Tamar Sofer-Geri from CarbDM pointed this out to me...
This Wednesday (May 29th), the California Supreme court will be hearing oral arguments in the case of nurses against some CA school districts on the question of who can administer insulin to children with diabetes in public schools. The nurses claim that only a licensed medical professional can administer insulin. Parents, the ADA, and other professional organizations are maintaining that unlicensed assistive personell should be permitted to administer insulin given the shortage in school nurses. Here's a link from the San Jose Mercury News on the topic.
There's a saying that "As goes California, so goes the country." (Which hasn't actually proven true in very recent years, but it's a saying that works well with this story so I'm quoting it anyway.)
Thought you parents might want to keep an eye on this one.
No parents chiming in? I for one would not want anyone without an adequate level of training injecting my children with insulin. I guess that really doesn’t solve the issue though if there are a lack of school nurses.
I don't think a nurse is necessary to administer insulin. Requiring a phlebotomy certificate or something would make sense. If my son ever needs to take insulin at school, my fist choice would be to have him do it, with supervision. Otherwise, I'd want to meet, and consult with whoever would be giving him shots.
I was diagnosed as a 3rd grader. I took 1 shot a day, before school. I am curious to know how very young children handle D in school, now?
Performing an IV injection is very different than a subcutaneous injection. I see no need to require a phlebotomy certificate. I mean jeez, if you have people who trust their 6 year old child to self administer an insulin injection then the injection itself is not the issue. The issue is really proper dosing which can be dealt with appropriately in other ways.
I agree completely. I think this it is more important that young students get their insulin, rather than waiting for an overworked nurse to show up. If a school official that volunteers and is properly trained, then I would have no issue. I can see students getting higher and higher and feeling worse and worse while waiting for over an hour for a school nurse to handle another situation.
I think this is a matter of providing care to students when they need it so they can learn better, not a matter of ensuring nurses that are overworked must give injections.
What about a slowly developing infusion set occlusion or infection? Is the pump infusion site sore and turning red? Or the other hundred and one things that can complicate a simple insulin dose calculation and injection? As a parent, would you prefer a mature, well-trained and experienced nurse or someone simply given the minimum knowledge to inject insulin?
I know that life demands that we make compromises with the ideal. But should we lose sight of what would be best? Is the slow erosion/elimination of school nurses really in our collective best interest? Is this compromise worth the life of even one child?
I remember my Dad having to go to my middle school when I was a kid (20 years ago) to explain about my diabetes to the school nurse. She asked for him to write down my dosages on a piece of paper. He replied that I was on a sliding scale, with corrections when needed rather than fixed dosages. She just could not understand the concept, and insisted a dosage needed to be written, so she would know how much would have to be injected if I was "sick." I recall my Dad trying to explain about high and low BG, etc. all to not much effect.
I got to know this nurse quite well, as very hard working and professional. Just rather limited.
These sorts of tasks seem simple to us because we are so familiar with them. It's a mistake to assume everyone has this capacity, or the nerve. Even basic aspects of handling syringes, safety, and providing a sterile environment would be difficult for many without some sort of training.
The issue isn't really about who is qualified to give insulin. It's about the nurses' union fighting to ensure job security for school nurses, in a state who believes the quickest way to fix their massive financial problems is to cut full-time nurses in schools. If a teacher or any other staff member can administer insulin, there's no need for a full-time nurse.
A better arrangement would be one that allows for unlicensed diabetes care assistants in schools where there is no full-time nurse or substitute. These people are trained in the basics of testing & insulin administration. It's working quite well in Texas.
"The amount is a matter of debate, but by any measure significant: between $1.2 billion, projected by Gov. Jerry Brown, and $4.4 billion, the estimate of the Legislature’s independent financial analyst. The surplus comes barely three years after the state was facing a deficit of close to $60 billion."
I'm curious about the Texas program that you refer to. What are the qualifications of the "diabetes care assistants?" What do they get paid? How many hours of training do they have? What do they know about diabetes? Do they understand about things like "insulin on board," insulin sensitivity factors, as well as insulin onset, peak, and duration? How long has Texas been doing this? Are there any critics?
The CA court battles have been going on for several years. At the time the case was originally filed, the schools were facing massive budget cuts. According to your more current info, that no longer applies, so it would seem the nurses' union has another agenda. Or it's possible that, as in most states, federal funding of schools has been cut so much the states are looking for anyway to cut expenses. A budget surplus for the state doesn't necessarily equate to a surplus of school funding.
The Texas bill (known as HB984) was passed & incorporated into the state public health laws. Specifically, it went into effect on May 25, 2005. It was an important piece of legislation because it not only addressed specifics of who could provide diabetes care in schools, but also guaranteed the rights of students to provide self care, including carrying a glucose meter & performing self-checks. Teachers & staff are trained on a volunteer basis (not paid), & testing of knowledge of basic skills is required. The law also protects the volunteers (known as UDCAs here) from liability. To my knowledge, they are not trained in the specifics of insulin (IOB, DIA, peak etc), which would be kind of pointless considering the varying treatment regimens. They're trained the follow the DMMP (endo's orders) with additional input from the parents of the child. The guidelines for training were developed by the state nursing association & several other state health agencies. If you're interested in the specific guidelines, the link below provides additional info. The guidelines for training & the areas covered begin on the bottom of page 9 & continue from there. As a side note, the guidelines were developed with the input & assistance of Dr. Stephen Ponder, a fairly well-known pediatric endocrinologist here in Texas, & a T1 himself for 45+ years.
