During the past two school years, teacher Julia Keyse had to enforce an unusual rule in her kindergarten and first-grade classroom: No interrupting while she pricked Caylee's finger to check her blood sugar and adjusted her insulin pump.
"They were so good. They would just sit and wait," Keyse said of her class at Etowah Elementary School in Henderson County, N.C.
It's a task Keyse never imagined when she became a teacher, but medical duties have become a part of the job for educators across the country as schools cut nursing staff or require nurses to work at multiple locations. The change comes at a time when more students are dealing with serious medical conditions, such as severe allergies, asthma, and diabetes.
It's a change that's unsettling for teachers, school nurses, and parents. "We don't want to pretend to be doctors or nurses," Keyse said. "I would have gone to school for that."
Federal guidelines recommend that schools employ one nurse for every 750 students, but the national average is one nurse for every 1,151 students, according to Amy Garcia, executive director of the National Association of School Nurses. A quarter of schools in the nation have no school nurse.
Although there is no historical data regarding the number of school nurses nationwide, members of the profession say there are fewer nurses doing more work, while teachers and other school workers pick up the slack. The average nurse splits her time between 2.2 schools, according to the association.
"Teachers deserve a school nurse because their time should be spent teaching," Garcia said.
Meanwhile, the workload of school nurses has increased since 1975, when the federal government mandated that schools accommodate disabled students, clearing the way for children with feeding tubes, catheters, and other serious medical conditions to attend school. Today, 16 percent of students have a condition that requires regular attention from the school nurse, Garcia said.
Many parents and school administers don't realize that nurses are handling life-threatening conditions as well as performing vision, health, and diabetes screenings, said Barbara Duddy, president of the Tennessee Association of School Nurses in Memphis.
"They think the school nurse is nice little job where you take care of boo-boos," she said. "School nurses work very hard to make sure every child gets exactly what they need."
Garcia blamed shifting priorities, shrinking budgets, and a misunderstanding of the school nurse's role for the loss of jobs.
The Southern Humboldt Unified School Board in Garberville, Calif., blamed a reduction in state funding when members voted in June to eliminate one nursing position and reduce the other position to 10 hours a week for the upcoming school year. "The nurses provide great services for our students, but so do all the other positions that we've cut," said Susie Jennings, associate superintendent for the 800-student district.
Robin Correll, the remaining nurse, worries how she will oversee the district's seven schools. She was already struggling to perform annual health and vision screenings. "It will be impossible to do all the work," she said. "It breaks my heart. Kids deserve better."
Correll, like many nurses around the country, has already trained teachers and secretaries to dispense medication, give shots of adrenaline, and help children use inhalers. So far the district has stopped short of asking nonmedical personnel to administer insulin. The thought of someone without a medical background managing Brandon Merrell's diabetes makes his mother, Amy Merrell, very uncomfortable. The Gilbert, Ariz., woman wants assurances that her 8-year-old son will be properly cared for while he's at Coronado Elementary School.