Before the first student arrives at Bobby’s Run Elementary School around 7:30 a.m., school nurse Kathy Barbieri has been busy checking her list.

That’s the prescreening report parents are asked to submit before sending their children to the Lumberton school. Then she meets walkers lined up socially distanced at a side door to make sure only those who are wearing masks have been cleared to enter the sprawling building.

“Yep, you’re good,” Barbieri, a nurse for more than three decades, said as she ushered a student inside. To another youngster: “Pull that mask up before you go inside.”

For the third straight year, school nurses are on the front line in the pandemic, still tasked with extra COVID-19 protocol duties as schools try to keep students and staff safe. Like other states, New Jersey has been coping with a national school nurse shortage that has made the job even tougher.

“Nurses have gone above and beyond,” said Lumberton Township School Superintendent Joe Langowski. “They are amazing.”

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New Jersey, which has about 2,700 nurses in public schools, requires at least one certified nurse in every district. That means not every school has a full-time nurse, and in some cases, nurses are assigned to more than one school. Pennsylvania mandates that students have access to nursing services, but many schools also have nurses only part time.

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Langowski said his Burlington County K-8 district with 1,100 students has a nurse at each of its three schools, and the district recently hired two substitute nurses to help with the workload. The days for Barbieri, though, remain hectic.

This week, Bobby’s Run had 33 students in quarantine because of possible exposure, and two confirmed cases, according to the district’s COVID-19 dashboard.

Statewide, New Jersey has had 39 school outbreaks so far this year, with 219 confirmed COVID-19 cases linked to schools. Camden County has had two outbreaks (three or more related cases among students or staff), while Burlington and Gloucester Counties have not reported any.

Barbieri, a former emergency-room and ICU nurse, spends much of her time dealing with COVID-related issues while juggling traditional responsibilities managing students’ health-care needs — administering medications, tending to cuts and bruises, and conducting health screenings. Still, she says she sees about half the number of students each day who used to come to her before the pandemic. Teachers now are equipped with kits and can deal in the classroom with the smaller stuff — Band-Aids, loose teeth — sending only the most serious ones to the nurse to limit exposure, she said.

A day in the life

After pausing for the Pledge of Allegiance on the speaker system, Barbieri closes the entrance door promptly at 8 a.m. and rushes to her office to begin returning phone calls from anxious parents. The first reported that her daughter had coronavirus symptoms.

“The fact that she can’t smell is a red flag,” Barbieri said. She asked the mother to get a COVID-19 test for her daughter or quarantine her for 14 days. Barbieri sent for a younger sibling who attends the same school to be removed from class and directed to the isolation room to await a ride home.

If positive results come back for both, Barbieri must do contact tracing, so she obtained the classroom seating charts for both students. The school, which enrolls more than 300 students, keeps them at least three feet apart, with their desks facing forward, and requires them to wear masks except while eating.

A few minutes later, a latecomer was sent by the front office to get checked by Barbieri. While signing the student’s slip, she continued to speak with the parent on the phone and questioned the student.

“Why are you late?” Barbieri asked the girl. She responded: “My dad’s fault.”

About 15 minutes later, the parent arrived to pick up her other daughter, and Barbieri used sanitizer to wipe down the isolation room. She turned on an industrial air filter to recycle the air and closed the door. She scheduled a CPR training for the district that she will lead.

By 9 a.m., Barbieri fielded several more telephone calls, tended to a student complaining of a migraine, and ran an attendance report for absent students. Then a boy steps into the office to report that he had a 100.3 temperature the day before and wasn’t feeling well.

Barbieri donned a face shield and escorted the boy into the isolation room. His temperature was elevated and he was congested with a cough, so he would be sent home until he was without a fever for 24 hours.

“This has probably been the most stressful time in my career,” Barbieri said. “It’s a major balancing act trying to keep everyone safe.”

Before lunch, Barbieri treated more students with a variety of ailments: a loose tooth, a cut, a sports injury, an upset stomach, and a melancholy girl in tears who perked up after Barbieri let her call her mother. She also conducted a glucose test for a diabetic student, filed immunization forms, and oversaw a health screening.

There was one light moment with a 9-year-old boy who came to get an insulin shot. When his blood sugar reading was lower than she liked, he told Barbieri to “use her superpowers” to fix it.

“Is it fun being a nurse?” he asked. She replied: “I love it. "

‘You can never catch up’

When it comes to making tough decisions to keep students safe in the Camden School District, veteran school nurse Robin Cogan asks herself: What would I do for my own children? The mother of two splits her day among three preschools.

“Right now, school nurses are de facto health departments,” said Cogan, a nurse for 21 years. “Schools are looking to them, and that has become more than a full-time job.”

Cogan lobbied school officials to bring back health aides who were let go when schools were closed in 2020. The district this week announced that it has hired three full-time floater nurses and two part-time health aides to help with the workload. The aides will assist with contact tracing and administrative duties.

“We don’t have time to guess right now. We want to cover everything children need,” Cogan said.

Every Camden school has at least one nurse and about one-third have two nurses assigned. They manage the health needs of about 6,300 students.

“They are definitely unsung heroes,” said Superintendent Katrina McCombs.

To help cope with the job, Paulsboro school nurse Janice Esters begins every day with a prayer: “Lord, just get me through this day.” Unlike last year, she has learned to take care of herself, and now typically leaves the school for her hour lunch and no longer works three hours past quitting time.

“You almost feel like you’re drowning,” said Esters, 58, of West Deptford. “You can never catch up.”

A former home health-care nurse, Esters transferred this year to Loundenslager Elementary School and covered Billingsport Elementary until the district hired a substitute nurse. One of the biggest challenges is contact tracing, she said.

“It can be all day,” said Esters, a nurse for 34 years.

Esters said she wants parents to understand that nurses are trying to keep everyone safe, and must sometimes make unpopular decisions, including sending athletes home.

“We don’t want people to be angry with us,” she said. “Our main job is to keep our schools healthy and safe.”