ATLANTA -- Georgia is among the worst states in the country for staffing nurses in schools, but state education leaders are hoping a new law passed this year will improve that standing.
For the first time ever, the state is funding nurses based on student enrollment. The law, which takes effect July 1, sets out money for one nurse for every 750 elementary students and 1,500 middle or high school students.
It's a vast improvement over the state's current ratio of one nurse per 2,300 students -- a number that has Georgia ranking 46th among all states and Washington, D.C. What's more, the state is also requiring for the first time ever that all money allocated for school nurses actually be spent on them.
In the past, schools received the funding but could spend the cash anywhere it was needed. Over the last few years, that led to some schools doing away entirely with school nurses to cover budget shortfalls or contracting with the local health department for services.
"Each year, it's been questionable whether school nurse services would continue," said Carol Darsey, president of the Georgia Association of School Nurses and head of the school nurse program in Liberty County along the state's southern coast. "I'm excited we're finally getting on the board with some, hopefully, sustainable funding."
Darsey and other nurses have been calling for the state to step in as they watched their ranks languish with the state's lagging economy. The number of school nurses in Georgia increased from 823 in 2001 to 1,300 in 2010. State officials say that number dropped since then, though more up-to-date numbers were not available.
The shift comes after state lawmakers and education leaders on a commission tasked with overhauling how the state funds K-12 education recommended that Georgia better fund school nurses. It's the first time the state has made major changes to its funding formula in more than 20 years.
"The time was right," said state Senate Education Committee Chairman Fran Millar, a Republican from Atlanta. "The consensus is that it's a priority in our schools simply because for a lot of these kids, it may be the only access to health care they have."
Georgia's school nursing program was formalized by former Gov. Roy Barnes in 2001 with $30 million in tobacco settlement money. As that funding dried up, the state began cutting the state allocation for nursing to save money.
That meant districts had to use more local tax dollars or donated services to continue staffing nurses in schools. School nurses in Georgia are funded with a combination of federal, state and local dollars.
The cuts came at a time when more medically fragile children are attending public schools and the rates of obesity, diabetes, asthma and food allergies have skyrocketed.
Just a handful of states actually require a specific number of school nurses, and a few more recommend a minimum ratio but don't police it. The vast majority of states let school districts decide whether to hire nurses at all, even though federal law requires schools to provide the necessary health services for any special-needs child who wants to attend.
Only half the nation's schools have a full-time registered nurse on staff, according to the National Association of School Nurses. And 25 percent of schools have no nurses on campus at all, even part time, the association estimates.
That can range from California, where on any given day only 25 percent of schools have a nurse available to students, to Delaware, where the state requires a registered nurse to be on staff in every public school.
Once upon a time, school nurses might have been in charge of simply bandaging cuts and scrapes and taking the temperature of sick students. Now, nurses give insulin shots, administer treatments for severe asthma attacks and line up dental care for poor students who've never seen a dentist. Experts say children born with chronic conditions who might have died before reaching school age in previous generations are going to school, making the nurse's job more complicated than ever before.
Advances in medical technology also mean that students with severe illnesses or conditions can now attend school.
"We are not just the person who's in there to put on a Band-Aid, but a person to keep them healthy, teach them how to be healthy," said Connie Trent, head of health services and a longtime school nurse in Forsyth County. "Many families have lost their health insurance or they just don't have any. The school nurse becomes the only health care person the child may see."
Trent said this year she worked with a local hospital to get free care for a student who had broken a bone but whose parents couldn't afford a visit to the doctor. Another student needed a toothbrush so he could stop sharing one with his sister, Trent said.
Nurses also train teachers on CPR and the Heimlich maneuver, as well as how to administer an epinephrine injection to a student with severe allergies, she said.
For Randy Richards, whose son is a rising high school freshman in Cumming, Ga., having a nurse at the teen's school is peace of mind. Richards' son has gastrointestinal problems that require up to four types of medicine, depending on his symptoms.
"It would be very scary to me as a parent if there's not somebody who's familiar with the medication to be handing out pills and not know what they're giving him," said Richards, who works at a pharmacy. "I'm not so sure that somebody like a secretary with no medical background would be qualified to make a decision on what to give my son if I couldn't be reached."
The National Association of School Nurses estimates that 13 percent of school children take medication daily and up to 30 percent have some type of mental illness that requires regular medical attention.
"Before the only districts that had it were wealthier districts," said Herb Garrett, head of the Georgia School Superintendents Association. "Once it got started, it set up the expectation that everyone would have it, and I don't think that's the kind of program where you can tell folks. 'We're not going to do that anymore.'"