School district officials know they don't have the recommended level of school nurses in South Dakota -- and they also know there's not much they can do about it, given many other education funding issues.

At many small districts, nurses from health agencies are under contract to visit periodically. And educators simply call 911 in emergencies.

Larger districts such as Sioux Falls and Rapid City are well-staffed compared to smaller schools but are still below a level recommended by professionals.

Still, almost every district has non-medical school staff members trained to cover minor medical issues.

South Dakota is one of the majority of states that do not require schools to employ their own nurses.

But state code says public schools "shall provide" services coordinated by a registered nurse -- and that schools may share those services.

Statewide, the ratio of school nurses to students is 1 to 1,354.