Not long ago, Denver Public Schools nurse Rebecca Sposato was packing up her office at the end of a difficult school year. She remembers looking around at all her cleaning supplies and extra masks and thinking, "What am I going to do with all this stuff?"

It was May, when vaccine appointments were opening up for the majority of adults and the Centers for Disease Control and Prevention were loosening mask guidance.

"I honestly thought we were trending down in our COVID numbers, trending up in our vaccine numbers," she says. "And I thought the worst was over."

Now, four months later, the pandemic is already upending the new school year across the country, as the highly transmissible delta variant continues to cause a spike in cases. In Arizona, coronavirus outbreaks are forcing thousands of children and teachers to quarantine. In Georgia, many districts that began classes in-person without mask mandates switched back to remote learning after the virus spread. And in Oregon, some districts delayed the start of the school year after teachers were exposed to possible infection.

School nurses are tasked with caring for the health and safety of children at schools, and managing a third school year in a pandemic has put even more strain on those in a profession already facing staffing shortages.

It's Groundhog Day for overwhelmed school nurses

Katherine Burdge is a school nurse in Tampa, Fla., where classes started at the beginning of August amid a struggle between school districts and Gov. Ron DeSantis, who threatened to cut state funding for public schools that required students and staff to wear masks.

A judge ruled that DeSantis' executive order banning mask mandates was unconstitutional, but Burdge says school nurses are "dealing with the repercussions" of the back and forth. Her district of Hillsborough County had to isolate or quarantine more than 13,000 students and staff in just the last month — over 2,500 of whom tested positive for the coronavirus.

"We're dealing with COVID on the front lines every day," she says. "It's a serious manifestation that is just overwhelming the district, the state, everybody."

Eileen Gavin, a school nurse in Monmouth County, N.J., also says it's been overwhelming and cites a beat up and faded "Parking For School Nurses Only" sign as a visual representation for how she and other school nurses are feeling.

"It's kind of like Groundhog Day: another year of contact tracing and vaccinating and kind of leading the kids back to school safely," Gavin says. "So, I do think we are traumatized."

Nurses are caught in the crossfire between parents and public officials

Gavin says nurses continue to show up and do their jobs, but are feeling the strain of a workload that has expanded beyond what they could have predicted.

"It really is a lot to bear," she says. "We are the only healthcare professional in the schools and we have input and weigh in on so many things."

Gavin says she spends a lot of time talking with parents to help them sift through "the noise and the misinformation and give them valid resources" on dealing with the coronavirus.

"We assist in giving them the information so they can make an informed decision to keep their child healthy and safe," she says.

Burdge, who's also the President-elect of Florida's School Nurses Association, similarly says that school nurses want to be a resource for parents, but that the fight over masks between public officials in her state has caused some grief.

"We don't want to have those nasty words or fights or debates or anything along those lines with them," Burdge says. "We are a resource for them, and open communication, I think, is key at this point."

Sposato says that where she is in Denver is "very pro mask." She thinks Burdge's experience dealing with outbreaks — likely intensified by DeSantis' order to eliminate mask mandates — indicate "why we need to be following the health guidelines and scientific evidence on this," she says. "The health guidelines work."

Fears over the safety of students and staff have grown going into a third pandemic school year

Sposato says her greatest fear heading into this new school year "is that one of the mutations is going to outflank the vaccine, and we will see steeper, higher numbers of COVID being present in our community."

Gavin says her biggest fear is over school closures. "Kids need to be in school. We need to be in school," she says. She hopes that putting layers of protection in place will allow the year to commence safely. "We need to kind of stand firm with that so that we can keep our schools open for our kids.

Burdge says school closures are on everyone's minds, but that she's also concerned "for our nurses and their safety and well-being — that we are going to get burnt out."

"Our school nurses are exhausted," Gavin says. "I think last year I had said school nurses felt like the weight of the pandemic was on their shoulders. We're on our knees now, with the weight of the pandemic on our shoulders."

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