LANSING, Mich. — In the cramped but cheerfully decorated nurse's office at Dwight Rich magnet school, Marybeth Braddick has just given 13-year-old Raven Wanger an asthma treatment.

Then a teen pours himself a cup of water as Braddick unlocks the medication cabinet for his daily pill. Another student waits to have her injured ankle wrapped.

"I like working with teenagers, and I'm very aware that one's health impacts one's ability to learn," said Braddick, full-time nurse to the 631 Dwight Rich students in grades six to eight.

Many kids nationwide have chronic health conditions that require daily monitoring or medication, such as asthma, diabetes and allergies. But most states (including Hawai'i) do not require school nursing services and less than a handful of states provide money for those services. Over the last decade, about half the states have improved their nurse-to-student ratios and the other half — including Michigan — have seen their ratios worsen, meaning more students for every nurse to handle.

In Michigan, nurses are among the so-called extras that schools cut to balance budgets.

Meanwhile, "the incidence of medical need has risen," said Jim Davis, Lansing's deputy superintendent. "We would love to have a full-time nurse assigned to every building."

Kids who get hurt at school are more likely to stay for the day's classes if a nurse is on site, said Amy Garcia, a registered nurse and executive director of the National Association of School Nurses.

"Nurses are critical to reducing absenteeism and to keeping children with chronic conditions in school," Garcia said.

The nurses association cites some health data for U.S. children from the Centers for Disease Control and Prevention: Thirteen of every 100 had to take regular prescription medication for at least three months in 2002, and 12 of every 100 have a history of asthma. Also, five of every 100 have been diagnosed with a food allergy, according to the Mayo Clinic.

Only 17 states and the District of Columbia have legislation mandating school nursing services, and of those, only Connecticut, Delaware, the District of Columbia and Vermont provide money for the schools to fulfill that requirement, according to the nurses association.

In states with unfunded mandates, the nurse requirement can be a stretch, particularly for rural districts that can't afford competitive salaries.

The ideal ratio, according to the National Association of School Nurses, is one nurse for every 750 students.

Over the last decade, about half the states — mostly in the Northeast and South — have improved their nurse-to-student ratios. The other half — notably in the Rocky Mountain region — has seen a decline, Garcia said.

At Dwight Rich magnet school, Braddick spends some of her time in the classroom, teaching kids about nutrition, healthy habits and hygiene. She may be the person who tells a parent that a child's eyes should be tested or point them toward health care resources in the community.

"Sometimes a student doesn't have a doctor, or they don't have insurance," Braddick said.