With less than a week until New York City public schools are slated to begin, here’s a quick health quiz:

Which of the following are not in many school nurses’ offices:

A. Personal Protective Equipment
B. Official guidelines on COVID protocols, including temperature screening and isolating potentially sick students
C. Class lists on paper for nurses without access to the computer system
D. Nurses
E. All of the Above

School nurses, supervisors, and union leaders say the answer is (E), All of the Above—and that the Office of School Health, which is jointly run by the city’s Department of Education and the Department of Health and Mental Hygiene, has become an information vacuum.

“They’ve been working out arrangements for teachers, but not for nurses,” said one school nurse who requested anonymity to speak freely about the elementary school in Lower Manhattan where she works. “Our principal is doing all they can, but we can’t make a plan, if we don’t know our responsibilities, and that needs to come from DOE.”

She said she’s been texting with fellow nurses at schools throughout Manhattan, Queens, Brooklyn, and the Bronx, and all are anxious about the lack of clarity—and the lack of PPE.

“Am I doing the temperature checks?,” the nurse asked. “Are they outside or inside? What about the isolation room? Is there just one place where kids go [who display potential COVID-19 symptoms]? What if there’s more than one? Am I in there, monitoring them? Then who’s in my office taking care of kids who come in?”

She added that nurses were supposed to have received a box containing PPE by now, but doesn’t know anyone who has.

With schools set to become the next big front for COVID-19, nurses are expected to play a pivotal role in containing the virus. Everyone from elected officials to epidemiologists expect some individual cases to emerge among the students slated to return to classrooms next week. It will fall to school nurses to help detect many of the cases and quickly isolate students until parents can come get them.

Mayor Bill de Blasio last month tapped the Health and Hospitals Corporation to fill nursing vacancies at 400 schools by using commercial staffing companies. Its status as a government corporation allows the city to contract workers without oversight from Comptroller’s Office.

“We’ve matched over 250 nurses with schools that need nursing coverage and we are on track to meet our goal of providing every school with nursing coverage for the first day of school,” said DOE spokesman Nathaniel Steyer. “There will be over 2,000 nurses available to DOE schools this fall.”

Another nurse who requested anonymity to discuss internal matters said a newly contracted nurse arrived last week to work with her—but this nurse, like all the contract nurses she’s heard about, did not have access to computerized files in the Automated Student Health Record system, or ASHR.

“If we had the class lists, she could at least work on organizing the paper files, but she doesn’t,” the nurse said. “I can do that through the computer system, but she can’t. So she’s just on her phone all day, making calls and, I guess, surfing the web or watching TV or something.”

Contract nurses – also called “agency nurses” – can make up to $50 an hour.

The DOE says all the nurses being hired will be adequately qualified and trained by the time the first bells ring next Monday.

Nurses reported to schools last week “to become acquainted with the school, their colleagues, and school policies,” Steyer, the spokesman, said. “They participated in staff professional development last week and they will be partaking in nursing-specific training on working with students with diabetes or those who have limited English proficiency and COVID protocols.”

He said the contract nurses will receive access to students’ digitized health records and four days of training on COVID-19 protocols.

But that amount of training pales in comparison to what school nurses usually receive. Union nurses told Gothamist/WNYC that they typically receive six to eight weeks of “onboarding.”

It would also be unusual for contract nurses to be able to access computerized health records, according to Mary Larson, a long-time school nurse supervisor who retired in February but is actively communicating with current supervisors and nurses. In the past, they’ve only used paper reports, which often were not up to date. When new medical incidents occurred and contract nurses updated files, Larson said, it always fell to regional supervisors to enter them digitally—a cumbersome, inefficient process that often involved time lags.

“I used to have 20 to 30 nurses to supervise,” she said, “but by the time I retired this year I was up to 45. All the supervisors are overwhelmed.”

In addition to providing real-time information on students, including their health conditions, care providers, and medications, the system also feeds a citywide “syndromic surveillance” system for detecting disease outbreaks.

Contract nurses are vetted and hired by private agencies. The Office of School Health has been using them for years to fill a growing proportion of school nurse vacancies. Starting this year, the office has started hiring them through the city’s public hospital system— a practice union and elected officials said is troubling.

“Health and Hospitals isn't interviewing these nurses. They’re leaving it to the agency to check to make sure that their licenses are up to date, that no one is facing any kind of disciplinary investigation, that their CPR certification is up to date, and so on,” said Judith Arroyo, President of Local 436 of District Council 37, which represents nearly 1,000 nurses employed by the city health department to work at public and private schools.

“The agencies for the most part do a good job of making sure that everything is above board and that the nurses are qualified and safe to go work in the schools,” Arroyo said. “But sometimes things fall through the cracks.”

The DOE confirmed that “contract agencies are responsible for the majority of training and supervision of nurses, which is different from newly hired [Health Department] nurses.”

Arroyo—whose union has steadily lost positions to contract nurses over the past decade—argues that contract nurses lack several advantages that their duly hired counterparts have. For one, school nurses are technically “public health nurses,” which means they can be diverted to work in different city settings, including public hospitals and clinics—something they did for much of the spring and summer, to help combat COVID-19. Contract nurses have no such requirement. School nurses also train teachers and other staff members in various first aid measures, such as using epinephrine for extreme allergic reactions or unblocking obstructed airways. Contract nurses are not authorized to conduct trainings.

Councilmember Mark Treyger, Chairman of the City Council Education Committee, said the city was “circumventing” normal hiring procedures by using non-union nurses.

“This is another hurried and sloppy attempt to try to manage a crisis and to try to escape any type of oversight,” Treyger said. “I think it's incredibly insulting to existing school nurses.”

Arroyo, the union leader, said members have been getting email pitches from nursing agencies to lure them with higher pay. She said it’s not clear how the city can afford to pay the higher wages.

The city refused to say how much it is budgeting for contract nurses.

The nurse at the Lower Manhattan elementary school said that she is considering leaving to go work in hospitals, where the pay is better, and she could work overnight and take care of her young son during the day. He is slated to begin charter school this fall, but its first day of school has been postponed until October, and in the meantime a neighbor has been watching him.

“I can’t have them do that forever,” she said.