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A faltering economy is forcing many states to cut money for school nurses. Some schools already have no nurses. The proposed cuts come as more students require medication for a host of conditions. In other words, just when school nurses are needed more than ever, their already thin ranks are being depleted.

At a conference in January, organizers passed out paper and asked California school nurses to write down anecdotes to show the state Board of Education what was happening in schools when nurses weren't there.

One nurse wrote about a student who often missed half the required doses of his seizure medication, administered by time-pressured aides. One day, the student went home, hit his head during a seizure and was found dead by his parents, who had assumed he was receiving all his medication.

Another wrote about a clerk who offered an inhaler to students who came to the office with stomachaches. In an elementary school, one nurse wrote, an office worker panicked when a student with epilepsy had a seizure. Instead of giving the student medication provided by the student's physician, she administered an injection with an epinephrine pen used for allergic reactions.

In another case, a nurse spotted a student sitting in the hall. Office workers assumed he had been sent to them because he was a discipline problem or on drugs. The nurse recognized he was a diabetic about to go into a coma and administered medication.

Nurses wrote of medications being stolen, of secretaries or clerks mixing up medicines and giving them to the wrong students, of doses of medications like Ritalin being inadvertently changed.

"These were anecdotes that we pulled together in a three-hour period," said Nancy Spradling, executive director for the California School Nurses Organization. "These are things that the average parent, the average community member and certainly the average legislative member is completely unaware of."

A shrinking budget

This year, a faltering economy is forcing many states to cut money for education. School districts in a number of states are considering slashing already strained budgets for school nurses. Some schools already have no nurses. Others have a nurse who visits a few hours per month or per week.

The proposed cuts come as more students require medication for conditions like asthma, seizures and diabetes; students with complex chronic health conditions are being mainstreamed into classes; and new studies are showing that future risks for health problems like high blood pressure and Type 2 diabetes can be affected by exercise and diet patterns in school-age children.

As states cut their public health and mental health programs, in some places, schools must pick up the slack, referring children to programs, or in some cases, taking care of the health problems themselves.

In other words, just when school nurses are needed more than ever, their already thin ranks are being depleted. Nurses are fighting back by lobbying legislators, establishing public education campaigns, fighting dismissal through their unions, even running for school board positions, but they face an uphill battle.

Many school boards and educators who control education budgets don't understand why health is important, or would rather cut nurses than teachers. Parents may not realize their school does not have a full-time nurse and relies instead on a health clerk or a school secretary to hand out medications and to call 911 in an emergency.

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