Our schools in Edmonton, Alberta do allow teachers to test. When we first approached our son’s school to have someone tested, the principal put her back up and stated “We are not medical people, blah, blah, blah”. Sorry, but SOMEONE has to do it!!! With a bit of pushing, we got things organized. Later, we found out the truth that teachers here are allowed to test. The principal lied (a principal of a Catholic school mind you). My point being that many schools are so worried about liability over a child’s health and well-being. It makes me sick.
I Can’t imagine that any school nurse would ever make as much as a Principal and I live in Massachusetts where that would NEVER Happen.( Weaver)
Don’t make the mistake of assuming School Nurses are in this for the money? I left a great job in the business world of Health Care and 10 years later I am still in School Nursing. Having said that, unfortunately for school systems diabetes and allergies(esp. food allergies) are on the rise and require more monitoring, nursing education and assessment than just teaching a basic finger stick or giving food for diabetic who is hypoglycemic. And in this country, lawyers chase cases that involve harm to a child for things that are basic and considered “reasonable care”. Alot of this has to make sense. Are there schools with nurse coverage of 1:2,400 who has no access to emergency medical response within 5 minutes and no hospital for 50 miles? Severe Hypoglycemia and Diabetic Shock can lead to brain damage as can Hyperglycemia and Diabetic Coma( severe High blood sugar). A child who stops breathing from allergic shock has about 5 minutes( as would heart attack victim) to receive proper care. Some schools buildings it takes loonger than that to locate the appropriate person who is trained. So how much do you value a childs’ life and future?
It’s harder with younger children, but we had Red Cross Standard First Aid as part of our 7th-Grade science curriculum. Perhaps someone (who?) can come up with a one-day emergency training for severe allergies and diabetes, and this can be offered both to schools (teachers and teachers’ aides required to pass… can be done by scheduling one of those teachers-have-something-but-students-stay-home days?) and to students at the junior-high or high-school level. (This can also be offered to the general community like standard First Aid, fees charged for the course, and certification expiring every so-often. It could/should also be added into the basic EMT program.) Just like CPR and AED training, this would give the people around us the knowledge to get things moving quickly while calling for help.
What bothers me about this is that school staff will administer an Epi pen but not an insulin shot. Why? What’s the difference? This decision by a Californian judge is only going to make some lives a real pain.
How is this supposed to work for every school? At my school, we’re in the process of moving so we’re a little messed up. We have two schools- k-6 in one and 7-12 in the other. They are a few miles from each other.
The school nurse works at the k-6 school, but of course, not the 7-12. And of course, I am in the 7-12 school. In the office, we have a small nurses bed behind a few shelves, so that’s where I manage everything. My backpack is kept there. I leave Math ten minutes early to do my shot, calculate things, test and have a few minutes in case I have trouble getting the shot in or something.
But the nurse bed is where the sick kids get to lie down, so it’s often full, especially at this time of year. At this time, I go to the Teacher’s Lounge- which is also often closed off. Then I go to an empty classroom and try to do things as quickly as possible (being careful to be accurate!). You never know when a teacher- or a class full of kids- will come marching into the room. And most don’t even know what diabetes or insulin is.
I find myself worried at school. I’ve educated my friends on what warning signs to look out for, who to call (911!), what to give me, what numbers I should be at, how to operate a syringe, how to work the pen, how to test sugar, how to give a glucagon). They’re basically experts now, but the teachers are not. My math teacher doesn’t know what blood glucose is and I have to explain my low in the middle of a math test- the resulted in a D-. My science teacher tells me that the place we’re going to on the field trip has a bathroom where I can do my shot, when all I want her to know is if I’m shaky, give me carbs. My P.E. teacher is telling me what to eat and what not to eat when I know that Type 1’s can eat a grocery store if they want- they just have to cover it with insulin.
School is so far my biggest struggle and offers the most stress. I would love to be homeschooled… although I would lose a lot of friendships. A teacher or ANY one can be trained to give an insulin shot, watch for warning signs, test glucose, ect. If my mom and dad can do it- if my brother can, anyone can!
you must remember that states instituted the Nursing Practice Act to protect the public from persons practicing nursing (like giving medicine and shots) without a license/training. giving a shot/medication encompasses oh so much more than just jamming a needle in…why should children in school be treated as second class citizens who cannot enjoy the protection of laws and professional care simply because they have a chronic disease and are in a school building? why not just have a mom come in and read to the kids who are behind in reading as well - who needs a reading specialist? also for the record the American Academy of Pediatrics’ position paper “Who Should Administer Insulin in Schools? Sorting Out the Controversy” published Sep 28, 2009 very clearly states that “at this time, only nurses in all districts should administer insulin to students incapable of doing so themselves.” the reasons are as follows: 1) medicating at home is different from medicating at school- conditions at schools enable far more errors than one patient in one home with one caregiver who is very familiar with the patient. 2) having a nursing license makes a difference - nurses are far more likely to catch the error and know how to correct it- plus will advocate for the patient against administrators if necessary - they are the medical experts in the school community. 3) insulin requires calculations 4) schools are the places least prepared for negative consequences of “accidental overdose of insulin” compared to say, a hospital.
right now, 99% of diabetic children are being managed just fine by the nursing staff in schools. Believe me, certified school nurses easily outnumber the demand - schools just won’t budget for them. I read a lot of anecdotal horror stories on this site but I see NO SCIENCE that shows a shortage of nurses or a pressing need for insulin to be administered by a bunch of “volunteers.” if it is so harmless(?!?!), as many vociferously state, then why is a clause being written into the law to hold harmless those who “volunteer” to give the insulin. I say if they’re going to take on the task that nurses are currently doing, then at the very minimum, they shoud be held accountable for their actions, just as nurses are now.
Who would be so arrogant as to ignore the American Academy of Pediatrics opinion?
check it out for yourself
http://pediatrics.aappublications.org/cgi/content/extract/124/4/1211
your comment on the American Academy of Peditrics supporting “volunteers” giving insulin in schools is incorrect. You need to go directly to their site where you will see they clearly state “at this time only nurses in all districts should administer insulin to students incapable of doing so themselves.” I have noticed a lot of information disseminated on this site that is just plain inaccurate and no one is double checkng to see what the truth is.
http://pediatrics.aappublications.org/cgi/content/extract/124/4/1211
“California nursing standards do permit and even encourage nurses to delegate certain medical tasks to other school personnel” nurses can delegate TASKS (i.e. check a blood pressure, collect a urine sample) but clearly not anything that requires nursing assessment and nursing judgement. I can assure you nurses would NEVER delegate calculating and giving medication by injection.
why not save money on a lawyer and just have a paralegal go to court for you? “we all know they the ones who really do all the work anyway.” (I actually have heard people say that).
Lahle, you are far too emotionally involved in this topic to be objective. You should be debating this topic with people of the caliber of Nancy Brent, RN, MS, JD, instead of scaring parents silly.
Its intersting in Austin Texas a cop that is trained can draw blood from a suspected drunk driver with no medical experience yet trained school staff is not allowed to administer insulin shots.
here is the difference, Blondie.
- a dose of epinephrine, if not needed, will never kill a child. A dose of insulin if not needed, probably will.
- epinephrine does not require calculation. basically one size fits all in the pen. insulin requires calculation. In fact, insulin is in the top 5 High Alert medications per Institute for Safe Medication Practice.
I have terrible mixed feelings about this. As a former school administrator, I appreciate the role nurses play in schools. Unfortunately, i also understand the problem with the thinning of resources. So there are a couple of things to remember.
First, there can never be enough nurses and do we as a society really want to hire enough to take care of all issues? Remember every nurse that is installed effectively displaces at least 1/2 a teacher. So let’s take a typical school. In many states the census to nurse is suggested at about 500 to 1. Now let’s look at two issues. First a large high school of 1,500. By rights that means the district would need a minim of 3 nurses, some would say for safety one would want 1 to 400 or 4 nurses. Be it three or four, we are talking about 1.5 to 2 teacher sin that building. In a school of 1,500 that means 1 and 1/2 schedules or the price of an art, band, PE, Literature or math teacher. Each teacher in a HS educates about 130 kids. So which one would you choose? Remember there are no zero sum gains.
Now let’s look on the other side a school of 200. This would likely be a small elementary but just like the big HS, this will mean at a minimum 1 nurse or half a teacher. Since of course, one has to account for sick nurses, the only safe policy is 2 nurses, though one can be a floater in a non-assigned fill-in position.
So, we have a nursing shortage in this county and an artificial increase of school nurses, means nurses will be removed from other places. So where do we give it up at? DO we wish less nurses in our intensive care units? ER’s? Maternity wards? And when you see that there is a law demanding school nurses be hired that means those nurses will have their salary raised to satisfy the demand. After all one cannot think of a person who would work at a school, for less money than a hospital? or doctor’s office?
The thing is, such laws are terribly inefficient and despite some good reasons, they rarely work. Sure, one can demand more nurses be employed. But what about doctors? How about nurse practitioners? why not cardiac surgeons? Not employing these is no more or less noxious than not employing a school nurse. I mean after all the number of diabetic accidents due to insulin overdoes in US schools last year? According to the department of education, none. The number of accidents due to cardiac arrest in school pools? 14. It makes more sense to force any school with a pool to hire a cardiologist, then it does to make a school employ a nurse.
In short it is waste of money. I prefer my kids with a qualified school teacher, instead of a nurse who sees as few as no kids for an insulin injection.
rick phillips
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Go read the ruling, Rick. The ruling is that the Nurse Practice Act already in place means the Diabetes Act is invalid. Only nurses can practice nursing. Just like only certified teachers teach. And administrators must have an administration certification. Why not just hire a part time dad to come in and be the principal of a school? After all, the only thing a principal does is break up fights and line up buses, right? For $125,000 a year. Talk about inefficient. And we’ll never have enough teachers so why not just have a mom volunteer to come in and read aloud to the kids… see how your argument against one profession sounds pretty silly when you apply it to another?
you must understand that the ruling is that the law has said for a looooonnnng time that only nurses can give insulin. the ruling is that the new diabetes act is invalid because there is an existing law on the books that already said only nurses can practice nursing.
drawing blood one time from a vein and giving a medicine that is listed in the top five High Alert medications by the Institute for Safe Medication Practices are two different things.
IMPORTANT UPDATE: Last month, in October 2010,the California Supreme Court granted the American Diabetes Association’s request to review this important legal case, and it will likely take at least a year before the court issues a decision.
In the meantime, because the California Supreme Court has decided to review this case, it means that:
- the California Dept of Education’s Legal Advisory on the Rights of Children with Diabetes in CA K-12 Public Schools remains in full force and effect. The Legal Advisory, issued to all schools in August 2007, states that it IS permissible to train unlicensed voluntary school personnel to administer insulin if a nurse is not available. And…
- the ruling issued by the Court of Appeal in June 2010 is no longer in effect.
Please read the ADA’s most recent message issued on 10/07/10 at: http://www.diabetes.org/assets/pdfs/know-your-rights/for-lawyers/education/CA-parent-message-10-7-10.pdf
A copy of the original CA Dept of Ed Legal Advisory can be found at: http://www.cde.ca.gov/ls/he/hn/legaladvisory.asp (Note: the CA Dept of Ed has not updated this webpage since March 2010.)
I agree, Luciano, about the value of the school having a nurse onsite, but given the financial situation in California and elsewhere how likely is that to happen? Instead these children will be without perfectly safely trained adults to give them their shots.
Not really, and I am not arguing against a profession. Let me explain. diabetics are taught and directed self care. Just like parents are teachers. Schools are full of non certificated individuals who do all sorts of tasks. Not everything a principal does is exclusive to principals. For instance principals break up fights in the cafeteria, but so do hall monitors counselors and secretariats.
my point and I stand by it is that insulin is in my opinion a task that can be done by non nurses. In fact, almost all type 1’s even the youngest live quit well without a nurse 24 / 7. I believe that in this area nurses are not required. Just as in most school corporations int eh country part time IA’s insert feeding tubes. I am far more uncomfortable with feeding tubes and catheters than i am insulin injections.
rick phillips
“I am far more uncomfortable with feeding tubes and catheters than I am insulin injections.” Exactly why you don’t understand the issue. Feeding tubes and catheter care are mechanical issues, just like starting an IV. but putting in insulin or deciding to withhold it requires far more assessment and calculations of a metabolic process. Imagine suggesting that non nurses in schools give morphine IV to children with pain because “families do it all the time” ( indeed families of hospice patients are allowed and trained how to give morphine intravenous.) Just because a family unit can provide the care within its own home doesn’t mean it translates into just any volunteer with a few hours of training doing it in a school. You are dismissing the complexity of diabetic care, just like I dismissed the complexity of a reading specialist’s training. After all, people read at home all the times to their kids, why would you need a reading specialist in a school?. Remember,bottom line is the American Academy of Pediatrics recommends in their latest position statement (Oct 2009) that only nurses give insulin in school. I would suggest you follow the link below to see what their rationale.
http://pediatrics.aappublications.org/cgi/content/full/124/4/1211
Actually, I have read it many times, thank you. I suppose we will need to respectfully agree to disagree, and while i hope such nonsense does not appear in Indiana, I will also let CA police their own educational environment. I will say this however, The infection that can result form an inappropriately placed feeding tube seems much worse for the patient, than a child who may give his own insulin in High School.
rick phillips