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School nurses: Key healthcare providers invested in increasing COVID-19 vaccine confidence, equity, and access

By Elizabeth Clark, MSN, RN, NCSN posted 04-24-2022 11:15


Special thanks to Amy Dark, BA, BSN, RN, CSNT, co-author of this blog.

The COVID-19 vaccine is a safe and effective strategy in preventing COVID-19 infection. Yet, only 33.4% of children ages 5-11 years have received at least one dose of a COVID-19 vaccine, as compared to 81.4% of the total population, as of March 8, 2022 (CDC, 2022). Vaccine confidence is critical for individual, community, and population health.

National Association of School Nurses (NASN) partnered with the Centers for Disease Control and Prevention (CDC) to engage school nurses in a 2-hour COVID-19 Vaccine Confidence Bootcamp on March 9, 2022, 4-6pm EST. Seventy-three school nurses, representing 42 states, participated in this interactive workshop to increase vaccination. The primary speaker, Dr. James T. Lee, CDC, emphasized three effective methods to use when engaging with the school community regarding vaccination, “empathy, understanding, and connection” which resonated with the school nurse participants.

As part of the Bootcamp content, NASN invited three school nurses to present their experiences regarding COVID-19 vaccination.

Jodi Bobbitt, MSN, RN, FNP-BC, NCSN, AE-C, School Nurse, Alexandria, Virginia, held culturally effective school located vaccine clinics (SLVs) coordinating monthly family food distribution events with health fairs. Special guest superheroes and princesses attended vaccine clinics supported by the local health department. Colorful, “I’ve been vaccinated” bracelets were very popular and served to promote future vaccine opportunities. Recently, a video of parents speaking about how COVID-19 has affected them and their decision to get their students vaccinated was added to their social media sites.

Erica Harp, BSN, RN, NCSN, Lead Nurse, Great Falls, Montana, held SLVs weekly in partnership with their local Federally Qualified Health Center. COVID-19 and Influenza vaccines were offered and administered by school nurses and FQHC staff. In the first clinic for individuals 5 years of age and older, 250 COVID-19 vaccines were given and 100 influenza vaccines. The school nurses have identified that working with Native American advocates and homeless coordinators in their schools has helped with vaccine education and outreach.

Amanda Santamaria, BSN, RN-BC, CSN, Director of Nursing Services, Summerville, South Carolina, hosted a virtual town hall event in conjunction with their state health department and state teacher organization to provide education to school staff and school nurses about the COVID-19 vaccine, specifically for students. It helped educators and school nurses feel empowered to encourage vaccination for themselves and their students.

After hearing success stories and strategies from school nurses practicing in culturally, ethnically, and geographically diverse areas, participants were divided into breakout rooms for a 20-minute small group activity. Assuming either the role of the school nurse or a caregiver, participants shared vaccination barriers and facilitators that exist in their school communities. Using the “Walk a Mile Activity,” participants explored six points along an individual’s journey to vaccination including knowledge, intent, preparation, point of service, experience of care and after service.

The common themes that school nurses shared highlighted their contribution to the school communities' experience of confidence, equity, and access.

Convenient and Accessible: It is convenient for families when vaccine clinics are held at their local school with times suitable for caregivers, such as after school and on weekends, often with paid time off for parents and excused absences for students post vaccination if needed. Offering childcare and form completion assistance with translators afforded accessibility.

Desirable: School nurses are trusted messengers and share factual information consistently with caregivers, the school community, and school administration. Several strategies improved desirability, engaging students and siblings in interactive activities, school staff champions serving as role models, providing after service approaches such as second dose reminders and education for common adverse effects, familiar school staff presence to offer care and reduce anxiety, and incentives such as food or gift cards.

Necessary and Beneficial: The sense of a return to normal for families with day care, sports, and recreational activities for students was noted. Offering routine vaccines such as required immunizations for students, and influenza vaccines during COVID-19 clinics normalized the experience. Addressing distinctive considerations for students with special healthcare needs and caregiver fatigue due to student missed school days related to exposures fostered the benefits and necessity for vaccination.

At the conclusion of the bootcamp, school nurses felt very confident in understanding key vaccine confidence concepts, understanding the status of COVID-19 vaccination in the US, and their ability to find communication resources related to COVID-19 vaccination. Over 90% of participants learned new strategies to use within their school/organization. NASN was pleased to partner with the CDC to offer this valuable interactive training to school nurses.

Resources (NASN & CDC)

COVID-19 Vaccine Confidence | CDC Strategy to Reinforce Confidence in COVID-19 Vaccine

12 COVID-19 Vaccination Strategies for Your Community | CDC A guide to support the work of Health Departments and Community Organizations

NASN Supports Pediatric Vaccination Against COVID-19 | NASN press release supporting pediatric vaccination against COVID-19

Champions for School Health | A project in partnership between NASN and the Institute for Educational Leadership (IEL) to increase confidence in and access to pediatric COVID-19 vaccinations

School nurses highlighted in President Biden’s COVID-19 Preparedness Plan | NASN press release

School-Located Vaccination Clinics: In the Era of COVID-19 | NASN School Nurse supplement to support school nurses work in vaccine advocacy

COVID-19 Reference | References and resources designed to assist school nurses in responding to the COVID-19 pandemic


Centers for Disease Control and Prevention. (2022). COVID Data Tracker. Trends in Demographic Characteristics of People Receiving COVID-19 Vaccinations in the United States.