The quiet monotony of testing students' eyes and ears came to an abrupt halt for school nurse Jan Hargreaves on a recent day with the ring of her cellphone. A fight between two girls at a high school 10 minutes away had left one student with a badly injured eye.
Seconds later, her phone rang again. An asthmatic fourth-grader at another school 10 minutes in the opposite direction wasn't responding to his medication and was gasping for air.
Hargreaves bolted out the door, preforming triage in her mind. As she drove to the high school, Hargreaves dialed the elementary school and ordered a rattled assistant there to call paramedics for the boy.
"I had to choose between a kid with a fractured eye socket and one struggling to breathe," said Hargreaves, who is responsible for about 9,000 students at 10 Riverside schools. "It is ridiculous what they are asking us to do. It's really unsafe. I don't think parents have any idea about the level of medical attention their kids are getting at school."
There was a time when most schools had a nurse at the ready for playground bruises and classroom fevers. Today, a severe shortage of school nurses in California has led to a system of care that health officials say leaves children at risk.
Nearly one of every 10 students in California -- more than 600,000 children -- attend schools in districts with no nurse on staff. The state's remaining 5.7 million students are overseen by about 2,800 nurses -- a third of what national and state nursing groups say is needed.
Filling the void are minimally trained, unlicensed staff members such as secretaries and attendance officers who handle not only runny noses but an ever-increasing number of children with chronic illnesses that require potent medications and daily treatments.
"It's a game of roulette," said Penny Stone, director of health services at Riverside Unified School District. "I'm scared every day."
Unlike other states, California has no law mandating that districts have nurses, except for special education students who are legally entitled to medical care at school. For all other children, schools must screen only for spinal curvature and sight and hearing loss, tasks that districts often hire private companies to perform.
The dramatic decline in California school nurses dates to 1978 when the passage of tax-cutting Proposition 13 greatly reduced school funding.
