California Supreme Court Decision: Parents v. School Nurses
In a victory for parents and children with diabetes, the California Supreme Court unanimously decided to allow nonmedical staff to administer insulin to children when the school nurse is not there. This August 12, 2013 ruling ended a six-year court battle between diabetes advocates and the state school nurses. It also included a brief from the Obama administration on behalf of the parents.
The nurses were concerned about the safety of insulin-dependent students being treated by non-certified school staff. As a retired school nurse, I can see their concern, but I also have dealt with many parents who must break away from jobs to come to the school for various emergencies or sudden illness. I worked in an urban setting where many parents worked low, hourly wages, and lost pay when off the job. Some had to travel long distances to get to the school. To me, the California decision makes common sense. However, a few concerns pop up:
- A staff member must volunteer to sub for the nurse. What if no one wants the task? If someone does, is this person reliable and capable of doing the job?
- The volunteer must be trained thoroughly in the administration of insulin. This should be done by a medical professional. Will he also be available to the youngest children to help with blood sticks? The number of children with Type 1 diabetes is rising, even in the 0-4 age group. Will volunteers be able to handle preschoolers?
- The volunteer must be trained to keep a meticulous record of medication administration.. This is a legal document.
- The child's teacher, as well as other staff should be trained thoroughly in the signs and symptoms of diabetes problems. All staff should be well-versed in hypo- and hyperglycemia, especially teachers of preschool and lower elementary school children, because they often don't say when they are feeling ill, and may not even be aware that they are becoming ill. Fortunately, the insulin pump has taken away much of the worry for serious incidents, but not all. Not every child uses the pump.
- The child must have an up-to-date Individual Health Care Plan (IHP) and an Emergency Care Plan (ECP). These must be prepared and given to the school by opening day. They should be available to staff when the nurse is not there.
The National Diabetes Education Program (NDEP, 2010) provides a publication, "Helping the Student with Diabetes Succeed: A Guide for School Personnel", which details what level of training should be given to all staff, the classroom teacher, and other teachers who will be working with the child.
With the California ratio of students-to-school nurses at 2200 to one, and an estimate of 14,000 children with diabetes in the public schools, only one court decision could have been made. It would be ideal if every school had a nurse, but this will not happen in the present economy, and probably never will Only 5% of schools in the state have a full-time nurse, and 26% have no nurse. It is a practical impossibility to not have staff trained.