When Karen Cummings' youngest child started kindergarten, she made a life-changing decision: to get a job at his school to make sure he and his sister stayed healthy.
Both of Cummings' children have Type 1 diabetes, and she knew Oquirrh Hills Elementary, like most schools in Utah, didn't have its own full-time nurse. The school shares its nurse with eight others.
"The school nurses aren't available at school all the time. There's not enough to go around," said Cummings, who works as an aide at the Kearns school. "It made me feel a lot better to know I could be here."
In Utah, school nurses are stretched thin, and some worry they might be stretched even thinner as lawmakers prepare to deal with the state's still troubled finances. Each Utah school nurse, on average served about 4,893 students in 2008, more than in any other state in the U.S., according to the National Association of School Nurses. And state lawmakers already had to cut about 10 percent from one pot of state money to support school nurses for this school year.
Fewer school nurses, officials say, means fewer professionals to deal with everything from playground injuries, to H1N1 swine flu to children with such serious medical issues as diabetes, asthma and seizures. Now, school nurses perform an array of duties, ranging from assessing whether children who feel sick need to go home, to helping schools prepare for a possible flu epidemic, to training other school staff how to handle students' medical issues.
"The more nurses we have the more children are protected," said Sen. Karen Mayne, D-West Valley City, who kicked off a campaign Tuesday to invite state lawmakers to spend time shadowing their local school nurses in hopes of raising awareness about the need for them. "With our budget cuts, I just want to make sure what we have is protected."
Mayne's late husband, Sen. Ed Mayne, first put additional money specifically for school nurses into the state budget several years ago. Now, school nurses are funded through a variety of sources, including the specific line item Mayne put in place, as well as Medicaid reimbursements, discretionary school money, and, in some cases, local health departments, said Shirley Stevens, president of the Utah School Nurse Association.
Other school staff can be trained to do certain things, such as take temperatures and give some shots, but, other things only nurses can do, said Janet Bryner, Oquirrh Hills' school nurse.
"We can look in their ears. We can look in their throat," said Jamie Ferdinand, past president of the Utah School Nurses Association and another Granite School District nurse. "We can do these nursing assessments that lay people do not do."
She said nurses across the state often serve eight to 10 schools each.
Both Bryner and Ferdinand serve nine schools each in Granite. On a typical day, Byrner said she visits three or four schools by lunch time. In addition to dealing with students who simply don't feel well, she also cares for about 15 diabetic students, a student on oxygen, at least three students with compromised immune systems, and at least 10 students with life-threatening allergies.
On a recent school day, she began her morning by helping three students at Oquirrh Hills test their blood glucose. A check of Cummings' son, 6-year-old Kade Cummings, showed relatively low levels, so Bryner gave him a snack and waited with him for 15 minutes before allowing him to recheck his blood glucose. Diabetic students can pass out, have seizures and/or go into a coma if their blood glucose dips too low, so Kade checks his levels three times each school day.
Bryner supervised as Kade pricked his finger on the lancet and again placed it on a test strip. She then helped him place the lancet in a safe disposal container. When she saw his blood glucose was back where it should be, she prepared to visit her next school.
"There is never a dull moment," Bryner said. "With more school nurses we could really meet the needs of more students."
Utah ranked last in the country when it came to the ratio of students to each school nurse in 2008. Here are the states that ranked the best and worst:
Best (students per school nurse)
1. Vermont, 275
2. New Hampshire, 347
3. Massachusetts, 419
4. Connecticut, 460
5. Delaware, 519
46. Oklahoma, 3,110
47. Montana, 3,137
48. Oregon, 3,142
49. Michigan, 4,204
50. Utah, 4,893
Source: National Association of School Nurses