This is the VOA Special English Education Report.

Last week, we discussed a new study of injuries in physical education classes in American schools. The number of students taken to hospitals increased one and a half times from nineteen ninety-seven to two thousand seven. Few injuries were serious. Then why treat them at emergency rooms? One possible reason: a shortage of school nurses.

Amy Garcia agrees with that. She is the executive director of the National Association of School Nurses.

Nurse Cindy Womack, right, talks to teacher Christine Quint about ways to prevent the H1N1 flu virus at their school in Houston, Texas

She says federal guidelines call for one nurse for every seven hundred fifty healthy students. In reality, she says, the number is more like one for every one thousand one hundred.

Every state is different. The association says Vermont has one nurse for every two hundred seventy-five students. In Utah, which has a bigger population, each nurse is responsible for almost five thousand students.

The recession may have reduced a national nursing shortage; health care is one industry that has kept hiring. But experts predict that the shortage will grow again. Another problem for schools is limited budgets. Nurses often have to split their time at different schools.

And not all schools employ registered nurses. An R.N. must have at least a two-year nursing degree. The Labor Department says registered nurses earned an average of sixty-five thousand dollars last year.

Amy Garcia says school nurses earn an average of forty-two thousand dollars. But some earn half that and are on the same pay system as cleaning people.

Pat Lewis is a school nurse in Beaumont, Texas. She and one assistant care for about nine hundred children ages four to eleven. She says many times the school nurse is the first one to bring health problems to the attention of parents.

Right now, as schools prepare to begin a new year, one concern is the H1N1 virus, often called swine flu. Last week, federal officials announced their latest guidelines for schools.

These urge local officials to balance the risk of flu in their communities with the problems that school dismissals could cause. The hope is to keep schools open. But if any schools do have to close, then the hope is to keep children learning -- for example, through phone calls or over the Internet.

Schools could also be used as places to give flu vaccinations. Federal health officials said they expect a vaccine for the H1N1 flu to be available by the middle of October.

And that's the VOA Special English Education Report, written by Nancy Steinbach and available at voaspecialenglish.com. I'm Steve Ember.