Justin Cook | The Roanoke Times

Trisha Irby, a full-time school nurse, inspects a pupil's finger at Critzer Elementary School in Pulaski. School nurses' tasks range from bandaging scrapes to teaching and planning lessons in "family life" classes, completing stacks of health plans and coordinating with students' doctors

Nurse Trisha Irby helps a pupil wash his hands after he cut his finger at Critzer Elementary School in Pulaski.

PULASKI -- Every 10 minutes after lunch Monday, a new child sheepishly stepped into Trisha Irby's office at Critzer Elementary School.

One boy cut his finger while working with scissors in class. Irby washed his hand and applied a fresh Band-aid to the wound.

Irby, one of Pulaski County's full-time elementary school nurses, spends her day tending to wounds or health emergencies. But across the county -- and the New River Valley -- students in higher grades don't have clinicians poised with bandages all the time. Nor are the nurses always available for what the health-care professionals think is an often overlooked role: education.

"We may not teach in a formal classroom setting, but we do education every day," said Lynn Newberry, president of the Virginia Association of School Nurses. "It could be as simple as teaching an elementary student how to blow their nose or a middle school student about hygiene."

Older students often need guidance on how to handle health issues in the "real world," such as birth control, she said.

School leaders in Pulaski and Montgomery counties are eyeing county funding sources to increase the number of hours that middle and high school nurses are present during the day. Meanwhile, the state association is pushing two bills in the House of Delegates, hoping lawmakers will note their importance and require at least one nurse per building.

"At 2 o'clock in the afternoon, you can't lock the door and turn away the children who are lined at the door," Newberry said.

One bill asks that at least one nurse work at every school, and the other would require a registered nurse as a health coordinator.

Montgomery County has 20 school nurses, including coordinator Joni Mitchell. Elementary school nurses work full time, but those at middle and high schools each work 20 hours a week and set their own schedules.

Montgomery County Superintendent Tiffany Anderson has proposed $111,000 in her budget to increase nurses' hours to 35.5 weekly to fix part of that problem. Right now, nurses set their own hours, as long as they add to 20 per week. Some nurses are split between schools.

Mary Hall, supervisor of nursing in Pulaski County, said she plans to ask for a boost in nurses hours, too, when the budget planning begins next month. In her division, two elementary schools share a nurse and other schools have nurses who work 35 hours a week.

"If a child's not healthy, they're not going to get the optimal learning situation," Hall said.

Neither division is in a pinch, according to the National School Nurse Association's guidelines that suggest schools have one nurse for every 750 students. Montgomery County has 9,752 students, which means about 513 students per nurse, and Pulaski County's nurses split about 624.

But not all the school nurses work full time, and the nurses say people don't understand the complexities of their jobs.

Nurses' tasks range from bandaging scrapes to teaching and planning lessons in "family life" classes, completing stacks of health plans and coordinating with students' doctors. Nurses also hold clinics for staff, helping them fend off illnesses brought in the buildings, and they also teach classroom leaders and administrators proper medical procedures for the gaps in clinic hours and field trips.

While most elementary schools have full-time nurses in the buildings, secondary schools have seen an increase in visits. Last year, Montgomery County students visited the nurse's office in their middle or high schools more than 17,000 times. That's nearly double the 9,000 from the previous year, according to county figures.

Nurses attribute the rise to the number of students who have chronic illnesses such as diabetes or asthma. Those illnesses require counseling and education on top of quick fixes to illnesses, they said.

"I do think the elementary nurses are busier than the high school, but it's a different kind of busy," said Eastern Montgomery High School nurse Tracey Cook. "Here, they're probably more sick."

Cook joined the high school's staff this year. Despite limited hours, she said teachers are grateful to have someone in the clinic more often.

Typically, she comes to school about 9 a.m. and leaves by 1:30. Early in the morning, students are regularly lined up or have stopped by the clinic or told other staff members they are sick by then.

"Usually they've already seen students come through and they just say, 'This person is sick,' " she said. "Whereas I can look at them and say, 'Well, you don't have a fever.' A lot of times they just send them home."