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In Philadelphia's public schools, 51 nurses were laid off last year. In one Houston suburb, 20 nurses, and another 15 in San Diego. Today, more than half of American public schools don't have a full-time nurse.

And as Michael Tomsic of member station WFAE reports, the situation is getting worse as school systems further cut budgets.

MICHAEL TOMSIC, BYLINE: At Githens Middle School in Durham, North Carolina, Suzanne Fuller walks into the office of her son's school carrying a little pill in a Ziploc bag.

SUZANNE FULLER: First of all, we got to get Rock up here because he didn't take this pill this morning.

VALERIE MITCHELL: OK.

TOMSIC: That's school nurse Valerie Mitchell. She's buddies with Rock. He's a 12-year-old with an attention deficit disorder, cerebral palsy, and he also has seizures. He says nurse Mitchell helps him, and one thing stands out.

ROCK: Like in fire drills, I - if something happens and I have a hard time, my ears start hurting and stuff.

TOMSIC: When the school had a fire drill a few months back, the sensory overload of the flashing lights, screaming alarm and rushing students was too much for Rock. His teacher thought he was having a seizure and called Nurse Mitchell.

MITCHELL: Had a bad headache, and he just felt like he was in a tunnel. That's what he kept telling me. I just tried to keep him calm, tried to keep him comfortable. You multitask during that time.

TOMSIC: Mitchell checked his vital signs, told the office to call his mom, and cleared out the nearby students. She says Rock got through it without going into a full seizure, and he was OK by the time his mom got there. She says Mitchell made a huge difference.

FULLER: Very, very lucky. I was very lucky that she's here.

TOMSIC: The thing is, Mitchell is only here two days a week. It was luck the fire drill happened on one of those days. The rest of the week, she bounces between four other schools. She's the only nurse at each one.

The National Association of School Nurses reports a quarter of schools don't have a nurse at all. The association's president, Linda Davis-Alldritt, says that's bad for schools, parents, and students.

LINDA DAVIS-ALLDRITT: Children are coming to school with increasingly complex medical conditions that need to be managed on a daily basis. And when there is no school nurse available, those kids are not going to be well managed in school, and so it puts them at risk for complications.

TOMSIC: And Davis-Alldritt says the staffing is getting worse. In the association's most recent poll, one-third of school districts surveyed said they reduced nurses in the last year. She says the recession has dried up local and state funding for school nurses. The director of nursing in Durham, Sue Guptill, says that's what happened in her district.

SUE GUPTILL: We've had two that were actually cut by the state. One that was actually cut by the county, and so we've lost three positions.

TOMSIC: Guptill says almost none of Durham's public schools have a full-time nurse. And some schools go two weeks without a nurse visiting. She says students' health needs fall to teachers and other staff.

GUPTILL: You're asking someone who is not a health professional to make a decision about is it time to give the child medicine, is it time to call a parent. And if a kid is kind of quiet, and you've got a room full of kids, a teacher just might not notice.

TOMSIC: But there's often no one else to take care of students. At Githens Middle School, the only people trained to help diabetics inject insulin are a janitor and a records specialist.

Ryan Dozier, the records specialist, says nurse Mitchell taught him what to do.

RYAN DOZIER: Of course, you know, you always hope that nothing serious ever happens. So that's kind of the nerve-racking part.

(SOUNDBITE OF CHILDREN)

TOMSIC: Back in the nurse's office, Valerie Mitchell shows a teacher's assistant what to do if a student has a seizure and she's not around. She tells the TA the timing is crucial.

MITCHELL: So he comes to me now at a quarter till and saying, I don't really feel well. You don't time it from there. You time it from the time that he goes out, has a seizure, breathing ragged. Sometimes you'll hear that deep (makes noise). Sometimes they may get a little blue around their mouth 'cause they're struggling to breath.

TOMSIC: Mitchell says this is an essential part of her job. She can't be at five schools at once, so she teaches staff members at each how to handle emergencies and that sometimes it's best just to call 911. For NPR News, I'm Michael Tomsic.

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