"Most parents are worried when their kids go to school for the first time because it's a big step, but I really am afraid," she said. "I'm afraid something is going to happen to him and there won't be anyone to help him."

Ballard's son has life-threatening allergies and asthma, and she is one of several parents at Point Harmony fighting to get a full-time nurse at the school.

Only four of Kanawha County's 70 public schools have a fulltime nurse. In fact, 35 nurses in the county divide their time among nearly 30,000 students.

At Point Harmony, a nurse visits three days a week and also takes care of students at Cross Lanes Elementary and local pre-schools, in addition to helping out surrounding middle and high schools.

"I'm a teacher. I'm ill-equipped to handle the medical issues of my students on my own. I would feel a lot better if there was a nurse by my side," Ballard said. "This is literally life or death."

Josh Hanson, Point Harmony PTO co-president, said he has tried everything to get the state and local school boards to help recruit a fulltime nurse to the more than 600-student school. Parents are even looking into ways to raise enough money to pay the nurse's salary themselves.

Hanson has two sons with type 1 diabetes who require daily care.

"When parents are forced to try to solve the problem on their own, something is wrong. For Kanawha County to be so large, we should be further along. They say they can't afford more nurses, but there are always ways to shift money in the budget if it's really important," he said. "If something happens, it's going to be up to the teacher to try to do what's best. We're one of the largest elementary schools in the county and have several students who need around-the-clock care. If we can't get a nurse, who can?"

Ballard and Hanson said that, although the nurse is at the school three times a week, she can't dedicate her undivided attention because her time is spread so thin.

"Kids should be able to go to school and worry about learning, and parents should be able to work knowing their children are in a safe environment," Hanson said. "Our main concern should be on their education -- without worrying about their health on top of it."

Last year, there were more than 130 students in Kanawha County with diabetes. Nearly 50 of those required daily interventions, and about 20 required two treatments a day.

Nearly 300 Kanawha County students have seizure disorders, and another 330 have life-threatening allergies.

More than 1,600 have asthma, and about 700 of those need to use an inhaler at school.

Brenda Isaac, Kanawha County's lead school nurse and coordinator of health services, said everyone wants more nurses, but that it's not that simple.

"Ideally, we would have a certified school nurse in every school. That's what we all want. In some schools, we could even use two. But there are budget constraints and a lot of needs in our school system," she said. "School nurses are stressed. We want to do more than just take care of emergency issues and special procedures. We want to focus more on health promotion and help kids lead healthier lives. That's supposed to be a big part of our job too, but it's tough."

The National Association of School Nurses recommends a nurse-to-student ratio of 1:750 for healthy students.

"That number is just for things like scrapes and stomach aches," Ballard said.

That student ratio number lessens depending on how many cases need daily intervention from a school nurse.

Kanawha County's nurse-to-student ratio is 1:812. West Virginia's ratio is 1:1,064.

"We have a number of students with health issues that require a school nurse to participate in their care," Isaac said. "Every situation is different. We don't deal with health conditions; we deal with students."

Each of the four schools in Kanawha County that do have a full-time nurse on site have at least one student enrolled with "very serious health conditions that can be immediately life-threatening," Isaac said.

"These students require procedures that are complicated enough that we cannot delegate non-health professionals to perform them," she said. "These students are entitled to an education and are otherwise able to learn."

The county's nurses work hard to identify student health problems, communicate closely with physicians and parents and put emergency plans in place, Isaac said.

"Just because there are not nurses designated to one specific school around the clock doesn't mean we don't have a plan. We have care plans and work with staff in the building that are trained to deal with situations," she said. "Every single nurse in the county has a significant caseload and is very busy dealing with these issues."

Isaac said that while Kanawha County has 10 more nurses than it did a decade ago, she's unsure of the feasibility of Point Harmony's plan to hire a full-time nurse at the school.

The average cost of a full-time certified school nurse in the area is about $60,000, including benefits.

"A school like Point Harmony would really benefit from a full-time nurse, and other schools certainly would, too. I appreciate what they're fighting for, but fundraising for that could be problematic," she said. "I would love to be able to find a stable source of revenues so that we could have nurses at every school -- or at least at our big schools -- but you've got to be able to show some sustainability if you're going to hire somebody. I'm not sure PTO money could provide that."

Kanawha County Board of Education President Pete Thaw said it's not an issue of whether more nurses are needed.

"It's just a matter of economics. I know we don't have room for that in our budget," he said. "We don't have the money to put a nurse in all of these schools. If we had the money, we would do it, but we don't."

Reach Mackenzie Mays at mackenzie.m...@wvgazette.com or 304-348-4814.