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Sullivan's Island Elementary School nurse Caroline Aton checks a student's breathing for congestion before administering asthma medication on Wednesday, August 21, 2019. Brad Nettles/Staff

There was a time when Caroline Aton was traveling between five Charleston area schools for work. It was 1996, and she had just started working as a school nurse. 

She jokes that she and other school nurses at the time probably needed a portable police siren to put on top of their cars.

“Because we were all moving between schools at high speeds," said Aton, who now solely works at Sullivan's Island Elementary. “We have come a long way." 

Today, the National Association of School Nurses reports that there are more than 95,000 full-time equivalent school nurses and more than 80 percent of all public schools in the U.S. have a full-time or part-time nurse.  

Ellen Nitz, the director of nursing services for the Charleston Country School district, said back when nurses like Aton were working with the district in the '90s, there were around 15 of them. 

"We now have about 100 school nurses that help to manage health care needs," Nitz said. 

That doesn't mean the workload has gotten easier. A common misconception people have about being a school nurse is that all they do is sit around and put on Band-Aids, Aton said. 

“In fact, I yearn for the days where that's all I do," she said.

School Nurse

Sullivan's Island Elementary School nurse Caroline Aton checks a students blood sugar level on Wednesday, August 21, 2019. Brad Nettles/Staff

Nitz explained that school nurses have the potential of treating anyone who happens to be inside the school building at any time. She described the school nurse's station as a sort of mini-emergency room.

They can see cases ranging from small abrasions to life-threatening condition, such as seizures. She also explained that now nurses are seeing more cases of children with chronic illnesses like diabetes. While they serve as a health resource for hundreds of kids, nurses must be acutely aware of children's insulin needs. 

In a study funded by the Centers for Disease Control and Prevention, between 2002 and 2012, the number of children and adolescents under the age of 20 with Type 2 diabetes increased by nearly 5 percent each year. 

“You just never know exactly what is going to walk through your door," Nitz said.

At Sullivan's Island Elementary, Aton said she is responsible for more than 500 kids. With each child, she has to keep an updated record of health history. That's why the emergency cards sent home with back-to-school paperwork for parents to fill out are vital. 

“When you look at school nurses today, it’s almost like being a parent of over 530 kids," she said. 

When the bell rings in the morning, she said she instantly has 30 patients. She keeps track of and oversees every student's individual medications and treatments. She has run a special program for children struggling with making it to the bathroom for a bowel movement.

In addition to daily nursing functions, she has to manually enter all of the children's health information into a database at the beginning of the school year. This includes information such as vaccinations and allergies. 

“I probably have 35 EpiPens," she said.

School Nurse

Sullivan's Island Elementary School nurse Caroline Aton places students' medications in plastic bags with their names on them for storage on Wednesday, August 21, 2019. Brad Nettles/Staff

This year, she said, 150 new kids are coming to the school, and most of them are kindergartners. So on top of updating information for current students, she has a whole new set of students she must get to know.

She usually finishes recording students' health data in the fall. Then it's time to start medical screenings.

“It would be nice to have six of me," she joked. 

In the past few years, the Medical University of South Carolina has been working with schools throughout the state to establish school-based telehealth programs.

Dr. Kathryn King Cristaldi, the medical director of the program, explained that parents sign a consent form for their children to participate. Then, in situations where a parent would typically need to pick their child up from school to take them to a doctor, the student can see a doctor instead via video conference. 

Cristaldi said they started organizing school-based telehealth programs about five years ago. At that point, MUSC was working with 11 schools in Williamsburg County. 

In the past four years, the program has grown to about 100 schools across the state. The schools that are often primary targets for the program are in areas where access to a health provider can be a challenge. 

Another focus with the program has been to support school nurses, Cristaldi explained. 

“The school nurse is there for every child. They see a ton of kids a day," she said. “They’re the front-line public health professionals." 

The telehealth program hasn't reached Sullivan's Island Elementary. Aton said she understands that schools with low health resources are a priority. And she knows it would make her job easier. She hopes that one day all schools will have access to a telehealth program.  

In the short-term, parents can make her job easier by filling out the emergency health cards in the back-to-school paperwork and returning them "to the teacher as fast as humanly possible."

People ask Aton all the time about nursing. Her response is usually that she feels she's lucky to be where she is. And she finds the job refreshing.

"These little people are amazing," she said. 

Reach Jerrel Floyd at 843-937-5558. Follow him on Twitter @jfloyd134.