HURON — For many, visiting the school nurse may conjure up images of applying a bandage to a scraped knee or giving out a note to excuse a student from class.

But in South Dakota in 2019, the position of school nurse provides vital access for students to a medical professional, helping them through their school day when they have a problem with a chronic condition, an unexpected illness or sudden injury.

It's a position Rita Baszler knows well. As the school nurse for the Huron School District and an 18-year veteran of the profession, she sees students in need of medical attention on a daily basis at the district's five schools. She has worked in hospitals and clinics throughout her career, but she found another calling for her skills when she began treating students as a school nurse.

And while she loves her work, she knows one thing for sure: South Dakota needs more school nurses.

"My understanding is that there are only about 120 school nurses in South Dakota, and there are (hundreds of) schools. It's not good," said Baszler, who also serves as president of the South Dakota School Nurse Association. "That is the position of the National Association of School Nurses and the South Dakota School Nurse Association - we would hope to have a nurse at each school."

Baszler said both the national and state association would like to see a ratio of one nurse to about 750 students. That ratio does not take into account students with special needs, who often require a closer attention than others.

“When there are special needs at the school, of course you would want that ratio to be lower,” Baszler said.

Baszler said she currently has a ratio of about one nurse to 800 students at Huron, not including special needs students. She said she considers herself fortunate to have a ratio that good.

“I have one of the lowest ratios. I would consider that really good in South Dakota,” Baszler said.

School nurses, like other professionals, can be difficult to find in South Dakota. The rural location of many schools in the state can be a deterrent to those seeking to land a job in the health care field. Schools across the state often struggle to budget enough to pay competitive salaries for teachers, and it’s no different for nurses.

“It is a budgetary thing,” Baszler said.

Rita Baszler is the president of the South Dakota School Nurse Association and a school nurse in Huron. (Matt Gade / Republic)
Rita Baszler is the president of the South Dakota School Nurse Association and a school nurse in Huron. (Matt Gade / Republic)

She said the Huron School District has done a good job of tabbing funds to support the school nurse’s office. Her position is paid through the teacher/professional salary system, but many schools pay an hourly wage below what most registered nurses would make at a hospital.

Some schools will often work around not having a school nurse by short-term contracting an area health professional to serve in the role. But even that is not always an option, Baszler said.

One way schools can help provide that medical care is through the Avera eCare program. The program distributes equipment to school staff around the state that allows them to help staff to remotely conduct examinations, allowing them to advise on appropriate steps to take. Baszler said the program has helped fill a need that has been difficult to address.

“It’s the next best thing (to having a nurse on-site),” she said.

Sheila Freed, eCare House School Nurse Director, heads up the program from her Avera office in Sioux Falls. She said the program began in 2015 and was boosted in 2016 by a federal grant that allowed them to expand the service. Four nurses are currently on staff with the program, she said.

Like Baszler, Freed said there is no perfect substitute for having a school nurse in every district, but the Avera program gives rural school districts an opportunity to fill an important role.

“I think of it as a gap service,” Freed said. “We know that the best service is having one nurse on site all day, every day.”

Freed said the program serves 23 schools in South Dakota and another 17 in North Dakota, with one of the most remote being about 15 miles from the Canadian border. Some schools are as far as 60 miles from the next nearest medical service provider.

School staff are trained to use a device similar to an iPad. The device can take photos, examine patients’ ears and listen to the performance of the lungs and the heart. The eCare nurses and school staff generally don’t diagnose a patient through the system, but are able to conduct an examination with enough accuracy to know when to alert parents and other medical professionals about the student’s condition.

“We intersect with secretaries, paraprofessionals, principals, and the equipment is very easy to use, so they are kind of our hands. They know the kids and their families, and we bring that medical knowledge and make the parent calls and explain what we have seen and make a recommendation.”

Freed said the program has received good feedback from the districts that utilize it.

“Avera is committed to continuing to grow it. It really fits in with the mission of taking care of kids,” Freed said.

Freed said nurses help keep an eye on two major areas. They help manage chronic illnesses like diabetes, as well as urgent care calls, such as earaches, colds and bumps on the head.

Oliver Brock, a fourth-grader in the Huron School District, visits Baszler’s office on a daily basis to help manage his type I diabetes. He said with the help of his parents, the school nurse has been a place to learn about his disease and how to treat it properly.

“(I see her) every day,” Brock said.

Huron fourth-grade Oliver Brock uses a DexCom monitor to monitor his blood sugar levels that Rita Baszler, President of South Dakota School Nurse Association and a school nurse in Huron, can monitor from an app. (Matt Gade / Republic)
Huron fourth-grade Oliver Brock uses a DexCom monitor to monitor his blood sugar levels that Rita Baszler, President of South Dakota School Nurse Association and a school nurse in Huron, can monitor from an app. (Matt Gade / Republic)

Like those who use the Avera eCare system, Brock benefits from advancing technology. He has an electronic monitor he wears on his arm to monitor his blood sugar. That monitor reads his blood sugar levels every five minutes, and alerts a number of people, including his parents and Baszler, if readings appear out of boundaries.

“Mrs. Baszler can see my blood sugar, and so can my mom and dad, even when I’m far away at school,” Brock said.

Brock said he doesn’t mind visiting the nurse’s office at all, and said that she, along with his parents, have helped him understand his disease and what it takes to stay healthy in spite of it.

“(I’ve learned a lot from Mrs. Baszler), and I’ve learned a lot from my mom and dad,” Brock said.

Baszler said there are other challenges to maintaining a school nurse position in a school district. Finding substitutes when a nurse can’t be at work can be difficult. Non-medical school staff can feel pressure working outside their field of expertise. A changing student demographic can often mean that language barriers cause issues.

“We can have trouble finding substitutes, so if we’re gone, one nurse will have to fill in for four schools. It puts a lot of pressure on the nurse, but also on the secretaries covering for them when they’re gone,” Baszler said.

In the end, school faculty and staff, along with the school nurse, have only the best interest of the health of the student in mind, Baszler said. Thankfully, modern technology allows them to serve those students better than ever before.

Baszler said she hopes to see more districts make a priority out of hiring dedicated school nurses to tend to their students. The success of programs like Avera eCare is encouraging, she said, but said there is nothing better than a student being able to come to an office at the school and have a one-on-one conversation with a nurse.

“I would say having a school nurse in every school, every day, would be the ultimate goal. Just having one in every district, every day, would be nice,” Baszler said.