19 Responses

  1. June S.
    June S. May 8, 2013 at 5:39 am | | Reply

    I work as a teacher in NJ, where school nurses are the norm. One of my relatives resides in Colorado, where taxes are lower, and where, I believe, no public school hires a nurse. I have mixed feelings about whether only nurses should be allowed to administer injections. It’s not just the injection technique, but the issue of just how much insulin needs to be administered. Should that amount be determined by someone who is not a medical professional? When I was a kid, I was on 2 injections of mixed NPH/Regular daily, so I never dosed at lunch. Non-pumping children nowadays, I suspect, may even need to take lunch between meals. An error in dosing could cause a big problem, and with schools constantly worrying about being sued, there is cause for concern. We are, after all, living in the age of the lawsuit (in my humble opinion.)

  2. Mike Ratrie
    Mike Ratrie May 8, 2013 at 5:43 am | | Reply

    Not having a CWD, I don’t have a dog in this hunt, but the California judge who said it is up to the legislators to make the change have it correct.

    Until either the California legislators decide to stand up for their diabetic-affected constituents (aka CWD parents) and future constituents (aka CWDs), OR the school nurses lobby reverses their position, diabetic students will be forced to choose the lesser of evils.

    BTW, following on the logic implied in the “only nurses are qualified” position, Mike — If you are not a nurse and you are giving yourself insulin, you MUST be doing it wrong :O

    1. Beth
      Beth May 15, 2013 at 11:19 am | | Reply

      giving yourself insulin or a family member is different. They want Nurses in the school to protect the students. Of course anyone could give insulin with training but wouldn’t you rather demand school nurses in every school?

  3. Keith
    Keith May 8, 2013 at 7:20 am | | Reply

    I just don’t understand the stand by the nurse labor union, nurse are in high demand. What happens in the next couple years when the union can’t meet demand.

  4. David
    David May 8, 2013 at 7:34 am | | Reply

    Jeez, common sense please! If necessary, bypass the unions by having parents sign a waiver to allow non-nurse personnel to administer shots.

    1. Jud
      Jud August 17, 2013 at 6:37 pm | | Reply

      You are very uninformed. Injecting a medication is not the same as giving a pill at the correct time. This problem is something that a trained medical professional must access. What is the bloodglucose level, how much insulin for the bloodglucose level, what to look out for, how to inject properly and where. These are just a few of many issues with this problem. Next, if something goes wrong, who is at fault? Will the parents sue the school district, the nonmedical person providing medical care or both. Parents need to think of the responsibility they are handing over to a non medical person who may only have a high school diploma and know nothing about the problems that can come up with a diabetic student. I would want to know what training this person has and at least have a certification that they are know what to do in the event of an emergency. .Funny that the public has been led to think there is a nursing shortage. This in fact is not true. Schools and hospitals do not want to hire nurses as it will cost them more. Instead, they work with fewer and overwork those on staff and then call it a nursing shortage. Many hospitals lay off trained nurses and hire out of state travelers which they can deduct as an operating cost. This cannot be done with instate nurses which are not deductable cost. Just a few thing you may want to digest. By the way, I am not in favor of the Nursing Unions which are not for the patients. That being said, many of patient safety issues are in law in california due to the California Nusing Association fighting for patients rights and proper number of nurses to take care of them. Chew some more and think if you would want your child’s insulin given by a non professional. Also in many California hospitals, two nurses are required to chek the dosage of insulin as it comes in different strengths and one can kill someone with the wrong dosage and strength. More to chew on.

  5. Mary Dexter
    Mary Dexter May 8, 2013 at 8:26 am | | Reply

    People fear the unknown. If testing and injecting come out of the shadows and become as visibly ubiquitous as texting, these actions will be viewed as normal, too.

  6. Albert R.
    Albert R. May 8, 2013 at 11:10 am | | Reply

    I think our child’s health is a serious concern and should never be mishandled and as far as nurses and paramedics are concerned, they have their liabilities and responsibilities to perform their routine tasks. I must say, these responsibilities should not be taken for granted the issue must be resolved.

  7. School Nurse Controversy Ruffles Our Diabetes Feathers

    [...] The post Sc… DiabetesMine: the all things diabetes blog [...]

  8. Kelly Rawlings
    Kelly Rawlings May 8, 2013 at 7:59 pm | | Reply

    For DiabetesMine readers interested in becoming advocates for kids’ rights and safety at school, here are resources from the American Diabetes Association’s Safe at School campaign:

  9. Dan
    Dan May 8, 2013 at 10:00 pm | | Reply

    The last thing a diabetic needs is someone who is not trained making decisions on what should be given to a diabetic student. If this law is changed, you know districts will use the cheapest person to interface with diabetics. The problem then will become equity of care. Yes, people who are not nurses can be trained to assist a diabetic. However, what will that training require? How do we know that they know what they are doing? Who would certify their training?
    The law should be expanded to allow maybe nurses, as well as diabetic educators (or whatever those certified people call themselves). Therefore, at least the diabetic community has some equality of care.
    It seems like a simple solution. But there will be all sorts of problems that will arise if this law is changed.
    I could just imagine some crazy assistant principal, or some lunatic teacher, or some campus aide making these decisions.
    Be careful what you wish for.
    Insulin is dangerous. It is an extremely dangerous drug. Adult diabetics should not underestimate or forget about the dangers of this drug. It is the type of drug that only a few select people should be giving advice to a diabetic about in regards to administration.
    I am a type 1 diabetic. I do appreciate that I had a school nurse back when I was in middle school and high school. And I am glad the school principal did not have the authority to pick who he wanted to interface with me on my blood sugar needs.
    And, if I had a kid who was a diabetic, I would not be happy if this law was changed in any dramatic fashion.
    If this law changes, trust me, there will be horror stories. No doubt about it.

    1. Beth
      Beth May 15, 2013 at 11:30 am | | Reply

      Nice to hear this from a student!

  10. Amy A
    Amy A May 9, 2013 at 12:38 pm | | Reply

    Well done article, those school nurse horror stories really made me grateful I grew up before all this ‘mandatory nurse’ nonsense.

    Fear of lawsuits drive too many behaviors these days imho.

  11. Wendy
    Wendy May 12, 2013 at 9:23 pm | | Reply

    Thank you for this well written article! As the parent of a CWD and a RN myself, I can confidentially say that NOTHING in nursing school prepared me for the task of raising a CWD.

    As a mother, I live and breath the ins and outs of my daughter’s diagnosis –> that life experience cannot be replicated by anyone, regardless of how many degrees they may hold.

    By the same token, I have administered MANY MANY MANY medications over the past 20 years as a RN. I’ve hung mult drips for cardiac emergencies, pushed drugs during codes/near-codes, given all kinds of meds with all kinds of scary side effects to brand new babies within minutes of their birth, injected combative psychotic people with medications in high doses that could kill your Average Joe…and you know what?

    There is only ONE drug I’ve ever given that required a second RN to confirm the order, double check my math, observe to make sure the right drug is being drawn out of the right vial of medication, double check the dosage in the syringe, make sure it’s given to the right person, and then sign the medical record to document that 2 RNs completed the task.

    That drug is insulin.

    1. Beth
      Beth May 15, 2013 at 11:33 am | | Reply

      I am a school Nurse and I think of this requirement everytime I give an insulin injection. It makes me always double check. I am alone in the office. I can’t imagin a teacher giving this in a crazy classroom with 30 other children.

  12. Karin
    Karin May 15, 2013 at 10:27 am | | Reply

    In 1974 when I became an LPN(LVN) in Maryland, there were 2 drugs we weren’t trusted to give. Heparin and Insulin. When I became an RN in 1984 there was one drug that needed another nurse to check your dosing. Insulin. People can die from incorrect dosing of insulin; and while the parent’s knowledge and skills are undeniable; that is 1 student, closely monitored and well known to the parent. Hypoglycemia formerly known as “insulin shock” can be a killer. Literally.

  13. Beth
    Beth May 15, 2013 at 11:15 am | | Reply

    RNs. School Nurses should be mandated for every school across this country. Have any of you lobbied your government for that because that is what needs to be done. That would settle the issue. There is a bill now for school nurses HR1857 call and support it. I bet you didn’t even know about it.

    If I were the parent of a diabetic I would demand a school nurse be in my child’s school the entire day. I would not trust staff or teachers to administer insulin especially in the disruptive classroom setting. Do you know in the hospitals before a nurse gives insulin she must have a 2nd RN verify it’s correct. What does that tell you? It’s different if you are the parent or relative giving insulin in the home setting, it’s your child. Nurse’s working in schools are doing so to protect children, not their jobs. A NY school Nurse.

  14. Nurse Jo
    Nurse Jo May 16, 2013 at 8:30 am | | Reply

    As a School Nurse, my biggest concern with insulin administration at schools is dosage calculation. The mechanics of giving a shot are relatively simple. As a part time employee, responsible for 1,000 students in 2 buildings, I have the need to train my non-nursing staff in diabetes care. Because of this, I take calls on my scheduled days off. The responses I get in training simple hypo or hyperglycemic care frighten me to think of what might happen when I am not in my buildings or available by phone. It seems no matter what I teach, the questions that come back to me show a very basic lack of understanding of this disease. The need to consider activity level, prior/current BGs and insulin doses, food already eaten and to be eaten, and the particular quirks of each student (when do you spike after pizza? do you spike or crash immediately after them mile run?), make writing a simple IHP for a lay person to calculate insulin doses a nightmare. Because of fear of making an error, staff frequently want to refuse feeding the student any type of classroom snack or treat offered out of the normal schedule, choose to treat highs and lows both with water and are uncomfortable to learn how to administer Glucagon.

    I take great pride in working with my CWD and educating my staff in the basics of care. I believe in 504s and the importance of including all my students in all school related activities. I work closely with parents and CDEs. I have a para-professional who covers my office when I am not here. I would love to have the time and resources to expand my staff teaching beyond basic care. But neither my schedule nor the staff’s allow for more than a couple inservices a year. I also understand that an individual who hires on as a secretary, principal, teacher, educational assistant, etc.may not be an individual who can find a comfort level with needles. This is evident when I have the staff members nearly pass out during EpiPen and Diastat training…

  15. anniejones
    anniejones October 3, 2014 at 10:43 am | | Reply

    I know this is old, but a similar law was recently passed in my state and I came across it.
    So when:
    “other kids get sick all the time,” so why should that particular student with diabetes get special treatment?”
    “the administrators clearly didn’t understand the basics of type 1 diabetes management”

    With schools like that, why would you lobby FOR giving school staff the ability to manage diabetes rather than a nurse who actually knows what it is?

    If you think nurses who have actually learned how to manage D can screw up, wait ’til you see laypeople doing it in schools. I’m worried!

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