ADA Launches Fight for Rights of Diabetic Children

classicdame, MSN, EdD · Aug 27, 2010

agreed. However, I was not aware they were not getting it. At least, not around my hometown because I train the school's non-nurses how to spot hi/lo blood sugars and what to do in emergency. As a diabetic myself I will say it is no laughing matter.

Neveranurseagain, RN · Sep 2, 2010

This disagreement is between the the California Nursing Board and the Dept of Education. The BON statutes limit what non nurses can do, and they feel managing a diabetic involves also assessment. The BON feels administering insulin is a skill that RN/LVN should do as it involves more than just task training. Granted, parents can be taught to manage DM at home, but lay people and volunteers are becoming health techs and replacing RN's by doing not only DM assesment and care, but tube feedings, asthma assessment and care, assessing injuries and illnesses and assessing/treating anaphalysis. They are also being trained to assess and manage trach/ventilator children. and children with seizures. The CA BON is trying to protect our profession and limit what non nurses can do. Even the Nurse Practice Act limits who can assess, but the Board of Education is trying to get round this. Unfortunately, diabetic children are now stuck in the crossfires of this battle.

This issue of allowing lay people to assess and manage diabetes in children at school is just the tip of the iceberg of a bigger threat that is happening to nursing. I think the CA BON is right is fighting this fight. By training health techs and volunteer lay people to give insulin and do all of the above, you have just taught someone to do everything an RN can do, without having to go to school. This dumbing down of nursing is not only jeopardizing our profession, but is cheating students out of having a qualified healthcare professional care for them.

Task training health techs is the beginning of the demise of RN's. I think in the future nurses are going to look back on this time period when lay people were trained to replace nurses, and shake their heads, knowing that this is when our profession allowed us to be phased out--we did it to ourselves. Instead of kicking and screaming to protect our profession, we willingly train lay people to do our job as evident by using health techs in schools. In my opinion, this is only going to get worse, with eventually pt care techs handling most of the duties that RN's do now. This getting their foot in the door is going to kick it wide open and I predict it will doom nursing.

In an analogy, why not tell teachers that they don't need to teach math anymore, that there is a task trained technician that will be doing it. This technician uses a prepacked math module and has had a few hours of classroom management skills. It is successful, so pretty soon the same thing happens in social studies, then science. Now you have 10 teacher technicians teaching all the classes, with one real teacher overseeing them. Think it can't happen? Well, it's happening in nursing. I mean really, does it take a masters degree to teach 2ind graders? At least if a teacher technician screws up, it's not life threatening.

Millions of dollars is still being pumped into sports by the school districts, yet when it comes to caring for the medical needs of children, no one wants to spend any $$$$.

country mom · Sep 7, 2010

Even when there is a school nurse present, there is never going to be one in every classroom, on every field trip, at every sporting event and on every bus ride every minute of every school day. At some point, a lay person is going to have to know how to assist a child with diabetes if that child is going to attend school safely. My heart goes out to these kids and their parents. I just don't think training school personnel to assist a special needs child in school is going to cause nursing to go out of business. That's like saying we should quit teaching community persons how to do CPR, because then nobody will need emergency rooms and all the ER nurses will be out of a job.

elkpark · Sep 8, 2010

I have to wonder about just how much responsibility schools should be expected to shoulder for the medical needs of individual children. They are schools, after all, not ambulatory clinics. Part of the reason they have so much difficulty providing kids with a substantive, meaningful education is that they've had so many other jobs and responsibilities piled on over the years.

geocachingRN · Sep 22, 2010

@awsmfn. In a perfect world, I would agree with you but RN's in my district are carrying a case load of 5300 students!!!! No, we cannot be everywhere and we have parents demanding a nurse follow around their child all day. This is a huge expense for the district which means fewer resources available for the nurses. Though I would love to go back to the days of a nurse in every school, that's not going to happen without legislation and/or a lawsuit. Given that, we need to make do.

Consider this, when surgical techs came along, they did not displace nurses in the OR. The nurses job for maintaining the safety of the patient became first and foremost. If we are able to delegate tasks, then our job becomes to look at the big picture and plan more, instead of putting out fires, which is all I have time to do now.

Neveranurseagain, RN · Sep 22, 2010

Our district considered hiring health techs, but then looked at our salary (very low!) and figured they would save less than $2000 a year per RN and felt it was not worth the extra liability. It would actually cost them more by hiring 5 health techs then also an RN to supervise them.

grannyrn65 · Nov 2, 2010

@awsmfn. In a perfect world, I would agree with you but RN's in my district are carrying a case load of 5300 students!!!! No, we cannot be everywhere and we have parents demanding a nurse follow around their child all day. This is a huge expense for the district which means fewer resources available for the nurses. Though I would love to go back to the days of a nurse in every school, that's not going to happen without legislation and/or a lawsuit. Given that, we need to make do.
Consider this, when surgical techs came along, they did not displace nurses in the OR. The nurses job for maintaining the safety of the patient became first and foremost. If we are able to delegate tasks, then our job becomes to look at the big picture and plan more, instead of putting out fires, which is all I have time to do now.

First, I am not a school nurse.

I agree with you, it is unlikly teaching lay people who displace RN's. My grandchildren attend school in a district that has about 20,000 students. They have two RN's, who supervise a group of LPNs covering two schools. One of my daughter's sister in law works at one of the school and we frequently talk. She recently told me the district was considering hiring care techs, teaching them the necessary symtoms and how to give certain medications. And terminating several of the LPNs and one RN. The reason being a project shortage of funding. They were stopped by the objection several physicians and the head of our tech school's PN program.

We would all like to look at the big picture but school districts look only at the bottom line. The ADA allowed children with all sorts of health problems greater access to our schools.What the Congress, our states and our local communties failed to do, was realise it is necessary to fund these programs. And this means higher taxes, which everyone wants to avoid.

GrannyRN65

MelanieND · Jan 5, 2011

As a parent of a child with Type One Diabetes and a nursing student, boy could I really get on a soap box with this one. Our son was six when he was diagnosed. His first grade teacher pointed out the first signs, the school nurse was WONDEFUL!!!, after diagnosed and while we had some issues with the new teacher every year, it was not bad. Then fifth grade and it has been HELL!!! He moved to a new campus. New school nurse and five teachers. Apparently, the school nurse could not read order and failed to correct his blood sugars 46 times in nine weeks, allowed his blood sugars to go over 500 for several school days...granted, his blood sugar numbers were fine when he was home, so do the past great history, I did not check every day, did not get calls from the nurse either and then they actual stopped our son from doing a correction dosage on his pump while at school and he told me about it. I could go on about teachers not helping him but I don't have enough time.

Children with type one diabetes,in one study, on average, make at least 81 life and death decisions every day. Do I feel well enough to go a play? Should I do a blood test first? Can I eat that cupcake?

While we need nurses at schools with children that are at risk, we need nurses that are trained to assist those students in their care. Any student, regards of their medical needs, has the right to a fair education. They also have a right to be safe at the time that they are getting that education.

ADA helped our state in getting laws passed to protect those rights in regards to testing blood sugars in the classroom instead of always leaving and going to the nurse's office. They are a wonderful group and are doing what is needed for the children with type one and two in CA to obtain an education and be safe at their school.

Think about if your child had this and was told that they had to go to the "diabetes school" becuase that is where the nurse was, that would require you to drive him/her 50 miles, in CA traffic, that's two hours, one way. And the school refused to provide busing. Your child knows no one at that school, it is not in your neighborhood, etc. What to you do? This scenio is real and not made up. Thanks!

Neveranurseagain, RN · Jan 6, 2011

I always test BS in the classroom! I am the first one in the district to start doing it and make rounds 3 times a day for testing--I look like the snack/juice lady rather than an RN, LOL! But by the time the child headed to my office, checked their sugar and walked back, they were missing almost an hr of school a day, if you add in their insulin/carb counting. So now I go to them for BS, and they come to me for insulin. My school is somewhat small at 450 students, so it is doable.

My diabetes all have bus plans. They have to be higher than 150 to ride the bus, and must always have a snack with them. They check their BS 15 mins before they board the bus as it gives me 15 mins to get their BS over 150 if they are low.

country mom · Jan 7, 2011

Thanks for sharing, MelanieND. What families and people with diabetes do every day just to stay alive is nothing short of amazing.