California falls significantly short of a new recommendation by an influential group of pediatricians calling for every school in the United States to have at least one nurse on site.

Fifty-seven percent of California’s public school districts, with 1.2 million students, do not employ nurses, according to research from Sacramento State University’s School of Nursing.

The call for a nurse in every school appeared this week in a policy statement by the Illinois-based American Academy of Pediatrics. The group’s new guideline replaces its previous one, which recommended that school districts have one nurse for every 750 healthy students, and one for every 225 students who need daily assistance.

The academy said the use of a numerical ratio was “inadequate to fill the increasingly complex health needs of students.”

Even when measured against that old yardstick, California’s schools are woefully deficient. Statewide, there is one nurse for every 2,784 students, according to 2014 numbers from KidsData, a program of the Lucile Packard Foundation for Children’s Health. That’s nearly four times more students per nurse than the academy had recommended.

And in some regions it is far worse than that. In Santa Cruz County, for example, there were 13,432 students for every nurse in 2014.

California’s school nursing shortage is troublesome, experts say, because nurses provide much more than basic health services to students. They help manage chronic diseases, assist with obesity prevention, and participate in emergency preparedness and behavioral assessment, among other things.

“School nursing is one of the most effective ways to keep children healthy and in school and to prevent chronic absenteeism,” said Breena Welch Holmes, lead author of the academy’s policy statement and chairwoman of its Council on School Health.

Kathy Ryan, a nurse in the San Diego Unified school district and president of the California School Nurses Organization, said the academy’s new guideline, which also calls for access to a physician in every school district, underscores the vital need to upgrade health services in the state’s schools.

She noted that the new recommendation is stronger than the previous ratio-based guideline for whole school districts. Having a nurse across town, even if it means a school district is meeting a numerical target, is not as effective as having a full-time nurse on site every day, she explained.

Ryan noted that when children are absent, schools loses money. So when school nurses help reduce absenteeism, they could eventually pay for themselves, she said.

California’s school nurse deficiency is due in large part to the fact that schools are not legally obliged to hire nurses, and employing them competes with other priorities for scarce funding, said Linda Davis-Alldritt, ex-president of the National Association of School Nurses and a former nursing consultant to the state’s Department of Education.

“Districts are stretched for money, and school nurses aren’t required, so they don’t see the need,” she said.

For California to attain the academy’s goal of a nurse in every school, the state legislature would need to make it a requirement, Davis-Alldritt said.

Barbara Feder Ostrov contributed to this report.

This story was produced by Kaiser Health News, which publishes California Healthline, a service of the California Health Care Foundation.