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Prince George's County school board member Pat J. Fletcher (Dist. 3) knows firsthand the importance of having nurses in school.

Last month, Fletcher's granddaughter, a second-grader at John Carroll Elementary in Landover, fainted in class and had what appeared to be a seizure.

The school's nurse was able to write down detailed observations of the girl's condition, which was passed on to the emergency medical crews and eventually, her doctor.

"It brings a sense of calmness and professionalism and quick thinking when you have a clinician in the building, particularly a nurse," Fletcher said.

Last year, Carroll did not have a nurse for the entire school year. But this year, all county schools will have a nurse because of increased funding in the school budget to hire them.

At the Oct. 16 board meeting, board members approved an additional appropriation of $790,000 that will allow the school system to hire an additional 13 school nurses and pay them more than in past years.

The county school system currently has 187 school-based registered nurses and the additional 13 will begin work this month or in December, bringing the system up to 200 school nurses when the new staff begin work at approximately 210 schools. The remaining schools that do not have school-based nurses are covered by "floating" nurses who travel from school to school on an as-needed basis.

Schools' health offices are also staffed with licensed practical nurses and certified medical technicians — staff members trained to give medication to students. Both positions are supervised by a registered nurse. Levels of staffing depend on the size and needs of the school.

According to the U.S. Bureau of Labor Statistics, training for LPNs lasts about one year and is generally offered by vocational or technical schools or at community or junior colleges. Working as a registered nurse requires two to four years of training, earning a bachelor's degree, associate's degree or diploma in nursing.

Betty Despenza-Green, chief of student services for the school system, said when she started in 2006, there were 60 school nurse vacancies, and 50 new nurses have been hired in the past year.

The average starting salary for a school nurse is now about $35 per hour. In previous years, it has been about $23 per hour.

Fletcher, who has worked previously in mental health, said it was crucial for county schools to raise the pay of school nurses so they could recruit and retain them.

"The salary was not competitive to recruit nurses. Once we raised that salary, they were knocking at our door," Fletcher said.

According to a September report from the American Association of Colleges of Nursing, there is a nationwide shortage of nurses, which is expected to increase as members of the baby boomer generation, Americans born between 1946 and 1964, require more health care as they age.

As of December 2006, there were 116,000 nationwide registered nursing positions vacant, according to a 2007 report from the American Hospital Association.

Karen Bates, supervisor of county health services, estimates that the average school nurse's office sees anywhere from 30 to 80 students per day, and thus far this school year, have dispensed more than 7,000 doses of medications to county students.

One key statistic Bates tracks in her job overseeing the county's nurses is the rate at which students return to class after seeing the nurse. Currently it is about 88 percent, and her goal is to get it to 90 percent.

Having a qualified nurse makes it more likely that the student's problem can be addressed quickly and returned to class, rather than simply calling the parents to take the student home, Bates said.

"The nurse actually performs an assessment to determine what the issues are, and they can return to class," Bates said.

Despenza-Green said the need for school nurses is critical because today's students deal with more illnesses at school — such as diabetes, allergies and asthma — than students did in previous generations. Bates also said students who have special needs, such as ventilators, require considerable attention from the school nurse.

"That's one of the reasons we have been pushing so hard to get a nurse in every school," Despenza-Green said.

In addition to managing immediate health needs of students, school nurses also track which students in the school are in compliance with their state-mandated vaccine requirements; county school officials have struggled to keep students in compliance in the past. This year, officials reported more students are getting their required vaccines. Currently, 98 percent of the county's students are in compliance with vaccine requirements.

County nurses are often also finding that students need medical care but lack health insurance and they are responsible for working with the family to find resources through the county health department.

Cynthia Norris, a registered nurse, has been the school nurse at Patuxent Elementary in Upper Marlboro for six years. The most rewarding aspect of her job, she said, is the opportunity to teach students how to live healthier lives. For example, when students come to her complaining of a stomach ache, the first thing she asks is whether they have eaten breakfast. If they say no, she talks to them about how important it is to eat breakfast every day.

"Every opportunity when they come in is an opportunity to teach them something. That's kind of the rewarding part of it," Norris said.

In addition to seeing ill or injured students, Norris is responsible for making sure students are up to date with vaccinations, managing the doses of medicine given to students during the school day, training staff on how to deal with health issues, and screening students' vision, hearing, height, weight and blood pressure.

Norris estimates she sees an average of 30 to 40 students per day.

"I think it's a combination of nursing, case management, social work, second mom second dad type of thing, and a lot of multi-tasking," Norris said.