California Supreme Court ruled against us.

[Spidey's mom, ADN, BSN, RN]

Calif. Supreme Court rules in school insulin case

Updated 11:17 am, Monday, August 12, 2013

SACRAMENTO, Calif. (AP)-Trained school employees can administer insulin shots to diabetic students if a nurse is not available, the California Supreme Court unanimously ruled on Monday.

The ruling reverses a lower court decision that said California law allows only licensed professionals to administer the shots.

The Supreme Court ruled that "state law in effect leaves to each student's physician, with parental consent, the question whether insulin may safely and appropriately be administered by unlicensed school personnel, and reflects the practical reality that most insulin administered outside of hospitals and other clinical settings is in fact administered by laypersons."

The decision supports a 2007 agreement between the state Department of Education and the American Diabetes Association, which addressed a shortage of nurses to attend to all diabetic students by allowing trained teachers and administrators to give the shots.

That agreement settled a class action lawsuit in federal court alleging the state's schools had failed to ensure diabetic students receive legally required health care services.

Nurses' organizations sued to block the agreement, arguing that state law only allows nurses to administer prescription medication, including insulin. They said inappropriately administered shots could hurt students.

But parents and groups such as the American Diabetes Association said many school districts across the state are experiencing a shortage of licensed nurses, which could leave the children who cannot self-administer their shots at risk.

There are an estimated 14,000 diabetic students in California public schools. The state has one nurse for every 2,200 students. Sixty-nine percent of California's schools have only a part-time nurse, and 26 percent have no nurse at all.

The Obama administration filed a brief in the case supporting the broader policy allowing school employees to administer the shots as well.

Lawyers with the American Nurses Association did not return calls for comment.

I honestly cannot say what districts will be doing in the immediate future. I heard that this will be taken to the US Supreme Court.

We shall see. In the meantime . . . . . school starts in a week. How to handle this now?

Because there is a shortage of school nurses, we bend the rules? I don't think that is logical.

I'm also not sure school employees will want to learn to do this (evidenced by how many don't want to be responsible for placing PR Diazepam).

Right now if parents send someone in to give the insulin, we allow for that. But not employees of the school district. Only the nurse can give insulin. Of course, we work with the kids so they are able to do so with only supervision, which is the optimum.

[veggie530]

As a type 1 diabetic... I don't need any nurse to give me my medication. I know a hell of a lot more about insulin and my disease than any RN (or school official) I've met, diabetic educators included.

But, that's a perfect world.

[Spidey's mom, ADN, BSN, RN]

Our goal (and the doctors' goal as well) is to get the kids to the point where they can give themselves their own insulin with just supervision. And that happens now with all of my diabetic kids except the 2nd grader. He has a pump and is saavy about it but needs supervision and can't give the insulin himself at school unless mom is there and says ok while we watch and make sure the numbers are correct. Otherwise, I give the insulin.

The problem with trying to train staff is the teachers are already overloaded and won't want to take on a medical role (besides being trained about recognizing highs/lows, etc.). So, we will have to either hire more staff (aides) or get volunteers. With the budget as tight as it is in California for schools, that will be tough.

The older diabetic kids with pumps do their own thing with their doctor's ok, parent's ok and school ok. But I have a diabetic 8th grader who refuses to get a pump and cheats on his carb count by sneaking food or candy or lying about how much he ate. He needs supervision when he carb-counts and checks his blood sugar and draws up the insulin. He is just not compliant.

It is more complicated than it sounds trying to solve this problem. Where are we going to find all these "volunteers" for the thousands of kids?

All schools will now be required to allow nonlicensed staff members to give insulin after proper training and with the approval of the student's doctor. Maio noted that no staff members will be forced to get the training. Instead, schools will rely on volunteers, and schools won't be required under the ruling to provide a volunteer if one doesn't step up, he said.

"We just want to make sure if somebody is ready, willing and able to do this that state law doesn't stand in the way," Maio said. "That doesn't guarantee there's going to be somebody - it guarantees there's no legal impediment to it."

Ruling lets school staff give insulin to students - SFGate

Schools can administer insulin without licensed nurses, court says - latimes.com

California Court Rules Unlicensed School Staff Can Give Medicine - WSJ.com

[ob-rnc]

I'm not sure how strong teacher unions are in CA, but my guess is they have a pretty strong voice. With that being said, I am fairly certain that there won't be many teachers rushing to volunteer! As you noted, they cannot make people learn, they have to volunteer. And I am sorry to sound negative but let's face it--the teachers (at least in my district) complain if they don't get their lunch AND planning period during their 7.5hr workday--how many of us school nurses get even a guaranteed 30 min lunch? More less a fairy-tale "planning period." I have teachers who have raised a house-full of children who don't feel "competent" to put on a bandaid....I know no amount of training would make them feel "competent" enough to give a shot of anything.

This year I will have 3 diabetics in two separate buildings, along with a multitude of students with other health-related issues. I am the only nurse for the district. A diabetic educator came to our school and gave an excellent demonstration and hands on learning meeting with the teachers that were to have the newest and youngest diabetic. The student has a pump which they've had for more than a year. All the teachers were asked to do was estimate how much food the child ate at lunch and to plug in the carbs into the pump. No one had any complaints until today--the day before school starts! They now say they are not even comfortable at estimating how much food the child has eaten. Oh please! I guess they feel too overwhelmed, seeing as how they have 40-50 other kids to watch in the cafe---so I am supposed to care for nearly 1000 kids in two buildings and that's okay--as long as I don't interrupt a planning period. Sorry, but in my opinion teachers are professionals and should be held to a higher standard. I'm sure this child's parents didn't feel comfortable checking blood sugars and giving insulin and placing an insulin set on their 3yr old at first either but they were willing to learn. I understand in an ideal world there would be enough nurses to care for every child with special needs but in reality that's not the case. If I have a wreck on the way to school and end up in ICU, I feel it's important that at least one other person in the school district is at least aware of how to handle this child, even if they don't possess a medical licensure.

[schooldistrictnurse]

Special Ed aides have medical procedures written into their job description in my district. No refusing allowed. With excellent training (if I do say so myself) and a nurse just a phone call away, it has worked out well for us.

[Spidey's mom, ADN, BSN, RN]

Press release from California School Nurse Organization (state branch of NASN).

CSNO

.....This decision also sets a disturbing precedent for California and the nation. In essence, the reversal of the lower court decisions permits a state agency other than the Board of Nursing to control the scope of nursing practice. Moreover, the California Supreme Court has essentially decided that state health care licensing laws meant to protect patients can be ignored to the detriment of vulnerable populations.....

[Cackalacky]

My area has been doing this for years. Doesn't make it any easier though. The parents aren't too keen on it either... understandably.

[SomeoneE1se]

I'm confused, how is this bad again?

The Supreme Court ruled that "state law in effect leaves to each student's physician, with parental consent, the question whether insulin may safely and appropriately be administered by unlicensed school personnel, and reflects the practical reality that most insulin administered outside of hospitals and other clinical settings is in fact administered by laypersons."

Spidey's mom's 8th grader isn't compliant and shouldn't get physician approval.

".....This decision also sets a disturbing precedent for California and the nation. In essence, the reversal of the lower court decisions permits a state agency other than the Board of Nursing to control the scope of nursing practice."

I don't understand this one as well. Pts can self administer, parents can as well. Why does anyone think this alters nursing scope of practice at all?

I'd also like to contend that they didn't rule against school nurses, but instead for school admins/students?

[100kids, BSN, RN]

This ruling is unfortunately a slippery slope which I think will eventually lead to there being fewer and fewer School Nurses in our kids' schools. Any diabetic student I have who can self administer and has proven that to their Dr and myself are welcome to do so at school but I'm there for those who can't and in case of problems. I'm also the There's a balancing act to be done with some diabetics and it's not always black and white. I'd hate to have a diabetic child like that in a school with no nurse.

[Spidey's mom, ADN, BSN, RN]

It is confusing right now - should the RN train the volunteer? CSNO, a state branch of NASN, sent this out today:

Interim Guidance on Medication Administration in California Public Schools

It is important to note that the State Supreme Court ruled that physician orders as well as parental consent must be obtained prior to allowing trained unlicensed personnel to administer insulin; further, current law still supports previously identified professionals providing medication administration in the school setting.

[skoolrn, BSN, MSN, RN]

My question is who is going to train the volunteers?? I wouldn't do it. I cannot "teach" 20+ years of nursing experience and 6+ years of education and expect a teacher to have my skills. Is the RN going to be held responsible when something goes wrong with the student being cared for by the teacher? Does the nurse get thrown under the bus? This is such a bad idea on so many levels.

[Jennifer Campbell]

Our group of RN Supervisors in a charter school system is looking into the possibility of getting a Certified Diabetic Educator to train the required number of staff member volunteers in the schools. We may also be asking the parent if she/he would like to provide the volunteers with additional "insight" into his/her particular child's situation. (My child eats off other childrens' lunch trays. My child pulls out his insulin pump when angry, etc.). Remember that the actions taken in health care have to be documented. The staff will need a way to document, and be trained to do it correctly. Then someone should be auditing that documentation routinely, to look for problems. Good luck, everyone!