One day last school year, Korbyn Edmondson's father picked him up from kindergarten at Park Elementary School in Casper and within 35 minutes, Korbyn was admitted to the hospital.

He stayed there three days as doctors stabilized his chronic lung condition.

His mother, Conney Edmondson, believes Korbyn could have avoided a hospital visit if someone at the school had notified her earlier in the day about him getting sick.

"His oxygen level had dropped real low and he didn't feel well," Edmondson said. "But there was no nurse there to evaluate the situation."

Edmondson has been an advocate for trying to get a full-time school nurse in every building in the Natrona County School District. She addressed the issue in her campaign for school board this fall. She was not elected and said the issue still concerns her.

Principals, secretaries, teachers and teaching aides across the school district, state and country have been given the responsibility of passing out medications and administering first aid to students because there are not enough school nurses to go around.

In some instances teachers are even administering insulin to children with diabetes and handing out antidepressants and medications for bipolar disorder.

"It's like having a English teacher teach math," said Edmondson, who received a bachelor's degree in nursing.

Amy Garcia, executive director of the National Association of School Nurses Inc., said many parents are unaware of this issue and the problem it poses because when most adults went to school, children with disabilities were not in mainstream classrooms Also, in recent years incidents of asthma and diabetes in children "have exploded."

"Things have changed," Garcia said. "There are kids in wheelchairs, kids with catheters, ventilators."

She said people are living today with debilitating genetic diseases that they did not survive before.

Korbyn, now a 7-year-old at Paradise Valley Elementary School, suffers from a form of cystic fibrosis and requires daily medications and consistent chest therapy.

Conney Edmondson decided to move him from Park Elementary to Paradise Valley Elementary at the beginning of the school year, because there is a full-time school nurse at Paradise Valley.

"If someone were to give him the wrong medication, he could stop breathing immediately," she said.

Finding the right ratio

Suzey Delger, head school nurse for the Natrona County School District and a nurse at Grant Elementary School, said there are 18 nurses in the district, which is up two from last year.

There are about 11,500 students in the district spread across 35 schools. Delger said this averages out to be about one school nurse for every 640 students.

But there is only one school nurse for each of the two main high schools, which have a lot more than 640 students, she added.

"We are blessed to have as many school nurses as we do in this district," Delger said. "But in a school setting, I wish we had a nurse in every building, especially the ones with diabetics.

"Diabetics need you over the lunch hour and if you have one at one school and one at another, you can't be in two places at once," she said.

According to Healthy People 2010, a prevention study done by the federal government, the ratio of health professionals to students should be about one per every 750 students.

Garcia said this number is misleading because it should say "750 healthy kids."

Nationwide, 12 percent of students have asthma, 5 percent have food allergies and 3 percent have attention deficit disorder or attention deficit hyperactivity disorder, according to Garcia. Thirteen percent of students take some type of prescribed medicine during the day.

Garcia said the number should be closer to one nurse for every 250 students.

Some schools in Natrona County, such as both the big high schools, Dean Morgan Junior High School and Centennial Junior High School, have full-time nurses every day of the week. Others have a school nurse only a couple of days a week.

Delger said every school has a registered nurse assigned to it and the nurses supervise secretaries and teachers.

Practice is legal

When a school nurse is not available, principals can designate a willing person to administer medications or first aid.

The principal is considered "in loco parentis" or in place of the parents and the principal is legally allowed to designate someone in place of the school nurse with the parents' permission, Delger said.

Wyoming statute says incidental health care can be administered by members of the family or friends of a child. School staff members are considered family friends.

Delger said the Wyoming School Nurses Association has sought the opinions of two state attorneys general on this issue and they both sent letters saying Wyoming law allows it.

"It's legal, so that's the ruling," said Cheryl Koski, the executive director of the Wyoming Board of Nursing. "It's up to the school districts to make policies and regulations.

"It is much better for a nurse to be there, but there is nothing we can do about it. The board is bound by law."

She said it is much safer to employ licensed nurses because they have the knowledge of the medications and why the children are on them.

The National Association of School Nurses agrees with the state nursing board's position.

"Every child deserves a school nurse," Garcia said. "But Wyoming certainly has an issue with spread-out schools."

However, Garcia said nonlicensed professionals are administering medications to students at schools around the country and it is more common than it should be.

Training required

Garcia said principals, secretaries and teachers must be trained specifically to meet each child's medical needs and this can sometimes take a great deal of time.

When Donna Hall took an office manager position at Grant Elementary School, she was told she might need to help out in the nurse's office.

"I thought, 'I don't have a problem with that but I want to be taught what I need to know, what I need to do,'" Hall said. "Suzey made me feel comfortable. I felt she explained everything."

Hall said when Delger is gone, she and the school librarian pass out a lot of medications.

To ensure students' safety, Delger said the secretaries at Grant Elementary go through a training course and take a test. Also, all medicine is locked up and documented.

The Wyoming Department of Education recommends each school nurse carry a cell phone when traveling to different schools so secretaries and teachers can reach them if they have any concerns, said Gerry Maas, health and safety unit director for the department.

He also said at most schools there is a three-ring binder in the nurse's office that has each child's picture in it with a list of the student's medications and a log of when he or she takes them.

"It seems to work pretty well," Maas said. "We think that system has been pretty safe."

Parental contact is key

Carol Boal, school nurse at Paradise Valley and the rural schools, which include Alcova Elementary School, Red Creek Elementary School and Powder River Elementary school, said the school secretary at Alcova does not hesitate to call her or a student's parents if she has any questions.

"With the rural schools, they have been there so long," Boal said. "The secretary out at Alcova, she knows the parents, those kids."

Shannon Jackett, chairwoman of the Natrona County school board and mother of two children in elementary school, she is aware there is not a school nurse at every school every day and has no problem with a secretary or teacher giving her child medication.

Jackett said this can "be handled fairly simply as long as there is parental contact. I don't see an issue as long as everybody in the circle knows what is going on."

Delger said every parent signs a form that allows a principal to designate a staff member to distribute specific, doctor-approved medications to a child. Children in the district cannot get over-the-counter medications without the permission of a parent or a doctor.

Since switching to a school with a full-time nurse, the Edmondson family has been more content.

Everyday Korbyn visits nurse Boal's office and does coughing exercises with her to make sure his breathing is all right.

"He's not a complainer and doesn't want to leave school," his mother said. "Carol is very good at evaluating him and will call me if something is off. When you are a nurse you are programmed differently and you're good at what you do."

Reach Allison Rupp at (307) 266-0534 or at allison.rupp@casperstartribune.net.