Patricia Contini, the only staff nurse in the 3,500-student Fillmore Unified School District, was at her office recently when she got a call about an injured student at a school eight miles away.
The elementary school student had run into a wall during recess and was complaining that her shoulder hurt.
School officials called Contini, who advised that the girl's arms be put in slings while help was sought. But officials at the school didn't have the training or equipment to do it, she said.
"That would have been the more practical response, but because I wasn't there it wasn't done," Contini said.
The student, whom Contini declined to identify, walked out of the school holding her arms to support her injured shoulders. She was taken to a doctor by her mother and later diagnosed with two fractured shoulder blades.
Contini said the incident demonstrates the need for more school nurses. "That was one of several scenarios when I wished to heck I was at that school," she said.
Countywide, about 50 school nurses serve more than 110,000 students in 20 school districts, according to the Ventura County School Nurses Assn.
And the nurses' ranks are shrinking as public school funding dries up.
Like nurses in other school districts in the county, Contini says she cannot treat all of the students she is supposed to serve. But at least most districts have at least one nurse on staff. Two districts, Santa Paula Elementary and Ojai Unified, have none.
Instead, minor medical emergencies are handled by school secretaries or clerks, usually trained in basic first aid and cardiopulmonary resuscitation. Their duties also include notifying parents when their children are hurt.
Edward Kessler, Santa Paula's director of special services, said that the district has three CPR-trained health aides who serve seven schools and that each has at least six years of experience.
Andrew Smidt, superintendent of the Ojai Unified district, said the district has tried to provide emergency training to as many employees as possible.
"We feel we're really providing a good response in terms of emergencies," Smidt said. "It's working well, and one of the reasons it's working well is we have a lot of folks alert to any particular problems."
In districts with no nurses on staff, medical duties sometimes are performed by nurses on contract from the county school superintendent's office and paperwork is done by clerical aides.
In the Simi Valley Unified School District, whose 11-member nursing program was considered a model and used as a training ground for new school nurses from Cal State Northridge, five nurses were laid off last spring as a result of $8 million in budget cuts.
Until this year, Camarillo's Pleasant Valley School District had only one school nurse, district Health Supervisor Jacqui Pease, who made the rounds at 13 schools housing the district's 6,500 students. The district hired another full-time nurse this fall, Pease said.
School nurses are required by the state to test vision and hearing and check for scoliosis, a disease that curves the spine and sometimes affects teen-age girls.
Nurses or their assistants must also keep track of student immunization records, said Wana Klasen, school nurse at Channel Islands High School and co-president of the county school nurses group.
In addition to the demands of school nursing, the education requirements are high, Klasen said. Registered nurses who work in hospitals are not required to have college degrees, but school nurses must have bachelor's degrees, be RNs and have credentials from the state Department of Education, she said.
"The whole image of the school nurse as someone who sits there and hands out Band-Aids has really, really changed," said Klasen, who sees between 35 and 40 students a day at the 2,800-student school. "That's a heavy caseload. They come in for everything you can think of--health counseling, emotional counseling, first aid of course. Or they may be ill with the flu and need to be sent home."
Klasen's district, the six-school Oxnard Union High School District, is one of the few in the county with a nurse at every school, she said.
Most districts require parents to sign forms indicating how they can be reached in an emergency. Or, if a parent can't be reached, the form gives medical authorities permission to perform emergency procedures.
In rare cases, a hospital might not accept the district's parental consent form but require a parent to be present when emergency treatment is given. In those instances, a court order would be obtained to treat the child, officials at several districts said.
Sandy Everhart, a secretary at Santa Paula's Barbara Webster Elementary School, said she takes care of students' minor cuts and scrapes almost daily; less frequently, she must seek treatment for students with more serious injuries, such as fractures.
"I feel qualified to handle all of the emergencies I've had thus far, and thank goodness we haven't had anything of a life-threatening nature," said Everhart.
Everhart said she has authority to administer medication to children with written permission from their parents and permission and instructions from the family doctor. However, she said some secretaries are uneasy about administering injections to students allergic to bee stings because they have not been trained to use syringes.
"However, in most cases if this should happen you would have a child's life in your hands. . . ," Everhart said. "They could die within 10 minutes or stop breathing. It really bothers me."
In Simi Valley, as a result of $8 million in cutbacks, all of the nurses at the elementary level have been eliminated, said Assistant Supt. Allan Jacobs. However, the district's other five nurses still provide the same coverage to other schools, he said.
In addition, the district's nurses are on call to respond to emergencies at elementary schools, Jacobs said. Minor elementary school injuries are handled by principals or secretaries, he said.
"All of us were very sorry we had to do away with a nursing program that was outstanding," Jacobs said. "Obviously, it would be better to have a nurse full time on each campus, and it would be better to have more nurses, but in the scheme of things we have to do what we can to meet our budget."
The district has rehired two of the laid-off nurses under special anti-drug grant programs, and two others are doing part-time vision testing in the district.
Another former Simi Valley school nurse, Sandra Holmgren, is program specialist for health services and education in the Ventura Unified School District.
"The feeling when the layoffs took place in Simi was that the children were being given short shrift," Holmgren said. "It was just a very good program and all of that was lost."
In Ventura, Holmgren supervises five nurses, including full-time nurses at both Buena and Ventura high schools.
During a typical, recent workday, Fillmore's Contini visited three schools for consultations and made three home visits, including two trips to deliver clothing that she purchased from the Salvation Army for needy students.
"Our role as nurses is extremely vast," Contini said. "It's a lot like being a social worker. I don't spend a lot of time on first aid."
But Contini, who, like several other county school nurses, gave up hospital work for school nursing, said she has no regrets about the trade-off.
"I love what I do," Contini said. "I like this environment. I have a lot of autonomy. I have great ability to impact a lot of people, and I think that's wonderful."