In Jefferson County, W.Va., schools, one part-time nurse and seven full-time nurses cover two schools.
"They do screenings, preventive health education and home visits, as well as coordinating medications," said Randi Hulse, the Jefferson County school nurse supervisor. "In the 2002-2003 school year, we handled 9,404 health visits."
Hulse said the county's school nurse program, begun in 2000, has been strongly supported by R. Steven Nichols, Jefferson County superintendent of schools.
"It is a wonderfully comprehensive school-health program that serves our kids well," Hulse said.
Before Spickler was hired by the school system in 1975, the Berkeley County Health Department covered the county's schools on an as-needed basis, she said. She worked with health department nurses in the schools until 1985, when a second school nurse was hired.
"Many of our school nurses don't have offices in their home school," Spickler said. "They find a small nook to work in and keep their stuff in the trunks of their vehicles."
Spickler said she is happy with the support the program gets.
"Berkeley County School Superintendent Manny Arvon has talked with all the school nurses and pledged his support," she said.
Washington County Public Schools doesn't have an in-house school nurse program. Nurse duties are handled through the county health department and administered by Melinda Malott, school health program manager.
"We have 15 registered nurses, including me and three licensed practical nurses, who are assigned to between two and five schools, depending on size of the school and distances," Malott said. "They are very busy."
The bulk of their duties involve students with special medical needs, Malott said.
At the beginning of each school year, a nurse works out care plans with students, their families and doctors.
There are health assistants in each of the 43 schools in Washington County, Malott said. Some are trained to dispense medications to students.
In the Chambersburg (Pa.) School District, there is one nurse in each of the 18 elementary schools, said Penny Shives, department chairwoman for school health services.
"We already had certified nurses in the three secondary schools," Shives said.
A certified nurse must be at least a licensed practical nurse. Many school nurses are registered nurses.
"This program has been a blessing for our students," Shives said. "The school nurses never have an idle moment."
The nurses' responsibilities include administering medications and insulin injections, and handling occasional emergencies. Some of those duties can be delegated to others who have been trained, but in many cases only a registered nurse or a parent legally can provide the care.
"One of our school nurses has six children in her three schools with diabetes," Spickler said.
Many school nurses in the Tri-State area provide preventive health-care instruction in elementary and middle schools. Subjects are varied to suit the age group. Most high schools also have health classes.
Personal hygiene practices such as brushing teeth, washing hands and checking for and preventing head lice also fall within the duties of school nurses.
Spickler, who has worked in operating and emergency rooms, has been a registered nurse for 29 years. She said there is something special about being a school nurse.
"All of our nurses are kind, loving people who have the students' best interests at heart," Spickler said. "I love what I do and want to come to work each day."