Can We say too much government . Let’s make our kids a political tool for the CSNO .
I do have another point. Sorry I know I said I would leave it alone but I am just compelled to make some points.
First and foremost, this is not an either or proposition. In the absence of a state law or regulation as is being discussed here, the parent holds a great deal of power over the dispensing of insulin in schools. Diabetics at all levels of K-12 are required by the 1974 disability act to be part of a section 504 conference. In these conferences, the parent, school administrator, teacher, therapists and often the school nurse meet to determine the standards that the school will comply with in order to provide a free and appropriate education. In order for anything to be done both the parent and the designated school administrator must agree on the services a school must provide in order to have the child at school.
If the school administrator and parent cannot agree on the required services, including nursing services, to be provided, then the child is provided at home services until an agreement is made or the issue is resolved either by the state or the EEOC.
So how does this work? Well let’s assume the parent wants a nurse assigned to provide the injection and the school does not want too, then the matter is appealed t0o the state authority and a hearing is held. All the while the child is being educated at school expense at home. A 504 conference deals with everything including but not limited to transportation, school services, homework, and sometimes where the child will have lunch etc. In short everything is on the table, for the duration of the child’s qualifying condition or the next conference that can be called by the parent or the school, but must be done at least once annually.
I have advised several of these conferences, usually invited by the principle, but sometimes by the parent. The key thing is that the parent holds many of the cards in such conferences. Let’s face it is usually more expensive to provide a home bound teacher then a school nurse for injections at the school. Especially when a school nurse covers more students than one, and a certificated teacher is one on one at a home bound location.
Now my point is that if the parent feels their child requires a nurse for injections then withholding their signature will often cause that happen. When I think of a rocky 504 conference, I can almost assure that if the issue is the provision of a school nurse or go into a state hearing the nurse is pretty easy to give. I believe most administrators would agree with that assessment and if a hearing does happen, the state reps will almost certainly order a school nurse if that will resolve the matter. My point is that under the current federal law, parents have the right in 49 of the 50 states to pretty much force a nurse’s presence for injections or Blood sugar testing if they wish.
To me this is much preferable to a requirement for a nurse in the building, because if a student needs it there is a nearly sure way they will get it, and if the parent does not find it necessary the state will not require it.
I say this is preferable on two accounts, first I was a diabetic HS student and took insulin. Had this CA requirement been in force in Indiana at the time, I would have withheld insulin in order to avoid a nurse injection. From my perspective I appreciated the nurse’s office to take my blood sugar and my insulin, but I assure all who will listen that If the nurse were required to give the injection I would have taken the matter underground. In fact the administrator would have had to expel me because no nurse was and even today will give me an insulin injection. I will, and would never allow it.
I can agree a lot sooner that elementary children might require a nurse, than MS and HS students. State law or no, I would have gone without insulin before I would have agreed with a nurse injector.
Second, I think parents know their kids better than a blanket state law that makes nurse intervention necessary, no exceptions. If a parent does not agree that a nurse is necessary, is the state a better judge? I think not. I trust that parents and principals in a round conference can make a better judgment about these matters.
One final point, this will not likely stop with school nurses. Does every sports team require an athletic trainer assigned to only their sport? Does every school have to have a speech pathologist, occupational therapists, or a dedicated parking lot attendant? If first it is school nurses then we have to be prepared to accommodate these other professions and as I said above, I do not see taxpayers, proposition 13, state revenue shortfalls or the failure of local income tax votes, willing to pay so that each profession can be provided for every situation.
This is a bad idea, and I hope it stays in CA, where many arcane school laws drive up the cost of k-12 education, while producing almost zero educational benefit.
No to address a point you have posed. I am not a principal; I do not hold an administrator or teaching certification. I was a school business manager in two districts, so if I seem more interested in financial matters it I because I have that experience. But as a young type 1 I also know what going to school diabetic means, and frankly, compliance is not the strong suit of any MS or HS student. I know it was not for me.
Rick Phillips
you bring up good points, Rick. I too am quite familiar with the 504 process, having a child with an ADHD diagnosis. No one is expecting school nurses to manage the HS and MS kids’ diabetes management. They have a diabetic care plan that is signed by the MD who determines whether he thinks the child can self manage. That’s great. As school nurses, we are all for empowering persons with their health care issues. School nurses provide a great deal of education, besides emergency care, direct care and chronic disease care. However, I keep reiterating - the legislators decided a long time ago that insulin was to be administered by nurses in schools. All the nurses did in this lawsuit was point out that there already was a law prohibiting this great idea to have “trained volunteers” give insulin. Which the judges promptly agreed on. Whether this is a good idea or not, the law is already in place. You can’t just slap a new law out there that is a direct contradiction of the existing one. Ex: The speed limit in 55. The new law says that school buses can go 75. Well… actually they can’t because that’s a direct contradiction of an existing law. You would have to go amend the first law, not write the second. So, what california needs to do is go back to the orginal Nurse Practice Act and say, we changed our mind. Anyone can give insulin.
What really blows my mind is all the diabetics who are so used to managing their complex disease that they think it is easy. And my final point, if there really is so little risk in having the “trained volunteers” give insulin, how come the law writes in that, by the way, they can’t be sued if they do it wrong. I think if people are really going to take on that responsibility, especially where children are invovled, they should be willing to be held liable for their actions. Just like nurses. 
I think the rub is that the law was written and passed in the first place. No complaint that people should follow the law, regardless of how we individually might feel about it. There are many laws I follow, which I disagree with and frankly that is just the way it is.
I suggest however that the law is ill-conceived in the first place. It strikes me as an attempt by adults (successful in this case) to use the legislature and schools to guarantee employment. I believe that the the protest over this matter should go further than complaining about the law, and instead, seek to repeal it, for all the reasons I have suggested.
However, the law is the law, and if it came to Indiana, I would fight it tooth and nail, and if it passed, I would comply with it, without question. My own experience with nurses, athletic trainers, science teachers, preschool teachers, administrators, parents, evolutionists, creationists, anti-domestic violence organizations, the Rotary, Kiwanis, and all the rest, is that they tend to seek school legislation to bolster their best ideas. Incidentally, almost all of these ideas supply money, workers, or converts to the cause they are pushing. Many of them require employment and several of them require a precious resource even more important than money, time. None of these are bad ideas, on their face, but when a school is then persecuted for not making academic progress, I never see these same groups saying, oh, well hey the school is doing a great job, instead we often get fried for not making academic progress and on the other side fried for not supporting every good idea in the world.
I know few other places where the same legislators who demand and criticize a school for lack of academic progress, can demand that the school spend resources on things not related to that academic progress.
Rick Phillips
I taught school for 23 years, mostly here in Reno, NV. We never had a full-time nurse, but did have a nurse’s aide. But it seems that under this law, the aide wouldn’t have been allowed to meter or give injections (what about glucagon?). And yet a child with cerebral palsy (who was not capable of participating in classes anyway), got a full-time, one-on-one aide.
This law goes further than just about diabetes. What about children with nut allergies or bee-sting allergies who need an injection with an Epipen? Does it have to be only the nurse that can give them their injections?
This ruling needs to be appealed, and it might be time to get the ADA Legal Team on the case.
Having taught for 23 years, I do want you to know that a teacher cannot interrupt teaching and controlling a class of 30 or more students in order to give an insulin shot (even my own!). That’s why we need health aides allowed to do it. If there is an emergency (I once had a student faint in class – not diabetic), we call the aide and she calls 911 immediately. (We don’t usually have outside lines in the classroom). The aide is invaluable – she does supervise kids taking pills, making sure they have the right medication and the right amount. So why can’t she draw up insulin and at least make sure it’s the right amount. I think the nurses are just protecting their own turf and being inconsistent on top of it!
then why not just have the parapros teach your class. Same concept. Looks easy enough, why not have someone with less training and costs less do the same darn thing?
this is true. most people are looking out for themselves. However, I refer back to what is probably sounding like a tired tirade. the american academy of pediatrics’ stance is that only school nurses should give insulin in school. Now there’s somebody who is not profiting from it at all, yet they, as experts in children’s health, state that ONLY nurses should be giving insulin in schools. Now you have to give some weight to that!? right?
Yes but no offense that is like saying that all people with blonde hair should have skin tests every year. I do not have to get the test, and I certainly do not have to pay for it. Yet no one can seriously deny that having a dermatologist do a skin exam once a year is a good thing.
If the doctors had some financial or programmatic involvement it might be meaningful, otherwise, it is just another good idea. It is awfully easy to come out strongly for something others pay for, and which a co practitioner (nurses) wants.
Why don’t they endorse having only RN’s working in doctors’ offices? Now if they did that, i would be impressed, otherwise, not so much.
rick phillips
I think yourself, like many others on this forum, just don’t understand the healthcare system. You yourself personally understand the educational system with all its heirarchies, but you don’t seem to be able to translate that into another system. In a doctor’s office, a doctor is present. A medical assistant gives care under the doctor’s supervision and direction, since they are unlicensed. Some doctors do have RN’s in their offices, usually at least one, because they value the education and training an RN contributes as compared to a “trained volunteer.” Which is exactly why pediatricians, as a group and supported by scientific evidence, state that – for the best outcomes medically – RNs should give insulin in school.
it has already been established that the epi-pen is a self administered dose, that does not need calculations and that will not do harm if given when not needed. Totally different than insulin.
And your comment about the child with cerebral palsy “who was not capable of participating in classes anyway” really smacks of an intolerance for the disabled.
Just stating the fact, ma’am. This child could not speak, could not use her hands, could not read and did not give consistent eye contact, so you couldn’t even get a reliable response to a yes/no question. And the class was Japanese, which is very participatory, not just a lecture.
She had an aide who fed her (she choked constantly because she could not swallow reliably), changed her diaper and wheeled her around.
I had 40 kids to teach (at 2 separate levels, no less!), so I allowed one of my more antsy, but sweet and loving kids to work with her, and he used the yes/no system, using one hand raised for yes, and the other for no – all she had to do was look at the appropriate hand but she was unable to consistently do that. He did entertain her, though, but as far as her learning anything, it is open to extreme doubt. She would have done much better in a school for the severely handicapped, where people would physically work with her and talk to her and love her, not just sit in a regular high-school class. She could even have gone swimming in the handicapped school – at least it would have been a sensation that might have pleased her. Because there was precious little I could do to make her life more pleasant!