Less than half of schools in Kentucky have a full-time nurse.

According to Bellarmine University research, 42.2 percent of state schools have a full-time nurse, 37.4 percent have a part-time nurse and 20.4 percent don’t have one at all. Healthy People 2020 recommends a ratio of students to registered nurses of 750:1.

Pat Stewart, director of pupil personnel at Warren County Public Schools, said a lack of state funding keeps the district from stationing a nurse at each school.

The district employs seven full-time nurses, he said.

“They usually serve at three or four schools, depending on the need of the students,” he said.

Though he’d like to have a nurse at every school in the district, Stewart commended the nurses’ performance.

“We have a very dedicated staff of nurses,” he said. “They work very hard.”

If a student does need medical attention when a nurse isn’t on site, office secretaries will do what they can to meet the child’s needs, Stewart said.

“Our secretaries, they wear many hats,” he said.

For the upcoming school year, the district is hiring part-time health aides, who will be trained by the nurses they’ll work with, Stewart said.

In addition, the district will also be training about 400 employees, including teachers and coaches, to administer medication, he said, adding that this is routinely done as part of a state requirement.

School nurses are often among the first positions to be cut when a district’s funding is reduced, according to Teena Darnell, an assistant professor of nursing who led the Bellarmine University research.

“I think to a principal, it looks better to have another teacher,” she said.

The state statute pertaining to school health services does not require a school to have a medical professional on site.

Darnell said her research indicated that schools with full-time nurses had higher grades and lower absentee rates.

“They help to keep kids healthy and in the classroom,” she said.

Mark Wallace, assistant superintendent of Barren County Schools, said his district has a nurse in every school, thanks to an agreement it has with the Barren River District Health Department.

In this agreement, which started six or seven years ago, health department-employed nurses are stationed in the district’s schools, with Barren County Schools paying a “reduced rate” of roughly $11,000 for each nurse to the department every year, he said.

“In a lot of instances, that wouldn’t even come close to hiring a nurse if you were to hire one straight out,” he said.

Before this agreement, the district employed one nurse, who, though she “did a great job,” often struggled to keep up with the demand for her services, Wallace said. “With as many schools as we had in Barren County, it spread her pretty thin.”

He said the district is appreciative of having medical professionals in its schools. “It just makes things go smoother during the day,” he said.

Dennis Chaney, BRDHD district director, said the fee it charges districts for providing nurses is $11,200 per nurse.

BRDHD provides nurses to Bowling Green Independent, Russellville Independent, Caverna Independent, Barren, Butler, Hart, Logan, Simpson and Metcalfe county schools, he said.

“It just has grown to the point where we have 44 nurses at schools throughout our area,” he said.

Robert Tuck, director of pupil personnel at Butler County Schools, said the district has a nurse at every school except Butler County Middle School because of a similar deal with BRDHD.

“They really provide us with a great resource. We’re very fortunate to have that resource,” he said.

Before its contract with the health department, Butler County Schools also had one nurse for the entire district.

“That was just common practice throughout the state,” Tuck said.

The nurse would go from school to school as needed while the school secretaries helped with medical issues when needed, he said.

Eva Stone, a nurse practitioner working with Lincoln County Schools and the co-chair of a group called A Nurse In Every Kentucky School Group, which is connected with the Kentucky Nurses Association, is working toward making on-site nurses a guarantee for students across the state.

The group, which was founded roughly a year ago, lobbies for legislation requiring every school in Kentucky to have a full-time nurse.

“We have lots of children with health needs in schools every day and there isn’t much top-down support for them,” she said.

School nurses remove health-based obstacles that prevent children from learning, cut down on students who are chronically absent and are crucial for low-income students who don’t have a chance to see medical professionals otherwise, Stone said.

“We feel very strongly that every child needs to have access to a nurse in their building,” she said.

Many schools partner with local health departments but this practice is not as common as it once was, Stone said.

Before November 2011, the state administered Medicaid reimbursements for many of the health department’s expenses, including the hiring of nurses, she said.

In 2011, Kentucky adopted a system where managed care organizations provided the Medicaid funds instead of the state. As a result, the amount health departments could get reimbursed decreased and some schools were unable to shoulder the rising costs, Stone said.

In its efforts to change the system, A Nurse In Every Kentucky School Group has met with state Sen. Reggie Thomas, D-Lexington, and seriously discussed its goals a few times, she said.

“We’re still early in our work, but we’re well on our way,” she said.

— Follow Daily News reporter Jackson French on Twitter @Jackson_French or visit bgdailynews.com.