WORCESTER, Mass. - Since the COVID-19 pandemic began, school nurses have been dealing with a heavier workload than usual, juggling testing, surveillance and the day-to-day duties they had before the virus arrived. Although this school year is off to a smoother start, the workforce is still reeling from two years of burnout.

Debra McGovern, director of nursing for Worcester Public Schools, said staffing levels are improving, but they're nowhere near where they need to be. 

"Last year, I was short 10 nurses all year," McGovern said. "Ten nurses! It was extremely difficult and I never recovered, because as soon as I hired a new nurse, I'd lose one. This year, I started the school year seven nurses short, and I'm getting a little bit closer. As of today, I'm six nurses short."

In the early days of the pandemic, McGovern said many older nurses who might have continued to work for several more years opted to retire. The remaining staff has had their hands full, with two nurses covering schools with 750 or more students.

"In those schools, I haven't always been able to place a second nurse," McGovern said. "It's been quite a battle hiring nurses, I've never had a problem hiring nurses in the nine years I've worked in this position."

Recent surveys show it's been a physically and mentally exhausting time to be a school nurse. In a survey from the National Association of School Nurses, nearly half of respondents said they've felt bullied, threatened or harassed since the beginning of the pandemic and their mental health is suffering because of it. 

Cathryn Hampson, president of the Massachusetts School Nurses Organization, said it's a troubling trend for the profession.

"Nurses have reported being threatened personally, being threatened with their jobs, 'I'll have your job, I'm going to sue you," Hampson said. "There definitely is a greater sense of strength and anger behind it than I think I've seen in the past."

In addition to retirements, some newer hires are stepping down from their positions after a few months on the job because of the increased workload over recent years. 

"We had nurses who left because they had family to take care of, and they couldn't spend 12 to 14 hours a day working contact tracing and taking care of other people's families," Hampson said. "They needed to take care of their own."

Advocacy groups like the Massachusetts School Nurses' Organization and the National Association of School Nurses say policy changes are key, including clearer procedures for reporting harassment or threats, providing health insurance that covers therapy, and leave policies to give nurses time to recharge. 

"We need to look at salaries," Hampson said. "We can't compete with the hospitals, I know that, because we don't have the same funding backgrounds, but we definitely need to look at getting as closely competitive as we can."

Hampson said looking down the road, there's also a pipeline issue. Despite the present challenges of being a school nurse, she hopes the next generation will still see the benefits and consider it as a career. 

"We need to engage students in high school and help them to realize that nursing is a very viable career, there's lots of options you can go a lot of different directions," Hampson said.