SALT LAKE CITY (AP) — Utah’s school nursing shortage slightly worsened over the past year, leaving school nurses with six times the recommended students under their care, according to a new state report.

Utah’s school enrollment continues to grow every year, but school nursing levels have not kept pace amid tight school budgets, leaving multiple schools relying on a single nurse and sometimes putting children at risk, parents and advocates say.

“For one nurse to be between three or four schools, that’s just ridiculous,” said DeAnn Kettenring, the health commissioner of parent-teacher group Utah PTA. “Especially when you have accidents, when you have different situations going on that require some kind of medical attention and people who are not really medically trained are doing these things.”

An annual report on school nursing from Utah’s Department of Health shows Utah had one nurse for every 4,543 students — up from last year, when Utah had one nurse for every 4,318 students.

The numbers are far above recommendations from the U.S. Department of Health and Human Services and the American Academy of Pediatrics that there be one nurse for 750 students.

State lawmakers are exploring whether Utah should use Medicaid money to pay for nurses, adding about $3 million.