse being there to provide that specialized care allows for that student to now come on campus,” Cruz said, “[That] is phenomenal and wonderful, because it opens the door for so many more students to be able to be a part of a school setting and be with other students and children, which is definitely where they need to be.”

For schools that don’t have a nurse in place at each campus, the obstacle is typically funding, said Cindy Zolnierek, CEO of the Texas Nurses Association. In 2019, the state legislature passed House Bill 18, which includes a requirement that school districts inform parents whether there is a school nurse on their child’s campus.

“The reason why that is so important is because parents may make a decision to send a student to school or keep them home based on knowing whether or not there’s a nurse there in case the child runs into trouble,” Zolnierek said.

But parents might have difficulty locating their district’s information about school nurses. Despite the fact that the law requires districts to include school nurse information on the website and in the student handbooks, a search of local district websites showed many have not posted the information. 

Perez said a list of nurses has not been posted on NISD’s website because every school has a nurse, and that parents could contact the school for more information. NEISD spokeswoman Aubrey Chancellor said vacant nurse positions would not be posted on the district’s site because they would be filled as quickly as possible.

Cruz said her own three children are still doing distance learning, and she would not consider allowing them to return to school during the pandemic if they didn’t have a school nurse on their campus.

“Even pre-COVID, you just never know what could happen at school,” Cruz said. “Things happen in a split second and to be able to have somebody who is a medical professional who’s equipped to properly respond to those emergencies is very important to me, not only as a medical professional, but as a mother.”

Jennifer Norris has been working in journalism since 2005. She's a native Texan, but a new San Antonian who is excited to get to know the city.