School nurses statewide have raised concerns about a new vaccine reporting system rolled out this year by the Maine Department of Education and the Maine Center for Disease Control and Prevention.

A letter signed by 70 school nurses from across the state that was shared with lawmakers and Gov. Janet Mills last Friday lays out three primary issues: the added time and effort required of nurses on top of their regular duties, student privacy, and a “mismatch” of state policies around vaccine records.

“While we fully support the importance of protecting public health and ensuring accurate immunization records, we are deeply concerned about the burdens and risks this system places on schools, school nurses and families,” the letter states.

State officials said they have responded to the concerns from school nurses by extending the deadline for this year’s annual report, making changes to the system to make reporting easier and providing assistance to schools in adjusting to the program. They said the system is compliant with state and federal privacy laws, and is intended to improve reporting and record-keeping of immunization data.

“The Maine DOE and the Maine CDC will continue to seek and incorporate feedback from school nurses and other school staff as this transition progresses,” the departments said in a joint statement Thursday.

This week, numerous school nurses told the Press Herald that they feel state officials don’t understand the work they do, and are underestimating the burden of adding time-consuming administrative tasks to their plates.

“We’ve worked so hard, and then we find out that this program includes a tremendous amount of administrative work, and there are just no hours left in the day,” said Jennifer Bowdish, a school nurse from Brunswick.

Maine officials announced in April that they would be rolling out Docket for Schools, a reporting module for student immunization records, during the 2025-26 school year.

State law requires students enrolled in public and private schools to show proof of vaccination, and in 2021 a new state policy eliminated religious and philosophical exemptions. It also requires district superintendents to maintain uniform records of the immunization status of every student and submit a summary report to the state by Dec. 15 each year.

In a June memo, the education department said that report was often “incomplete, erroneous, or not received.” During the 2023-24 school year, only 77% of schools submitted the survey, and 39% of those that did had at least one missing student record.

The new system was adopted to ensure uniform record-keeping and thorough data.

A group of school nurses first raised concerns in a mid-September letter to the commissioner of education, and in response the state’s school nurse consultant and the director of the Maine Immunization Program held a meeting to answer questions.

But concerns persisted and the group of nurses responded by sending a letter to lawmakers.

“We barely scrape by getting the work done that we need to,” Bowdish, from Brunswick, said. She sees 50 students daily and administers more than 20 medications. “You’re doing the work of a nurse and of an administrative assistant. For some kids in your school, you are the only health provider that they are ever going to see.”

One of the biggest frustrations nurses have with the new system is that school nurses don’t actually give immunizations. They are usually administered by a pediatrician, but the program requires the nurses to input original records from the student’s primary care provider, which are often full of small clerical errors made by those offices, made several years earlier.

“We’re being asked to create a database about work we didn’t do,” said Denise Leathers-Pouliot, a school nurse in Monmouth.

Sarah Sartory is the school nurse at Fryeburg Academy, a private school minutes from the New Hampshire border, and said hundreds of her students are now “noncompliant” because that state’s immunization program isn’t compatible with Maine’s. She can’t access work that has already been done to collect vaccine records in New Hampshire. Instead, she’s responsible for pulling the original immunization files from doctors’ offices for every student.

“This is time that I just don’t have,” Sartory said. “I don’t see the benefit to the students. I don’t see the benefit to our school. It’s a hindrance to school nurses.”

In their letter to lawmakers, the nurses wrote that the comprehensive, personally identifying data required by Docket for Schools, “raises concerns about overreach and unnecessary data exposure” because state statute only requires summary reports.

Several nurses said that since the COVID-19 pandemic, they have felt overburdened with work, and had to rebuild relationships with families that eroded during that tense period. They’re concerned that parents didn’t give informed consent to have detailed personal information be uploaded to a third-party platform.

AGENCIES RESPOND

In response to last week’s letter, state agencies announced they had extended the deadline for the annual immunization report to February, added a new feature to the system that will allow nurses to add or remove students without redoing the entire roster, and said that school staff are no longer responsible for correcting errors made by primary care offices.

Other efforts include live assistance with the record review and upload process, and on-site visits if requested.

Maine’s Departments of Education and Health and Human Services said in a joint statement that the user agreement only allows the release of records in compliance with federal privacy laws.

They also noted that personally identifiable data can only be accessed at the school level, and that state officials can only view aggregate-level data.

The agency spokespeople said the third-party platform will ensure the summary reports are thorough and accurate by automating the review process, and that real-time record keeping will be essential to the Maine CDC in the case of an outbreak.

“Following the transition to Docket, it will mean less work for schools and easier record keeping, including when students move between schools,” they said.

For now, nurses said the program feels like reinventing the wheel with no benefit. Sartory, from Fryeburg, appreciates that the state extended the report deadline, but is still frustrated that the burden of transition has fallen to nurses.

“That still doesn’t mean I have more hours in my day,” she said.