California judge rules only nurses can give insulin to kids

A Sacramento Superior Court ruling Friday marks a major shift in the treatment of nearly 14,000 California schoolchildren with diabetes.

Judge Lloyd Connelly sided with the California School Nurses Organization, the American Nurses Association, the California Nurses Association and other nursing groups in their challenge to a 2007 rule that enabled trained school staff – not just school nurses – to administer insulin shots to diabetic kids.


Finally, a state that understands and values the importance of the school nurse for our children. Now, how long will it take the rest of the country to follow?? Thank you Judge Connelly for setting this precedence.

This is nuts! I am not a nurse and most of us aren’t, but we can administer shots. If we can be trained to keep our children alive that means other willing people can be trained too. Schools only typically have one nurse if that many. What… Are our kids just supposed to sit around and wait while they are busy with other kids or to travel from another school??? All I can say is that I am disappointed in the judges who allowed this and for the nurses that were only thinking of themselves and not what problems this will cause to their patients who should be their first priority. Don’t get me wrong, I appreciate nurses in general but I disagree with this move.

The battles we go through My daughter was diagnosed over 16 years ago she also has developmental delays. She has always been in Special Ed. When she was diagnosed, I had to fight for two years for the nurse to make the staff blood test her. She did not want to train them to this because it was blood products. I said what do you do when a kid cuts himself. Give me a break! We had aides and staff that would not even code her meter because they were not medically trained. It went against their union and job decription. I could tell you more stories and battles we have gone through with this condition. Now she is in a day program. The diabetes educator would like her having insulin with each meal. She can test herself and give herself insulin under supervision. I mentioned her having insulin at lunch to some of the staff that care for her. You should have seen their faces. Maybe some day that staff will give insulin. Right now her insulin regiment is a cocktail with a small amount of NPH with the Novolog for breakfast to hold her through lunch. She gets Novolog for dinner and Lantus at bed time. She does the pen herself.
When my daughter was diagnosed, I did not have a medical background. I had never given anyone a shot in life. Yet I had to learn how to care for her. It was over-whelming at first. I do not see why lay people can’t learn to do this. Home health aides and nurse’s aides and other willing health care workers could be trained to do this. They probably have more medical training than most people. Unfortunately insulin must be taken as a injection or pump to maintain health. Can’t pop a pill for Type 1 diabetes.

There is on going program in Riyadh started by our best diabetologist Dr Khalid Al Rubean with the cooperation of school health department to give courses to teachers about diabetes care at schools. It is very important to manage diabetes by well educated staff, and how to manage the hypo and hyper especially where there are no available nurses or doctors.

This is SO bogus. It’s just making it harder for parents. If I can learn to give insulin injections properly, so can anyone else—it’s not rocket science and doesn’t require a nursing degree. Shame on the nurses for fighting parents on that—they should be working to help us make life EASIER, not harder. And in reply to Luciano, don’t you think the school nurse’s time is better served taking care of kids who are actually SICK than in performing what amounts to maintenance? There’s usually only one nurse per school, and in some districts there’s one nurse for several schools. So what’s to become of my son when he has a high reading during the day but the nurse is off in another school for that afternoon? Sure, you can argue all you want that it simply points to the fact that each school needs its own nurse, but budgets are what budgets are, and many school districts in rural areas can’t AFFORD a nurse. So you have one of two choices: raise taxes to fund the nurse (which only stresses parents more because most of us can’t afford any new expenses) or allow a non-professional to administer the insulin.

I don’t think anyone with diabetes will argue that having a nurse in schools would be best, but some of our communities can’t afford it.

By taking the care out of the hands of the adults who care for a child (by limiting the care to nurses), you are seriously limiting the care a child with diabetes may get. And what if that “child” is 15 or 16 and wants to do their shot themselves?? There was never a school nurse when I was in school. I could check my own blood sugar by the time I was in kindergarten. And there was always a teacher who knew how to do it too. I didn’t go on mdi’s (I was only 2 shots per day) until I was a freshman in high school. Guess what…still no school nurse. Not that I would have let them near me anyway. I did my own care. And did just fine, thank you.

This is a HUGE blow to the class action lawsuit and the credibility of the California Board of Nursing. The question now remains just how the schools will comply with their requirement to provide an equal opportunity to students with diabetes. The nurses have refused since being ordered to comply, to do so. Now, it seems they can legally refuse to comply. The nurses have endangered our children and overburdened schools who are STILL required by law to take children with diabetes only now, they cannot provide care for them.

Shame, shame, shame on the nurses associations AND the teachers association that came out with big guns to keep our children out of public schools.

Very few states in the nation have any laws requiring nurses at school and as a professional legal advocate I get letters every single week from parents across the country whose children have either been unable to attend school or have been seriously injured at school when no one recognized or treated blood sugar problems. Most schools in the nation do NOT have nurses so no one onsite can or will help our kids. It literally has boiled down to “sure, the law says we have to take your kid, but enter at your own risk.”

I was very involved with this case from the start and the bottom line was the considerations were not about our children but about the nurses who have long been ignored pushing the need to hire more school nurses. While I fully support our poor overworked school nurses, this will not lead to hiring more health professionals to help with the crisis. It will lead to more children with diabetes being unable to attend school, and more serious diabetes crisis in school because now, even more than before, schools will be “hands-off” for our children.

CA faces a nursing crisis (3rd worst in the nation). There are not enough nurses to hire to fill our California schools. How many children will die at school before the courts care? And yes, children have already died at school in California because of inept diabetes care. How many of us parents are nurses? We are sent home still reeling from diagnosis with our children to learn as we go. To say that only a nurse can provide care is a poor excuse. My 9-year old can give her own insulin now, but at age 5 she could not. The law does not permit nurses to train staff, but parents can? HELLLOOOO???

My daughter remains home schooled because her school, which did not have a nurse on site, literally, nearly killed her because they would not do anything for her without a nurse around. Nor did they even call me. I went to check on her as I always did several times each day and found her slipping into a coma unattended on a playground. Only minutes before she complained to her teacher she was not feeling well. With no nurse avaiable, she simply sent her out to play with other children in 100+ degree weather “until your mom gets here.” But “Mom” was never called. Had I not arrived when I did I shudder to consider the possibilities.

Our school district policy is literally “if something’s wrong all 911. Then call the parents.”

I wish I could say this decision saddened me, but frankly, it enrages me beyond belief. It was about MONEY not about children and liability.

This battle is not over. Not as long as I live in CA and have two kids home schooled because of diabetes and a school system that would rather not deal with “my” problem.

insanity-rest of my angry thoughts here:

This is frightening and very self-centered of the nursing associations. But what frightens me more is what has been said about not allowing diabetic children to attend school. Am I reading this right? If a child has diabetes he/she will not be admitted to a school? That is absolutely crazy and with the epidemically growing growth rate of the disease there will be more children being schooled outside the system than in it.

In some school systems, there is one nurse for every 3 to 5 schools.
I remember when my daughter went into anaphalactic shock, and they had to call the nurse who was at another school to come over.
It was ridiculous.
Time counts, and the school secretary made the wise judgement of calling 911 too.
They got there first.

Every school should NOW be mandated to hire a school nurse who will be there from the start of school till every after school child has gone home. Crazy.

In some school systems, there is one nurse for every 3 to 5 schools.
I remember when my daughter went into anaphalactic shock, and they had to call the nurse who was at another school to come over.
It was ridiculous.
Time counts, and the school secretary made the wise judgement of calling 911 too.
They got there first.

Every school should NOW be mandated to hire a school nurse who will be there from the start of school till every after school child has gone home. Crazy.

In our school district in California there is one (yes one) district nurse that services all schools - more than 7,000 students and 12 schools. This is even in violation of federal law that requires a certain number of nurses per schools (but not one in each school). California has never been held accountable for being in violation of this “minimum” federal law so they will now get away with turning our children away from public school.

But in our district school staff are not permitted to administer any form of medical care without the nurses’ involvement. The school that my daughter briefly attended kindergarten even had a vocational nurse on site (instead of a health tech) but even she was not allowed to do so much as help with a blood sugar check let alone give insulin. She quit a month later in part out of frustration that being “just” a VN instead of an RN she could not be trusted to do her job.

In California we have the third worst shortage of nurses in the country. 80% of all the currently employed (in CA) actively licensed RNs with a bachelors degrees (which is required in school district job applicants for school nurses) would have to quit working in hospitals, clinics, private practice, and home nursing to come work in our schools. I pointed this out to the Board of Nursing, by the way, citing their own nursing statistics. They took it under “consideration” long before their vote against parents, children, and even against schools.

A nurse in every school would be a dream come true. But it just is not going to happen. Since CA is not even in compliance with minimum federal law how are they going to now adhere to the 10-fold increase in demands of the nursing board?

This does not just affect kids with diabetes. It impacts kids with everything from peanut allergies (think epi-pen) to asthama. In our district, kids with asthma may not even carry inhalers with them. They must go to the health office, the nurse is called and then gives “permission” to let the child use their inhaler.

Thank you, Board of Nursing for pursuing a political agenda that did not even mesh with a number of your own nurse members who boldly and openly vocally opposed your position. You set a low standard of care model for the nation in this historical class action suit that makes it easy for schools to refuse care “per the law” to any child with any medical need, no matter how minor.

If only a nurse can give care to a child with diabetes, I want my license handed over to me now because I have been doing it for fours years without a nursing degree.

YOU SAID IT!!! I don’t even live in your state and it makes me crazy to think of how incredibly stupid that rule is. Why not just duct tape parents’ hands and feet while they’re at it? I hope you’ll write nasty letters to the Board of Nursing as well as any and all members of your legislature.

Oh, my GOD, what a horrible story. THANK HEAVENS you got there in time. I am just as enraged as you are. How dare they take such chances with your daughter’s life???

It’s a major setback that only nurses can do the shots in school. It’s okay if they absolutely want to train the school staff to do the shots, but to forbid the staff from doing them is insane!

Some compelling facts that make this ruling all the more concerning for California’s 13,886 children with diabetes in schools and their families…

There is a severe shortage of nurses in California that has a severe impact in the public schools and makes a nurse in every school physically impossible:

-California has one of the worst ratios of students to school nurses in the country: 2700:1 vs. the federal government’s recommended average of 750:1. In some counties, the ratios are worse (e.g Orange County is 3,064:1).

  • Of the 1,236 districts in California, nearly half have no school nurse at all.

-In 2006-07, most school nurses were “roaming” from school to school and spent an hour a week, if that, at some campuses.

  • Of those students that graduate from nursing programs, few choose to enter the school workforce because of harsh working conditions and low wages ($13,600 lower than a teacher).

  • The California Board of Registered Nursing found in 2007 that California faces a severe nursing shortage ranging between 10,294 and 59,027 full-time equivalent registered nurses, depending on the format of the forecasting measures.

  • Even if a district has a nurse, it is physically impossible for that person to be available at all times when a student needs an insulin dose. Delays in administering are bound to occur.

Despite assertions by the nursing organizations, diabetes medical professionals agree that administration of insulin does not require “highly specialized skill”,

  • Among the medical experts who support this position: American Academy of Pediatrics, American Association of Clinical Endocrinologists, American Association of Diabetes Educators, Lawrence Wilkins Pediatric Endocrine Society, Pediatric Endocrine Nurses Society, American Dietetic Association, American Diabetes Association, Children with Diabetes, Juvenile DIabetes Research Foundation.

  • The National Diabetes Education Program also supports insulin administration by unlicensed personnel in its guide titled Helping the Student with Diabetes Succeed: A Guide for School Personnel. This guide, published by the federally sponsored partnership of the National Institutes of Health, the Centers for Disease Control, and more than 200 partner organizations, includes research, medical, professional, educational and other groups.

Federal laws require that insulin administration be provided.

  • Section 504 of the Rehabilitation Act and Individuals with Disabilities Education Act (IDEA) require schools to provide related healthcare services in full to student in need.

  • Schools/districts may NOT require a parent or parent designee to provide admin of insulin/diabetes care as a condition for facilitating a child’s attendance at school or school-sponsored activity. Doing so is a denial of a child’s right to a free, appropriate public education (FAPE).

Scary stuff. I am glad to see so many caring parents :slight_smile: As a nurse I think this is crazy considering the shortage issues as mentioned and as far as school staff there is no reason they can not and should not be trained as first responders. Also is it that difficult to call 911? I fear for your children.


I feel it is important to try to digest this ruling and understand where it might be trying to go. In reading the article, this is solely for the administration of insulin injections - most educators do not want this responsibility and furthermore will state that it is not in their contract. But, I can’t imagine an educator or administrator willingly allow something to happen to our children - they are in the “child” business. With 504’s in place, and the fight for nurses in our schools, counties and states may find themselves mandated to provide nurses in schools. I believe this is where the ruling is trying to go, and I quote from the article:

“Spradling, with the School Nurses Organization, said “districts need to be told that school nurses are not a luxury, but a necessity, and with so many children with chronic conditions, they have to find a way to fund them.””

Although the child with diabetes is our concern, other chronic conditions are in the schools, both child and adult, and the school systems need to wake up and realize that a nuse, or LPN is a must.

The problem with this is that school systems can’t afford this, so they are stuck with one or two nurses system wide…and then they are forced to tell parents, "Yeah, we know your other 3 kids go to X school, but there’s no nurse there, so your diabetic child will have to go to Y school."
And that has been happening all over the country.