Nurse of the Week – NKF Honoree Rosley DeClaro: Nephrology “Patients Need Hope. I Try to Give Them That.”

Nurse of the Week – NKF Honoree Rosley DeClaro: Nephrology “Patients Need Hope. I Try to Give Them That.”

Each year the National Kidney Foundation (NKF) considers the work of hundreds of specialists in the field of nephrology and selects those who most exemplify the relentless efforts of NKF to enhance the lives of patients through action, education, and accelerating change.

NKF honoree Rosley DeClaro, RN, BSN, CNN.
Maria “Rosley” DeClaro, RN, BSN, CNN, Council of Nephrology Nurses and Technicians honoree

Their work is vital to the 37 million adults in the U.S. who are affected by kidney disease and the 1 in 3 people who are at risk. NKF will honor these outstanding professionals at the 2021 Spring Clinical Meetings, which will be held virtually April 6-10. Among those honored this year will be our Nurse of the WeekMaria “Rosley” DeClaro, RN, BSN, CNN, who is receiving the Council of Nephrology Nurses and Technicians Carol Mattix Award (named in honor of a home dialysis training nurse of the last century who was devoted to improving the lives of kidney patients).

“I love my job and didn’t expect to be rewarded in this way for the work that I do,” Ms. DeClaro said. “But it makes me very happy. When I see my patients, they are learning about kidney failure, a diagnosis that is life-long, so they need hope. I try to give them that.”

Ms. DeClaro has been a registered nurse at Fresenius Kidney Care for more than 20 years. During her time at Fresenius, she has served in many roles, including direct patient care and managerial roles. In 2009, she truly found her professional calling as she entered the world of home therapies.

“When I see my patients, they are learning about kidney failure, a diagnosis that is life-long, so they need hope.
I try to give them that.”

“As a home therapy nurse, Rosley has worked to give her patients the freedom and quality of life they never imagined while attending a center for dialysis,” said NKF President Paul Palevsky, MD. “Rosley’s guidance and wisdom is more valued and appreciated by her fellow nurses than ever at this time.”

In addition to her compassion and patience, DeClaro is a leader and an innovator. She has been instrumental in developing nine home therapy programs throughout the Chicago Region. While this is certainly an undertaking, she draws strength from her ability to understand the whole picture, from the technical aspects to staff development, to patient and physician engagement. Most recently, DeClaro has expanded her skillset to include pediatric dialysis, where she has been adept at delivering services to children of varying ages and developmental needs.

Most recently, DeClaro has expanded her skillset to include pediatric dialysis, where she has been adept at delivering services to children of varying ages and developmental needs.

DeClaro said she is excited to be attending the meetings this year, something she has not been able to do for many years.

“These are very valuable sessions,” she said. “It gives all of us a chance to come together, with one goal, to make our patients’ lives better.”

You can still register for the NKF Spring Clinical Meetings. Nursing students will be admitted free of charge.

Published courtesy of the National Kidney Foundation.

Become a 2021 NCLEX Success Story with a Pandemic Study Plan

Become a 2021 NCLEX Success Story with a Pandemic Study Plan

Being a nursing student in the midst of a pandemic is challenging, to say the least. Remote learning, virtual conferences, abbreviated clinicals, adjustments to the NCLEX®—these are just a few of the educational interruptions students have faced.

Though challenged, students are undeterred. Learning is still taking place, nursing programs are adapting quickly, and the demand for nurses is skyrocketing.

So, how does a determined nursing student thrive in the midst of turmoil? How do you overcome the interruptions and properly prepare for the NCLEX? How do you gain the knowledge you need to be successful on day one?

It all begins with a plan. And in the midst of COVID-19 precautions, that plan will look a little different than before the pandemic. Vaccines are being distributed and cases are dropping, but this pandemic isn’t going away anytime soon.

Here are three things you can do to build an effective pandemic study plan:

1. Start Studying Earlier

Whether it’s an end-of-semester exam, a clinical med math exam, or the NCLEX exam, begin your preparation time earlier than you might have pre-pandemic.

As we’ve seen, COVID-19 presents a variety of challenges in learning (some of which are unexpected). This is not the year to procrastinate in your test preparation. It’s the year to do the opposite: Give yourself extra prep time to offset any learning obstacles you might encounter.

2. Make the Most of “Found” Time

A study plan is all about building out a study calendar for the days, weeks, and months leading up to your high-stakes exam like the NCLEX. As you build out that calendar, be sure to make the most of a daily gift this pandemic has afforded you: extra minutes in your routine for study.

Consider these bonus minutes you didn’t have before:

  • You’re spending more nights staying in than you used to. Use one or more of those nights for NCLEX test prep.
  • With many of your classes being taught remotely, you’re saving some time each day. No getting ready in advance, no commute to class. Though virtual learning has its disadvantages, make the most of this extra time.
  • Many states and programs have had to reduce the number of required onsite clinical hours for nursing students. This is certainly a disadvantage. However, those hours of learning don’t have to be lost. You can use that time to study and practice with case studies to help develop your clinical judgment.

3. Lean Into the Experience

It’s easy to bemoan the challenges of learning during a pandemic. Why did I have to go through this? Why is this so hard? Am I going to learn everything I need to know?

But nursing is all about facing unique situations, remaining calm, thinking quickly on your feet, and making the proper decisions. Whether you realize it or not, the pandemic is actually preparing you for a career in nursing with each new day.

You’ve been met with a unique situation, and you’re staying calm, making adjustments, and moving forward one decision at a time.

Each day, and each patient, in nursing is different. Your ability to stay flexible and overcome obstacles will be tested on a regular basis. Consider your education during a pandemic as a type of on-the-job training—and lean into the experience.

It has been a year since COVID-19 drastically changed the way we live our lives. Thankfully, it appears the worst is behind us and life might soon return to a sense of normalcy. Until then, nursing students will continue adjusting to the COVID interruption and entering the workforce armed with knowledge and enthusiasm. If you’re one of these students, you’re going to have a story to tell for the rest of your life: You answered the call to become a nurse in the middle of the COVID-19 pandemic.

“It Helps to be a Good Role Model for Your Patients” – NPs Talk Variants, Vaccination, and Community Care

“It Helps to be a Good Role Model for Your Patients” – NPs Talk Variants, Vaccination, and Community Care

With millions of Americans now receiving COVID vaccines, the country may soon start to control the pandemic that has so greatly challenged the healthcare system and nursing. Still, the threat remains, with the potential that new variants of the coronavirus will cause more suffering and death. 

As these variants menace public health, nurse practitioners (NPs) work to control those new strains. NPs have been on the frontlines of the pandemic since it started.  Some 61% of NPs are treating patients who have been diagnosed with COVID-19, according to a recent survey from the American Association of Nurse Practitioners (AANP).  Almost as many (58%) are offering COVID-19 testing at their practices.

In this article, we’ll take a look at the variants, testing, vaccination, and how NPs are dealing with patients who are hesitant to get the inoculation. First, let’s look at some of the numbers. 

Tracking the variants

To understand the spread of the COVID variants, healthcare providers can consult a map from the Centers for Disease Control and Prevention (CDC) that tracks three “variants of concern.” 

  • B.1.1.7 (United Kingdom): This variant was first detected in the U.S. at the end of December 2020.
  • B.1.351 (South Africa): Cases from the variant were first reported in the U.S. at the end of January 2021.
  • P.1. (Brazil): This variant was first detected in the U.S. at the end of January 2021.


These variants, says the CDC, seem to spread more easily and quickly than other variants. As of mid-March, the U.K. variant was found in 49 states. According to the CDC, the U.K. variant is on track to be the dominant strain in the U.S. by April, says Mary Koslap-Petraco, DNP, PPCNP-BC, CPNP, FAANP, Pediatric Nurse Practitioner House Calls, Inc., Amityville, NY.

Testing challenge

In general, most healthcare providers are unlikely to know if a COVID patient has the variant. A lab result will simply say if the patient does or doesn’t have COVID, notes Sophia L. Thomas, DNP, APRN, FNP-BC, PPCNP-BC, FNAP, FAANP, president of AANP in an interview with DailyNurse. She practices at a community health center in New Orleans that serves a diverse patient population. 

“We don’t know who has the variant or not.”

Doreen Cassarino, DNP, APRN, FNP-BC, BC-ADM, FAANP

“We really haven’t drilled down to testing every patient to see if they have a variant or not,” Thomas says. “That’s to come in the future. Right now, we’re doing so much testing it would be virtually impossible to test every patient to see what variant they have. From a patient’s perspective, they just want to know if they have COVID.”

Doreen Cassarino, DNP, APRN, FNP-BC, BC-ADM, FAANP

“We don’t know who has the variant or not,” agrees Doreen Cassarino, DNP, APRN, FNP-BC, BC-ADM, FAANP, who practices at an internal medicine practice in Naples, FL. “All that we will get when we do testing is positive or negative. We don’t actually know if one of our patients has the variant or not.”

The treatment for COVID doesn’t differ with a patient infected with a variant. The symptoms are no different, notes Koslap-Petraco.

NPs can ask to have their patients typed to identify if the patient has a variant, Koslap-Petraco says. This can assist with public health, she notes. She worked as an NP/public health nurse for the Suffolk County Department of Health Services for 30 years.

“The problem with the strains is they’re more communicable,” Koslap-Petraco says. “When you have something that’s more communicable, you’re going to have more people being affected, and ultimately you’re going to wind up with more deaths, more long COVID and all of the other issues that are related to these viruses. But in order to contribute to public health efforts, nurse practitioners can ask to have these strains typed so that they know exactly what is circulating in their community.” 

Koslap-Petraco hopes for more surveillance. “If the variants take hold and the vaccines don’t work, we’re in a lot of trouble. So that’s why we have to track these variants,” she says.

Vaccination to prevent mutation 

Mary Koslap-Petraco, DNP, PPCNP-BC, CPNP, FAANP

Getting vaccine shots into arms as fast as possible holds the key to combating variants. “The big issue here to prevent the variants from taking hold further is to get as many people vaccinated as quickly as possible so we keep the virus out of the community, and then the virus doesn’t have the opportunity to mutate,” Koslap-Petraco says.

The Pfizer, Moderna, and AstraZeneca vaccines offer effective protection against the U.K. variant, notes Koslap-Petraco. NPs want to make sure, she says, that their patients get vaccinated before any other strain of the virus starts to take over, as the U.K. variant has done.

“For the most part, what I’ve seen is when patients hear that their friends, family, loved ones, or even me as their healthcare provider has gotten the vaccine, they’re much more likely to take it.”

Sophia L. Thomas, DNP, APRN, FNP-BC, PPCNP-BC, FNAP, FAANP

Cassarino agrees. In her Florida practice, since the week of February 22 she has tracked an increase in the number of patients age 65 and over getting the vaccine.  “More and more people are getting vaccinated, which is really the main thing to preventing these variants–to encourage vaccination as soon as possible.”

Addressing hesitancy

Sophia L. Thomas, DNP, APRN, FNP-BC, PPCNP-BC, FNAP, FAANP

With getting jabs into arms the major method to limit the spread of variants, vaccine hesitancy presents an obstacle NPs have to help overcome. “Overall, we are seeing some vaccine hesitancy,” says Thomas.

“Quite honestly, we saw a lot more vaccine hesitancy at the beginning of the pandemic because people didn’t know what to expect with the vaccine,” says Koslap-Petraco. “I am definitely seeing much less vaccine hesitancy now, especially in the African American population, but it’s all about building trust.”

“For the most part, what I’ve seen is when patients hear that their friends, family, loved ones, or even me as their healthcare provider has gotten the vaccine, they’re much more likely to take it,” says Thomas.

“I am definitely seeing much less vaccine hesitancy now, especially in the African American population, but it’s all about building trust.”

Mary Koslap-Petraco, DNP, PPCNP-BC, CPNP, FAANP

It helps, says Cassarino, to be able to tell a patient that Cassarino herself has received the vaccine, as have members of Cassarino’s family who are eligible. “It helps to be able to be a good role model for your patients,” she says.  

Therapeutic communication plays a part, says Thomas. That involves acknowledging a patient’s concerns, showing empathy, and sharing the evidence and science about the vaccine, as well as sharing that the NP herself has gotten the vaccine. “The most important thing is communication with our patients, and when we do it effectively, it really makes a difference,” Thomas says. 

“Nurse practitioners provide a huge potential service as far as educating our patients and the general public as well on the importance of vaccination, preventing the spread of this terrible virus,” says Cassarino.

Serving the community

As inoculations continue, the theme of NPs serving the community comes into play.  “We have to treat this like we’re at war, and every single person in the United States is important,” says Koslap-Petraco. “That’s so important about what nurse practitioners do. We’re out there to make sure that everyone stays healthy.”

“We have a lot of NPs that are volunteering their personal time to go work at vaccine clinics on their off time. Service to the community is so important,” says Thomas. “The health of the community impacts the health of our nation, and so I think our dedication to community health just rings true as we see these NPs volunteering their time to go help others.”

Inmates’ Distrust of Prison Healthcare Fuels Vaccine Hesitancy

Inmates’ Distrust of Prison Healthcare Fuels Vaccine Hesitancy

One November night in a Missouri prison, Charles Graham woke his cellmate of more than a dozen years, Frank Flanders, saying he couldn’t breathe. Flanders pressed the call button. No one answered, so he kicked the door until a guard came.

Flanders, who recalled the incident during a phone interview, said he helped Graham, 61, get into a wheelchair so staff members could take him for a medical exam. Both inmates were then moved into a covid-19 quarantine unit. In the ensuing days, Flanders noticed the veins in Graham’s legs bulging, so he put towels in a crockpot of water and placed hot compresses on his legs. When Graham’s oxygen levels dropped dangerously low two days later, prison staff members took him to the hospital.

“That ended up being the last time that I seen him,” said Flanders, 45.

Graham died of covid on Dec. 18, alarming Flanders and other inmates at the Western Missouri Correctional Center in Cameron, about 50 minutes northeast of Kansas City. His death reinforced inmates’ concerns about their own safety and the adequacy of medical care at the prison. Such concerns are a major reason Flanders and many other inmates said they are wary of getting vaccinated against covid-19. Their hesitancy puts them at greater risk of suffering the same fate as Graham.

Inmates pointed to numerous covid deaths they considered preventable, staffing shortages and guards who don’t wear masks. While corrections officials defended their response to covid, Flanders said he’s apprehensive about how the department handles “most everything here recently,” which colors how he thinks about the vaccines.

Reluctance to get a covid vaccine is not unique to Missouri inmates. At a county jail in Massachusetts, nearly 60% of more than 400 people incarcerated said in January they would not agree to be vaccinated. At a federal prison in Connecticut, 212 of the 550 inmates offered the vaccines by early March declined the shots, including some who were medically vulnerable, The Associated Press reported.

The Missouri Department of Corrections said March 12 that more than 4,200 state inmates had received the vaccine out of 8,000 who were eligible because they were at least 65 years old or had certain medical conditions. Officials were still working to vaccinate 1,000 additional eligible inmates who had requested the shots. The department had not begun vaccinating the remaining 15,000 inmates or surveyed them to determine their interest in the vaccines. So far, about 18% of the total prison population has been vaccinated, which roughly tracks with the overall rate in Missouri even though inmates are at higher risk for covid than Missourians generally and should be easier to vaccinate given they are already in one place together.

Missouri placed the majority of inmates in its lowest vaccine priority group. It is one of 14 states to either do that or not specify when they will offer the vaccines to inmates, according to the COVID Prison Project, which tracks data on the virus in correctional facilities.

Another is Colorado, where Democratic Gov. Jared Polis moved inmates to the back of the vaccine line amid public pressure. The emergence of a more contagious variant of the virus at one prison, however, forced officials to adjust their plans and instead start vaccinating all inmates at that facility.

Lauren Brinkley-Rubinstein, prison project co-founder and professor of social medicine at the University of North Carolina, said that disregarding health officials’ recommendation to prioritize people living in tight quarters might make inmates less trustful of prison staff “when they come around and say, ‘Hey, it’s finally your turn. Let me inject you with this.’”

States cannot mandate that inmates take the vaccines. But Missouri officials have tried to encourage them by distributing safety information about it, including a videodebunking myths featuring a scientist from Washington University in St. Louis.

But persuasion is proving difficult at Western Missouri, given inmates’ longtime distrust of prison management. Flanders, Graham and others were transferred there from neighboring Crossroads Correctional Center following a 2018 riot that caused an estimated $1.3 million in damage and led to its closure. Inmates were angry that staff shortages had reduced time for recreation and other programming.

Officials acknowledge that staff shortages have persisted through the pandemic. “Corrections is not the most popular place to work right now,” Missouri corrections director Anne Precythe said at an early March NAACP town hall on covid and prisons.

Flanders, who is serving a life sentence for first-degree robbery, said the prison didn’t have enough nursing staffers to check on him during a bout with mild covid in November. He said other sick inmates also didn’t receive appropriate medical attention. Karen Pojmann, a corrections department spokesperson, said she could not comment on specific offenders’ medical issues.

Tim Cutt, executive director of the Missouri Corrections Officers Association, said he’s seen no evidence that Western Missouri even had a plan to contain covid. “They were quarantining for a while,” he said, “but it was a haphazard attempt.”

Also fueling skepticism of prison health care, inmates said, is the failure of many staff members to follow the corrections department’s mask mandate. Byron East, who is serving a life sentence for murder at South Central Correctional Center, two hours southwest of St. Louis, said in a phone interview that he has begged officers — many of whom live in conservative, rural areas where masks are less common — to wear face coverings.

“As an employee, your job is to protect, and we are not able to protect ourselves,” said East, 53. “You can catch something and then come in here and spread it to us.”

Amy Breihan, co-director of the Missouri office of the Roderick & Solange MacArthur Justice Center, a nonprofit civil rights law firm, said she didn’t see a single officer wearing a mask on Feb. 10 when she visited a correctional facility in Bonne Terre, Missouri.

Corrections Department Deputy Director Matt Sturm confirmed Breihan’s account at the NAACP town hall and said it has been addressed. He said the department expects staff members in all prisons to wear masks while inside when they can’t stay 6 feet apart from others.

“Right from the beginning, the Department of Corrections in Missouri has taken covid extremely serious,” Sturm said. The department deployed “everything we could get our hands on to help either prevent or contain covid,” including equipment for ventilation and disinfection.

Still, Missouri has reported at least 5,500 covid cases and 48 deaths among inmates at the state’s adult correctional institutions during the pandemic. The department doesn’t break down covid deaths by prison, but data from the advocacy group Missouri Prison Reform showed Western Missouri had 21 total deaths from covid or other causes last year, more than any other state prison even though its population isn’t the largest. Statistics on deaths in the previous year were not immediately available.

An automatic email reply from Eve Hutcherson, a former spokesperson for Corizon Health, which manages health care in Missouri prisons, directed a reporter to Steve Tomlin, senior vice president of business development, but he didn’t respond to questions. The company, one of the country’s largest for-profit correctional health care providers, faced more than 1,300 lawsuits over five years, according to a 2015 report from the financial research firm PrivCo. In Arizona, Corizon paid a $1.4 million fine for failing to comply with a 2014 settlement to improve inadequate health care for inmates.

Despite concerns about prison health care, however, some inmates have agreed to get the shot. East, who is Black, said he initially decided against it because he didn’t trust prison health and thought about the legacy of the Tuskegee experiments from 1932 to 1972, when researchers withheld treatment for Black men infected with syphilis. But he changed his mind after reading about how safe the vaccines are.

Flanders, meanwhile, is still weighing whether to get vaccinated as he mourns the death of his longtime cellmate Graham, a convicted murderer whom he considered a friend and father figure.

Flanders’ mother, Penny Kopp, said Graham helped Flanders manage his finances and kept him from gambling and getting involved with “inmates who are troublemakers.” Kopp, a former corrections officer in Indiana and Colorado, said she understands the challenges of working in a prison but wonders if enough was done to save her son’s cellmate.

Flanders said getting the shot would mean putting himself at the mercy of prison staffers, as Graham did — and that’s something he’s not ready to do.

Why Are CRNAs So Valuable?

Why Are CRNAs So Valuable?

As healthcare costs continue to increase and access to care remains challenging for many people, Certified Registered Nurse Anesthetists (CRNAs) are a clear solution to the nation’s healthcare struggles. As advanced practice registered nurses, CRNAs fill critical leadership roles, are involved in every aspect of anesthesia service, and provide essential care in tens of thousands of communities, particularly in rural and medically underserved parts of the United States. CRNAs are also cost-beneficial for both patients and healthcare facilities.

Over the past year, as multiple waves of COVID-19 have spread through the United States, CRNAs have used their skills in advanced airway and ventilation management, vascular volume resuscitation, and advanced patient assessment, among others, to care for critically ill patients. They have taken the lead in the face of ongoing and serious medication, equipment, and staffing shortages.

The Centers for Medicare & Medicaid Services (CMS) recently said CRNAs are among the most utilized healthcare professionals in the country, and it ranked CRNAs among the top 20 specialties that served the most beneficiaries in non-telehealth care from March 2020 through June 2020. The agency said its decision to waive the physician supervision requirement for CRNAs was among its top healthcare accomplishments between 2017 and 2020. The waiver has since been extended, after the U.S. Department of Health and Human Services extended the COVID-19 public health emergency into April.

Key studies also show that CRNAs reduce costs while using the same procedures as physician anesthesiologists. A 2016 study in Nursing Economic$, “Cost-Effectiveness Analysis of Anesthesia Providers,” found that nurse anesthesia care is 25% more cost-effective than the next least costly anesthesia delivery model. Although Medicare provides the same fee for anesthesia services provided by a CRNA, physician anesthesiologist, or both working in tandem, CRNAs provide lower-cost care than physician anesthesiologists, helping to protect Medicare revenue.

The landmark Nursing Economic$ paper found that as demand for healthcare continues to rise, increasing the number of CRNAs and allowing them to practice in the most efficient delivery models will be essential to containing costs and maintaining quality care. The researchers also concluded that CRNAs are much less expensive to educate and train compared with physician anesthesiologists.

CRNAs have a demonstrated safety record, and they spend more time with patients before, during, and after surgical procedures. A 2010 report in Health Affairs, “No Harm Found When Nurse Anesthetists Work Without Supervision by Physicians,” confirmed that anesthesia care provided by a CRNA practicing independently from physicians is safe. Furthermore, they are qualified to make independent judgments about all aspects of anesthesia care based on their education, licensure, and certification — and are the only anesthesia professionals with critical care experience prior to starting formal anesthesia education.

Nurse anesthetists have rigorous academic and clinical requirements for recertification, involving clinical best practices and the most up-to-date advancements in patient care.  Meanwhile, as CRNAs’ responsibilities increase, their malpractice premiums have decreased every year — another indication of the value they bring to patient care. Given their safety record and ability to provide high-quality, cost-effective care, experts expect CRNA-only anesthesia services to expand nationwide.

In rural parts of the country, the value of CRNAs is especially clear. More than 80% of the anesthesia providers in rural counties are CRNAs, and one-half of rural hospitals in the United States use a CRNA-only model for obstetric care. Additionally, county-level analyses of CRNAs and anesthesiologists indicate the greater availability of CRNAs in counties with more vulnerable populations, including those who are uninsured, eligible for Medicaid, and unemployed.

Rep. Jan Schakowsky (D-IL) recently introduced in the House of Representatives a resolution “Recognizing the roles and the contributions of America’s Certified Registered Nurse Anesthetists (CRNAs) and their role in providing quality health care for the public” (H.Res.807). The resolution calls attention to the role of CRNAs as the primary providers of anesthesia care in rural America, and highlights CRNA practice in the military. “(CRNAs) have been the main provider of anesthesia care to United States military personnel on the front lines since World War I, including all current United States military actions around the globe.”

Matthew McCullough MS, CRNA, APN-A, Senior Vice President, Chief Compliance Officer, UltraCare Anesthesia Partners, notes that their business — a full-service anesthesia and staffing company that services locations in 13 states — is predominantly owned by CRNAs. Before the COVID-19 pandemic hit, McCullough says the company provided “a traditional model of anesthesia delivery.” But now, they are more “intimately involved in COVID-19-related functions,” he says, and have been “called upon by several different health systems in the area to provide CRNAs, APNs in anesthesia to function in a non-anesthesia role assisting in running COVID units.”

As the pandemic continues, healthcare administrators looking to provide value at their facilities while reducing costs would do well to consider CRNA-only models of care. Post-COVID, permanent removal of physician supervision of CRNAs will benefit both patients and healthcare facilities, as many canceled or postponed surgeries will need to be rescheduled. Permanent removal will also help ensure that patients come first while increasing competition and network adequacy.

School Districts Present TX Town With Duelling Mask Policies

School Districts Present TX Town With Duelling Mask Policies

The two school districts in this Central Texas town headed in opposite directions after Gov. Greg Abbott ended the statewide mask mandate, sparking heated debates over safety and government responsibility.

For locals and tourists, it’s hard to overstate the charm of New Braunfels, a place of spring-fed rivers, dance halls and German festivals.

Yet against this idyllic backdrop, the nation’s ongoing fight over mask-wearing has pitted neighbor against neighbor and put the region’s schoolchildren squarely in the middle of an overheated argument.

In what quickly became a conversation about science, personal liberty and the role of government, the town’s two school boards, New Braunfels Independent School District and Comal Independent School District, landed on opposite sides of the face-covering debate earlier this month after Gov. Greg Abbott announced the statewide mask mandate would end March 10.

In New Braunfels ISD, which serves more low-income and Latino students, the school board opted to survey parents, resulting in a vote to keep the school mask mandate. The Comal ISD board, representing whiter, more rural parts of Comal county, voted 5-2 in an eleventh-hour meeting to make masks voluntary after members touted personal responsibility and parental choice. One Comal ISD board member, Marty Bartlett, cited the arguments of well-known conspiracy theorists and vaccine skeptics who say masks are government overreach, not sound science.

The mask battle in New Braunfels clearly has political overtones, but this isn’t your typical liberal versus conservative fight. New Braunfels sits on the southeastern edge of Comal County, whose residents gave former President Donald Trump 70% of the vote in November.

In this case the fight is more about moderate conservatives versus those on the far right.

And Comal ISD’s political leanings are already affecting students and teachers in a big way as masks disappear from classrooms, Comal ISD parents and teachers say.

Students are facing peer pressure to abandon masks. Teachers don’t know whose parents prefer for them to wear the masks. Parents who don’t want their children in class or crowded hallways with unmasked people must decide whether to go back to remote learning.

“Teachers had no time to prepare,” said Comal ISD middle school teacher and parent Kate Fraser, adding that students showed up without masks the day after the board meeting. “You feel as a teacher you can’t do what you need to do to protect the kids.”

The fast-growing suburbs and exurbs of San Antonio and rural areas of the Texas Hill Country where children attend Comal ISD schools have pulled the county further to the right, while more moderate conservatives struggle to hold on to the city of New Braunfels.

“I’ve always been a conservative, still am, still vote the Republican party. But the shift has been further and further and further to the right,” said Doug Miller, who represented Comal County in the Texas Legislature before losing his seat to state Rep. Kyle Biedermann, a far-right conservative who attended the Trump rally in Washington, D.C., on the day of the Jan. 6 insurrection.

Trump won all but one precinct in Comal County in 2020, capturing up to 79% of the vote in some precincts. His margins were widest in the rural areas in Comal ISD and smaller in New Braunfels ISD.

The two districts, both headquartered in New Braunfels, the largest city in the county, have subtle but important differences: New Braunfels ISD is majority students of color (54%) to Comal ISD’s 48%; 38% of New Braunfels ISD students qualify for free and reduced lunch, while 30% qualify in Comal ISD.

The demographic differences between the two districts may seem small, but parents say Trumpism has had an impact on the county, and the way the two boards settled the mask debate is the perfect example. Anti-mask beliefs have become synonymous with far-right conservatism.

“I really think it was ideology and not anything else,” Valerie Garza Estes, a Comal ISD parent, said of the board vote. “Listening to the board meeting, that’s perfectly clear.”

After Trump, Comal parents and students with “privilege,” Estes said, “are willing to be louder and meaner and push their ideas or views without even feeling there would be consequences.”

Board members who voted to remove the mandate cited parental choice, while the two dissenting votes argued masks were critical for safe in-person learning.

“What the data shows is that after every break from school we have a lot of kids who come back who get exposed outside the school,” said trustee Russell Garner. The number goes down once kids are in school. With masks, the transmission rate is “almost zero,” he said.

During the board meeting, trustee Jason York argued it should be up to parents to decide how best to keep their children safe and voted to lift the mandate.

His daughter, York said, would be wearing one. If other parents want their children attending prom, graduation and other activities, he said, “then they’re going to continue to send their children with a mask.”

That may not be true.

Sandy Mathis, a parent of three elementary school students in Comal ISD, said her family respectfully complied with the mask requirement, even though they believed that wearing masks all day had a negative effect on their children’s health and distracted them from learning.

“Now that we have been given the gift of parental choice, my kids will no longer be wearing a mask to school,” Mathis wrote in a message to The 74. Some at her children’s school have kept the masks; others have not. Some children are wearing them for a few weeks out of caution as spring-breakers return.

Removing the mask mandate gives parents a choice, but not teachers who may now have to spend entire days with maskless students, trustee Tim Hennessee argued during the board meeting. He voted to keep the mask mandate. “I think this shows a total lack of respect to the teachers.”

Of the schools he represents — in a suburban part of the district with the highest population of people of color — three quarters wanted to keep the mask mandate, he said. York countered by saying three quarters of the campuses he represents — which are in the most rural part of the district with the highest white population — wanted to be able to choose.

A Facebook group called Open Comal County Schools Safely conducted its own survey and plans to present the results to the board at its Thursday meeting.

When asked about the overall preferences of the district, Superintendent Andrew Kim said most teachers and principals indicated they would continue to wear masks.

“It varies by certain areas of our school district, I will say that,” Kim said.

His comment — and the feedback from Hennessee’s and York’s districts — suggests the tension between conservative and ultraconservative viewpoints exists not just between New Braunfels ISD and Comal ISD, but within Comal ISD as well.

Estes said that Trump’s racist and xenophobic rhetoric immediately showed up in Comal ISD schools in 2016, when classmates began to taunt her son about his Latina mother. During the pandemic, some students echoed Trump’s cavalier attitude, she said.

In August, board President David Drastata referred to COVID-19 using Trump’s racist “China virus” epithet in an athletic booster club email. He later apologized.

Miller described the new conservatism as uncompromising and domineering. “Their position is: If you disagree with me, you’re wrong.”

Kim expressed concern that emboldened parents with strong anti-mask views would become a distraction for teachers and principals if the district kept its own mandate without the state mandate backing it up.

“I think the last thing I would like to see is our administrators having a protracted philosophical conversation with our parents in the hallways,” Kim said.

The answer, the board decided, was simply to let those parents have their way.

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