Diabetic Coverage at all activities

SaltineQueen · Mar 21, 2018

I would say it depends on what your state laws say. In my state, it's written into law that students with diabetes must have a plan to cover "during school hours or at a school related activity." It does not specify that it has to be a nurse, however. We can use "volunteer health aids" who are trained in dealing with diabetes. Have you checked with your state DOE?

KKEGS, MSN, RN · Mar 21, 2018

Yep this has come up for us recently as well. I'm in Minnesota. Loooooooong story but we have a kindergarten student with a 504 that states that at least 1 trained personnel (not necessarily a nurse) must be on site at all times during the school day, field trips and school sponsored extracurricular activities. This family is so intimidating and difficult to deal with that our unlicensed people are now refusing to accept the delegation so it naturally falls back onto the school nurse. This family is now reaching out to other families in the district and we have now a second diabetic student's parents asking for a 504 and asking that this same language be in place for their child. We district nurses were having an email discussion with our Director of SpEd yesterday wondering exactly what that covers -- after school clubs, sports, etc. Our director says it does so now we are in the position of having to provide nursing coverage for those things. And no it doesn't have to be a nurse but our experience has been that most of our para or teacher staff wants nothing to do with these types of situations. If we are seriously expected to cover all of those activities outside of the regular school day...we do not have the man power for that and can't require our school nurses to work evenings. One of the district nurses joked that we are soon going to need to staff a 3-11 shift at school.

ruby_jane, BSN, RN · Mar 21, 2018

So...field trips are part of free and appropriate public education. Dances/after school club/child care is not - unless of course, the school rules that they are.

This is a district problem. What does your contract say your hours are? They can't ask you to work consistently past your contract hours. It seems unwise to have you flex hours so you'd be available for one or two kids after school and not the multitudes during school. Maybe the district can hire a contract nurse for the field trips? Maybe the parents are on the hook for the stuff that's extra?

grammy1 · Mar 21, 2018

By Jr. High most of ours a pretty independent. For field trips teachers are trained in testing, insulin administration, and most important....glucagon administration. The teachers (and sometimes the student---depending), have our cellphone numbers to call us with BGs, we calculate dosage and then student administers his/her own insulin. If they have a pump, they are generally self sufficient and have our phone numbers for emergency purposes.

KKEGS, MSN, RN · Mar 21, 2018

So...field trips are part of free and appropriate public education. Dances/after school club/child care is not - unless of course, the school rules that they are.
This is a district problem. What does your contract say your hours are? They can't ask you to work consistently past your contract hours. It seems unwise to have you flex hours so you'd be available for one or two kids after school and not the multitudes during school. Maybe the district can hire a contract nurse for the field trips? Maybe the parents are on the hook for the stuff that's extra?

We were told that activities sponsored by the school which would include dances and after school clubs and high school sports would require coverage if the 504 states it. Community education, which runs our after school child care, are not school sponsored so that department decides how they will handle it. This same family I mentioned above enrolled their child in the before and after school program through Community Ed and wanted a 1 to 1 nurse hired for the child. Community Ed was going to do it even knowing that it would be ridiculously expensive. I found language in the ADA law that basically said if the parents insist that a medical person be hired then the cost of that medical person can be passed onto the family since that is above and beyond what is required by the ADA.

I will say that most parents do not expect a nurse to available for their child around the clock but some of these families would totally push for this.

aprilmoss · Mar 21, 2018

The question is whether a nurse is required for the intervention needed. Does this snowflake never go anywhere without medical assistance? Hell, there are districts in our state that don't have any nurses in the buildings (just "health clerks") and I know there are type I diabetics there. My son is a Type I and not even a particularly well controlled one and I'd never had such a thing in his IHP/504.

amoLucia · Mar 22, 2018

What's next? School nurses at the proms?

Slippery slope.

Again I will say it that I admire you guys for the craziness that you must sift thru.

ruby_jane, BSN, RN · Mar 22, 2018

We were told that activities sponsored by the school which would include dances and after school clubs and high school sports would require coverage if the 504 states it. Community education, which runs our after school child care, are not school sponsored so that department decides how they will handle it. This same family I mentioned above enrolled their child in the before and after school program through Community Ed and wanted a 1 to 1 nurse hired for the child. Community Ed was going to do it even knowing that it would be ridiculously expensive. I found language in the ADA law that basically said if the parents insist that a medical person be hired then the cost of that medical person can be passed onto the family since that is above and beyond what is required by the ADA.
I will say that most parents do not expect a nurse to available for their child around the clock but some of these families would totally push for this.

I find this interesting. In HS our parents of students in the sheltered classrooms just "assume" that their student will stay in HS until s/he is 21. Because that's how it's been done. But our staff now are stating at every ARD that it is believed that the student will graduate with his/her class (and usually not more than a year after). And every year there's push back, but the resources just don't exist. It is, indeed, a slippery slope to write into a 504 that nursing coverage for a diabetic student is available for all school activities. Someone above your paygrade ought to clarify... Good luck!

BeckyESRN · Mar 22, 2018

Luckily, nursing is only required to cover field trips and the school day. All after school activities/dances/sports are the parent's responsibility. The athletic trainer is available for HS students during sports, but nursing coverage is not required. I can't even image what a schedule would look like if coverage was required for every activity...we have at least one after school club or activity everyday most run until 5 or 5:30!

AdobeRN · Mar 22, 2018

Luckily, nursing is only required to cover field trips and the school day. All after school activities/dances/sports are the parent's responsibility. The athletic trainer is available for HS students during sports, but nursing coverage is not required. I can't even image what a schedule would look like if coverage was required for every activity...we have at least one after school club or activity everyday most run until 5 or 5:30!

Our district is the same. I am at elementary level so alittle different. My diabetics have something similar written into the 504's - but it states nursing, UDCA, parent or parent representative to accompany the students on school day field trips. If a teacher has a diabetic student they are trained as the UDCA so I do not need to go on field trips anymore unless the parent is insisting on it. With the exception of our 5th grade overnight camp trip - I don't do anything with school activities that are after 3:30pm.

NYschoolnurse, BSN · Mar 22, 2018

Let me clarify.. these middle school kids are capable. However... One BG drop to the 40's(they have a cgm, never should have happened) their parent decided that they are too foggy to tell adult that they are low and don't know how to handle it. So now they are not always reliable to be self responsible. What if.... they fall low before school, at the dance, at practice etc. They want agency nurse's. There just aren't that many. Plus it can be sporadic - only for practice etc. But.. it's always the Disability Act that gets tossed around.... THEY HAVE THE RIGHT... because the families become so difficult, teachers are not willing to deal with it.