Somewhere in a Putnam City school is a first-grade student whose uncontrolled asthma has already caused her to miss several days of class. Now, her wheezing is beginning again, and panic is creeping into her eyes as she struggles to take a full breath.

Somewhere in a Putnam City school is a middle school student with diabetes who is close to a blood sugar crash. Because of shakiness, dizziness, anxiety and other symptoms, he can’t concentrate in class.

Somewhere in a Putnam City school is a student with an undiagnosed seizure disorder. Some day soon, she’ll fall to the floor, lose consciousness and go into convulsions.

"Many people think of school nurses as handling no more than boo boos and band-aids, but that era is gone," says Georgene Westendorf, RN, Putnam City’s Health Coordinator.

Take asthma, now the most common chronic disorder in childhood. According to the Centers for Disease Control and Prevention, asthma prevalence among children increased by an average of 4.3 percent each year between 1980 and1996. An average of three children in every classroom in the country now has asthma. It’s a serious enough condition that it is third-ranking cause of hospitalization among those younger than 15 years of age and accounts for 14 million lost days of school missed annually.

While students with asthma are allowed to carry inhalers, not all students have doctor-prescribed inhalers and not all students with asthma know they have asthma. That means school nurses and health aides must be alert to wheezing or labored breathing to make sure students are safe.

Another factor changing the job of the school nurse is that students are taking more medications at school than in the past. Every day, more than 3.5 million children across the nation take medication at school. In a special report in March 2005, the American School Board Journal cited a study saying students were taking about 200 different kinds of medications in 2003, up from the 58 found in a late 1980s study. Westendorf says it’s not unusual for a district school to have as many as 100 medications locked in the school health clinic awaiting student use. With few exceptions, medications taken by students at school require administration by the school nurse or health aide.

Too, school nurses have become primary health care providers for many students, especially those in high-poverty areas. It’s not unusual for students with a sore throat, fever or injury over the weekend to report in to the nurse’s office on Monday morning. Westendorf remembers one student who came to school on a Monday with what was instantly recognizable to her as a broken arm.

"It’s not so rare that parents want the school nurse’s opinion before they spend money and time on a doctor’s appointment or emergency room visit," Westendorf says.

Research backs up the claim that school nurses make a difference in education. A December 2005 article in USA Today cites a 2003 study in 16 elementary schools in Toledo, Ohio, that showed asthmatic students who attended schools that had full-time nurses averaged three more school days annually than did asthmatic students at schools with part-time nurses. A 2001 study in Alabama of more than 10,000 students in 22 schools found that fewer students checked out of school for medical reasons when a full-time nurse was at a school. The December 2005 issue of The Journal of School Nursing reports on a study in a Midwest urban public school district that found 57 percent fewer students left school early with school nurse contact compared to those who left school early without such contact.

According to Westendorf, student attendance and attention in class can be improved even when a nurse looks at something as simple as a recurring stomachache. Some stomachaches are due to temporary gastrointestinal problems. After visiting with students, nurses find that some stomachaches are due to hunger. Such students don’t need medication to return to class, Westendorf says. Instead, they need food in their stomachs and an application that will allow them to join a program that provides free or reduced-cost school breakfasts and lunches.

Common sense and research both say that more time in class means more opportunity to learn. A 2002 study in Minnesota found that students who were in class 95 percent of the scheduled school day were twice as likely to pass a Minnesota language arts class as those who were present 85 percent of the time or less. A 1988 study found that students who missed more than 11 percent of scheduled school days fell behind in their work and had difficulty understanding and completing their work at grade level.

Westendorf says it all comes down to one thing.

"We strengthen the educational process through better student health," she says.