LOS ANGELES (Reuters) - Los Angeles teacher Natali Escobedo says she will never forget the image of a diabetic fourth-grader “wilting” at her school because there was no nurse on hand to administer his insulin.

FILE PHOTO: Some of the more than 30,000 teachers in the Los Angeles public school system hold a rally at City Hall after going on strike in Los Angeles, California, U.S., January 14, 2019. REUTERS/Mike Blake

The episode, which followed years of tight budgets that left little money for medical staff, highlights the potential impact of a lack of nurses throughout the Los Angeles Unified School District, one of the key reasons Escobedo and her colleagues are on strike.

In L.A., as in many districts across the United States, the school nurse is the first and sometimes only point of entry for many families into a complicated and expensive health-care system.

Like most schools in the more than 1,200-campus district, Lockwood Elementary, where Escobedo teaches, has a nurse just once a week. Children who become ill are left to the care of first-aid trained administrators or simply wait for a nurse to come from a nearby school to help them.

“There were times when the student would be struggling because of his condition,” Escobedo said. “He would have to wait or the nurse would get sidetracked due to some other emergency and my student had to sit in the office like a wilting flower waiting for his medicine to arrive.”

Teachers in the massive district, which serves more than 600,000 students, have been on strike since Jan. 14.

In an unusual twist for a labor negotiation, the two sides are fairly close on salary, but teachers say they are holding out for an improvement in student conditions, citing the need for more school nurses, psychologists and smaller class sizes in a district where as many as 46 students are sometimes crammed in a single classroom.

The teachers are demanding a full-time nurse at every school in the district, compared with a current nursing staff of about 400.

A previous offer from the school district came close to meeting the teachers’ demand for a 6.5 percent salary increase, but would increase the number of nurses for just one year. The union, United Teachers Los Angeles, rejected the proposal.

Even if the district was willing to hire more medical staff, it may have difficulty finding suitable candidates because of a nationwide shortage of nurses, said Sosse Bedrossian, director of nursing services for L.A. Unified, which

currently employs 400 nurses and has openings to hire 30 more.

“I would always advocate for more nurses,” said Bedrossian, herself a school nurse. “But even if we did have a full-time nurse at every school, would we be able to fill those positions?”

In a typical day, a school nurse might work with diabetic students administering insulin, assess school athletes to make sure they are healthy enough to play safely and handle a succession of cuts, bruises, fevers and upset stomachs, Bedrossian said.

If there is no nurse, she said, school administrators trained in first aid will take a child’s temperature, call parents and in emergencies, call paramedics to assist. Nurses in nearby schools will also come to help if needed.

The school district also has about 30 clinics and wellness centers at various campuses, an acknowledgement of the key role that school nurses play for families in disadvantaged areas.

But nurse Stephanie Yellin-Mednick, who works at four different schools as well as a nursing field office, said that is not enough. An on-site nurse can not only help a child in an emergency, she said, but might also notice medical or psychological issues that administrators who are not health care professionals would miss.

Once, she said, she decided to take the blood pressure of a child who was wearing a hooded sweatshirt on a hot day. Pushing up the child’s sleeve, she saw evidence of the self-harming behavior known as cutting, a sign that the student was having serious mental health problems.

At Gaspar De Portola Middle School in the San Fernando Valley, administrators were so worried about not having a nurse on campus every day that they decided to devote federal funds that would otherwise go to pay for textbooks and other needs to paying for a full-time nurse, said Susan Calkins, a teacher who is the school’s union representative.

The need is particularly acute at schools in poor areas, where families have little access to medical care, and parents cannot leave work to simply pick up sick children and take them home, said Escobedo, the fourth-grade teacher.

“When you are working at a school with children who do not have the basic necessities of life, then a school nurse is absolutely vital,” she said.