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School nurses in short supply

When Roberta Nilsson first saw the little girl at Tarpon Springs Elementary, the 8-year-old complained that she had stuck herself in the leg with a piece of wood. Nilsson cleaned the infected wound and asked the girl's mother to take her to a doctor. A week later, when Nilsson checked on the second-grader, the wound had festered. Doctors who saw the girl one day later at an area hospital discovered wood deeply embedded in the leg.

"I truly believe that if she hadn't received medical attention at school, she would have wound up with an infection throughout her whole body, and she could have lost part of her leg," Nilsson said.

As part of a $108,000 pilot project, Nilsson and two nurse's aides are available full time for students at Tarpon Springs elementary and middle schools.

That's the way it's supposed to work, school and health officials say.

But throughout Pinellas County, students in elementary, middle and high schools have virtually no regular contact with health workers. Pinellas ranks near the bottom of Florida's 67 counties in providing medical care to its students, some health workers say.

In a recent study, the Health Council of Pasco-Pinellas Inc. reported not nearly enough nurses work at Pinellas schools. At middle and high schools, nurses are "on call" for emergencies but seldom are available for any one school.

The St. Petersburg-based council is a non-profit corporation established by the Florida Legislature as a local health planning group that does data collection and community education.

According to national standards, each school nurse should be available to treat no more than 1,500 students, said Teresa Kelly, a Health Council planner. In Pasco County, the ratio is one nurse for every 2,000 students.

But in Pinellas, each nurse is available to an average of 7,800 students. The Pinellas County Health Unit supplies only 13 community health nurses for all of the county's 130 school buildings, said Joanne Bailey, a nursing supervisor for the health department. "It's overwhelming," said Judy Marshall, a school nurse based in Clearwater.

"We just keep plugging away and doing the best we can _ knowing we will not be able to reach some kids we need to reach," Marshall said. "Most schools have no clinics."

At Tarpon Springs elementary, middle and high schools, students can visit a nurse or nurse's aide when they feel ill or get injured. Also, the nurses have time to review children's health records to make sure that chronic problems are being addressed, Nilsson said.

As a result of the School Health Improvement Pilot Project (SHIPP), 76 percent of the students who reported sick to a nurse were treated and returned to class, the Health Council wrote.

"A big part of the program is to keep kids in school," Nilsson said. At other schools, parents are called to retrieve their children, and the youngsters often miss the rest of the school day.

In most schools, children who say they are ill are forced to wait at an office while secretaries try to locate a parent or friend, Kelly said. If an adult can't be found to pick up the child, he or she may spend hours waiting, supervised only by a clerk or secretary.

"You cannot have kids sitting there for hours at a time, so your immediate response is to send a kid home," Nilsson said. "Or a child may be sent back to class where they go unattended with a temperature, or they may vomit in the classroom."

And because there are so few nurses available, health workers are unable to chart a student's progress to make sure a problem is being addressed, said William Harris, principal of Largo Middle School.

Having a health worker on campus can help teachers, Harris said. While teaching at Tarpon Springs, Harris visited Nilsson to discuss a headache, he said. Nilsson monitored his blood pressure and asked him to visit a doctor when the blood pressure remained high.

Harris eventually had a kidney removed. But his illness may not have been detected as quickly if Nilsson had not been available to see him.

"Obviously, there are some big advantages," he said.