The School District of Philadelphia laid off or lost to attrition more than a third of its school nurses last academic year in ongoing efforts to shore up its budget.

A new survey by the Education Law Center in Philadelphia found some of the nurses who remain say the shortage is putting students at risk.

About half of the 70-plus survey respondents, mostly school nurses, said students were not getting needed urgent medical care. A third said students were not getting medications at prescribed intervals.

"It's impacting schools, it's impacting families, and it's even impacting the larger community because we have an increase in calls to 911," said Maura McInerney, senior staff attorney with the Education Law Center. "One of the school nurses reported that just in the last month their school had to call 911 three times for things that should have been handled by a school nurse."

McInerney said cutting school nurses also affects academics: Half of survey respondents said students were missing class time because of the staffing cuts.

School nurse Eileen Duffy, who splits her time between two Philadelphia high schools, said students know when she is not in the building.

"The students will also know they might not want to be in school. So on that day they know there's no nurse in the building, (they think) 'I can go home sick because all I have to do is say I have a headache, then I'm out the door,'" Duffy said. "We are often gate-keepers... But you can't do that from a distance."

More nurses are splitting their time between more than one school, and the district has trained teachers and principals to dispense medication and provide other services to meet the needs of disabled students.

Philadelphia School District spokesman Fernando Gallard called the decision to lay off nurses "extremely difficult." He said the district factored student health into school nurse assignments.

The district is reportedly looking to partner with local universities to get supplemental health services into schools.

The report urges the state to adjust its mandatory minimum nurse staffing rules. Pennsylvania currently requires one nurse for every 1,500 students. The National Association of School Nurses recommends one for every 750 students.

According to nurse staffing and enrollment numbers provided by Gallard, the current nurse-to-student ratio at Philadelphia public, parochial and private schools is one nurse for almost 950 students.