Agyili Mitchell sends her daughter to Richard Wright Elementary every day holding her breath.

Aaila, 5, loves school, but the kindergartner has sickle cell anemia, asthma, and allergies that can send her into anaphylactic shock, and Wright, in North Philadelphia, has a school nurse only one day a week.

More than a dozen of the Philadelphia School District’s 220 schools lack a full-time nurse. Some of those schools share nurses, receiving care one or two days a week. Some aren’t covered at all.

Beset by a pandemic and a national nursing shortage, the district has roughly 18 nurse vacancies and nine nurses out on long-term leave. The nurses who are left are essentially performing two jobs — their regular duties plus the public health work required while COVID-19 rages.

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For families at schools with hundreds of children but part-time or no nursing services, it’s “unthinkable,” said Mitchell, who feels lucky because her sister works at Wright as a paraprofessional and would be close if Aaila gets sick. But Aaila’s aunt isn’t a medical professional, and “what about all the other kids who don’t have that type of access to somebody who can be there?” Mitchell asked.

“I’m scared to death,” she said. “I need for somebody to know how to care for my daughter if she ever goes into crisis.”

Philadelphia’s school board last month authorized spending up to $4 million to add contract nurses and other health services to supplement overburdened school nurses, but it’s not clear when relief might actually arrive. State law requires that students have access to school nursing services but does not mandate such services are provided full time.

Monica Lewis, district spokesperson, said the district recently issued a request for proposals for medical help. Though vendors are also faced with labor challenges, the district aims to have the contracts in place “as soon as possible,” Lewis said.

“Like many school districts and organizations across the country, the School District of Philadelphia is experiencing the impacts of a national nursing shortage,” Lewis said in a statement. “We recognize the valuable role of our school nurses in supporting healthy school environments for all students, and remain fully committed to recruiting and retaining top nursing talent in our schools.”

In the meantime, the vacancies are growing. Megan Boyle, the school nurse at Southwark Elementary, resigned last week, overwhelmed and frustrated by a system that she says leaves nurses to drown and, therefore, endangers children.

“I asked what was the plan to attract and retain nurses, and the response was, ‘We don’t know.’ It came to a point where I took it as, ‘Help is not on the way,’” said Boyle. “It wasn’t a light decision to leave, but it didn’t make sense for me to stay.”

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A former special-education teacher, Boyle was uniquely suited to be a school nurse, loved the work, and felt respected by her school’s administrators. But there was a lack of clarity on system protocols, confusing directives, and decisions made by people who lacked medical experience that made the overall experience “untenable,” she said.

Boyle accepted a position as a traveling nurse.

“The compensation is excellent, the health benefits are good,” said Boyle. “Why wouldn’t I?”

That poses problems for Southwark, which enrolls more than 900 students. One of them: Other district employees are prohibited by district rules from administering COVID-19 tests to students, parents say. That means when children display potential virus symptoms, they must be sent home.

Sulay Sosa, mother of a Southwark fifth grader, is worried.

“I’m concerned because there’s no one to check up on the kids,” Sosa said through an interpreter.

A group of Southwark parents are pushing for answers and help for schools across the city grappling with the nurse issue. Several hundred parents and other community members signed on to an open letter to Superintendent William R. Hite Jr. calling on the district to fill nurse vacancies and to provide the community with a timeline for when they will take action.

“The current situation is dangerous for our children and both unsafe and unfair to teachers and staff,” the letter said.

Parents “shouldn’t need to worry if there’s going to be a nurse at their child’s school when they need it,” said State Rep. Elizabeth Fiedler (D. Phila.), also a Southwark parent. “Having a school nurse feels like such a basic, fundamental thing.”

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It certainly is for the Bryant family, who have a third grader and kindergartner at Fanny Jackson Coppin Elementary in South Philadelphia, which has a nurse who will go out on medical leave soon — with no plans for a replacement, parents say.

Ben Bryant’s older child has epilepsy; if he has a seizure lasting more than five minutes, he requires emergency medication that can only be administered by a medical professional.

“For a lot of people, they only see the Band-Aids that go on when a kid gets scraped, or the call you get when your kid has a fever and you have to pick them up,” said Bryant. “The nurses play this role of being really critical first responders, and teachers can’t do that. They don’t have the experience and training, and it’s not fair or smart to put that burden on them.”

When Sherice Sargent discovered that her children’s school, George Washington Carver High School of Engineering and Science, lacked a school nurse, she equipped her kids with small first-aid kits to carry in their bags. Sargent found out about the nursing vacancy by accident, when she showed up at Carver to talk to the nurse and give her paperwork required for her eighth grader’s asthma medication and found there was no nurse.

“Right now, you have children getting first-aid administration by the secretary staff,” said Sargent, whose children’s school has nursing services only on Wednesdays. “Were they properly trained? What about liabilities? And there’s a pandemic. How is all of that being managed?”

Roxanne Carson relies heavily on nursing services for her daughter Deana-Rae, a second grader at Richard Wright and an insulin-dependent diabetic.

Because of Wright’s limited nursing services, Carson was able to get her daughter’s insurance to pay for a full-time private nurse to go to school with Deana-Rae. Without that, Carson said, the child couldn’t attend school. But Deana-Rae’s nurse can’t help the other children at Wright.

“There are so many gaps,” said Carson. “It just leaves children at a disadvantage. They’re not able to receive proper care.”