Q&A with Julie Silver, school nurse for Buncombe County Schools

Julie Silver wanted to be a school nurse from the time she was in nursing school.

“It was fun because you got to do rotations through the different nursing careers and shadow them,” says Silver. “I really enjoyed going to do my shadows with the school nurses because it’s not just boo-boos and Band-Aids. There’s a lot more that [goes] into being a school nurse.”

After eight years of working in a hospital setting, Silver became a school nurse three years ago. She is employed by the Mountain Area Health Education Center, which contracts with Buncombe County Schools and Asheville City Schools, and splits her time between West Buncombe Elementary School and Joe P. Eblen Intermediate School.

Over the last two years, school nurses have added COVID-releated responsibilities to their daily tasks. Those responsibilities include keeping up with changing state guidelines, administering COVID-19 tests, alerting students who have tested positive and contact tracing. Silver believes she and her colleagues have met these challenges “head-on.”

Xpress spoke to Silver about working with schools, masking and the role of a COVID coordinator.

This interview has been condensed for length and lightly edited for clarity.

How does school nursing compare to the other kinds of nursing you’ve done?

Being in a hospital, you knew what you had to get done, like assessments, vitals, medications. With school nursing, what’s really amazing is you never know what your day is going to hold. I think that’s so awesome because within a day I get to talk to the students, especially those with chronic illnesses. I schedule time with them, usually during lunch, and we talk about ‘How’s things going? How’s your school year going? How are your grades?’ We talk about whether they have diabetes or asthma or allergies and about managing that in school.

I also talk with the staff and collaborate with them on finding resources if families need it. We work closely with social workers and counselors to figure out if a family needs any resources, such as housing or things that I may not be able to help with on the medical side.

You said being a school nurse is “not just Band-Aids and boo-boos.” What would surprise people about your job? 

We do the typical things where we care for those students who have injuries or they’re sick. But there’s also managing immunizations where we make sure every kid’s up to date. We try to train every staff member [in case] a student needs an EpiPen or an inhaler or any type of medication.

One thing I do like to do is get to know the students and their families who may not have a resource — like if they don’t have a primary care doctor for this student. Maybe I can find out if there are any offices that are taking new patients to help them get the care that they need.

What are some of the biggest challenges of your job?

These past two years COVID has really been a big challenge for us, just with keeping up to date with our guidelines from [the N.C. Department of Health and Human Services] and then collaborating with the Buncombe County Health and Human Services Department, making sure we’re following all that guidance. The state gets the CDC guidance and, based on that, they come up with protocols for isolation and quarantines and masking.

What is your responsibility when a student has to isolate or quarantine?

When we know that a student has been exposed, we look at the quarantine guidance — now it’s five days — and we make sure that those students are aware. We talk to the family, give them guidance for their return dates. We talk to them about the symptoms if anything develops. That’s really what quarantine is, because isolation is when you’ve actually tested positive.

We work really close with the Buncombe County Health and Human Services Department. They help us do our case interviews and they’ll help us figure out the return date for the students. There is testing available at school, and so that’s one thing we’ve added this year. We look back and do contact tracing as well in the schools. We work with our health assistants and our COVID coordinators at school to talk with those families and let them know if their student has been involved in any exposures. Then we made sure that everybody, like teachers, knows the return dates.

Who takes on the role of COVID coordinator? Is that a nurse or another school employee?

Someone within the school. If we have several close contacts, they help us do phone calls. We gather letters to go home with the students. They help us keep up with our spreadsheets to make sure that the teachers are aware which students they have out and what their return dates are. Then the MAHEC health assistants that we have now in some schools are helping us with testing and with calls.

There has been some controversy about children wearing masks in schools. Have you heard from any parents who don’t want their child wearing a mask in the classroom?

In some cases, you do see that. But it’s also nice to have a conversation with the families and explain why we have these guidelines. When we explain to the family that we have universal masking and we talk about some of the reasons why, a lot of times they are very appreciative of that because they realize that’s the way their students get to stay in school.

Are you concerned about the possibility of getting COVID because you interact with so many people every day?

No. I feel that MAHEC gives us the proper PPE [personal protective equipment] we need. That’s the protective equipment we use: our mask, our gloves, gowns, face shields, whatever we need to be able to do our job. I do not have any worries about that.