Diabetic student staying after school

Jedrnurse, BSN, RN · Mar 21, 2021

Many after school programs hire a nurse to be on grounds in this situation. Don't give your time away for free- once you start that precedent, you'll regret it.

peaceful2100, BSN, RN · Mar 22, 2021

11 hours ago, Jedrnurse said:

Many after school programs hire a nurse to be on grounds in this situation. Don't give your time away for free- once you start that precedent, you'll regret it.

I wish the one at my school would. I am incredibly doubtful they would.

Staying until she at least get her snack and I can dose her would put me right at my 8 hours for the day.

Friday I stayed later because it was her first day staying after and I had no clue until that day.

I definitely had to do some quick education going into the most important aspects.

LikeTheDeadSea, MSN, RN · Mar 22, 2021

Is the after school program part of your school, or are they a separate entity/company? I would be very uncomfortable providing any type of "training" to a third-party operating in the school.

My state doesn't allow for glucagon to be delegated to non-licensed personnel, so besides educating staff about calling EMS sooner than later if they start to decline and making sure the parents are aware there is not a nurse on site after a certain time, there isn't much I can do. If a parent requests nursing coverage for the glucagon for school-sponsored activities, we provide one, but our after school program is different company, so not sure how that would pan out. I would bounce it up to administration who hopefully has their legal team look it over.

k1p1ssk, BSN, RN · Mar 22, 2021

If the after-school program is school/district sponsored and the student's 504 dictates that a nurse must be present, then the district needs to hire a nurse to stay after school as the program essentially acts as an extension of school day. Insulin (even via a pump) and glucagon cannot be delegated. While it was good for you to educate them on s/s of hypo/hyperglycemia, they cannot assess and treat these conditions. Otherwise, the family should sign a waiver, if that is even recommended by the district legal team.

Different scenario, but I had a student with a seizure disorder and orders for diastat. His 504 stated that a nurse must be present in the building, on all field trips and for all after school events. He wanted to attend an after school program that was being put on by one of the teachers and was school and PTO sponsored. The district paid for me to stay until the program was over at 4:30 each Wednesday. I think they paid me $25/hour. They also used me for general first aid care, but that would have been on them had this particular student not been involved.

I think at the highschool level, the nurse becomes less involved in diabetes care as the student is expected to start taking more responsibility, so the 504 may change and the nurse isn't needed after school. But that would be up to an interdisciplinary team to decide.

peaceful2100, BSN, RN · Mar 22, 2021

6 hours ago, LikeTheDeadSea said:

Is the after school program part of your school, or are they a separate entity/company? I would be very uncomfortable providing any type of "training" to a third-party operating in the school.

My state doesn't allow for glucagon to be delegated to non-licensed personnel, so besides educating staff about calling EMS sooner than later if they start to decline and making sure the parents are aware there is not a nurse on site after a certain time, there isn't much I can do. If a parent requests nursing coverage for the glucagon for school-sponsored activities, we provide one, but our after school program is different company, so not sure how that would pan out. I would bounce it up to administration who hopefully has their legal team look it over.

I’m in a state where glucagon can be delegated.

I felt/still feel very uncomfortable, but feel what choice do I have in this.

This is one reason I am seriously thinking of getting out of school nursing.

This is a very slippery slope to me.

peaceful2100, BSN, RN · Mar 22, 2021

5 hours ago, k1p1ssk said:

If the after-school program is school/district sponsored and the student's 504 dictates that a nurse must be present, then the district needs to hire a nurse to stay after school as the program essentially acts as an extension of school day. Insulin (even via a pump) and glucagon cannot be delegated. While it was good for you to educate them on s/s of hypo/hyperglycemia, they cannot assess and treat these conditions. Otherwise, the family should sign a waiver, if that is even recommended by the district legal team.

Different scenario, but I had a student with a seizure disorder and orders for diastat. His 504 stated that a nurse must be present in the building, on all field trips and for all after school events. He wanted to attend an after school program that was being put on by one of the teachers and was school and PTO sponsored. The district paid for me to stay until the program was over at 4:30 each Wednesday. I think they paid me $25/hour. They also used me for general first aid care, but that would have been on them had this particular student not been involved.

I think at the highschool level, the nurse becomes less involved in diabetes care as the student is expected to start taking more responsibility, so the 504 may change and the nurse isn't needed after school. But that would be up to an interdisciplinary team to decide.

Some states do allow Glucagon to be delegated even to unlicensed personnel and I am in one of those states.

I certainly feel this is a very slippery slope.

This is yet another reason I am thinking of leaving school nursing.

Things like this make me feel uncomfortable.

Crazy how this is my 7th year as a school nurse and never dealt with this.

Somehow I have hardly had any students who was diabetics in any of my schools. I have done High School before too. Only came across 2 on a high school level. They was very independent and allowed to do everything on their own according to Dr orders. I only dealt with them a a couple times after receiving orders for hypoglycemia.

Flare, ASN, BSN · Mar 23, 2021

my state has allowed delegation of glucagon. The rub is that the staff need to be willing to volunteer to be trained delegates. I have had a few staff members over the years who were either diabetics or had diabetic children / family members so they were already comfortable and well versed with the process. Never-the-less, it's not something that I'm as comfortable with as delegating an epipen. Perhaps if the intranasal glucagon becomes the norm, I'll feel better, but as I don't know much about that, I can't say for sure.

ajessrn, BSN, RN · Mar 24, 2021

as others have stated if it is a school sponsored program after school then the district needs to hire a nurse to be present or train volunteer assistive personnel depending on the laws of delegation in your state.

I have chosen not to do our after school program for my 8 yo because it is a separate program from the school and I would have to train someone and have a third set of supplies since they wouldn't have access to his stuff in the nurses office. He doesn't self carry his supplies yet other than his receiver for his cgm.

so 1. is this a school sponsored program giving you or your district responsibility for training someone or hiring another nurse?

2. if so who is willing to be trained to manage things.

3. if not you need to pass the baton to the after school program and leave it up to mom and the head of the program to decide on what they are comfortable with.

please don't over extend yourself and make sure you are setting boundaries for what you can and are responsible for.

I would not expect my sons school nurse to stay after school for him. I cannot stay after school for my students.

peaceful2100, BSN, RN · Mar 24, 2021

Yeah, apparently they do not understand the importance of hiring a nurse for after school program especially since I am in a state where tasks can be delegated to unlicensed personnel. I am really at a lost here. It makes me feel incredibly uncomfortable.

ajessrn, BSN, RN · Mar 25, 2021

12 hours ago, peaceful2100 said:

Yeah, apparently they do not understand the importance of hiring a nurse for after school program especially since I am in a state where tasks can be delegated to unlicensed personnel. I am really at a lost here. It makes me feel incredibly uncomfortable.

Are there at least two people in the after school program willing to be trained? If so that is what I would probably do. You cannot be expected to stay after every day. mom needs to establish a relationship with the after school people.

On 3/23/2021 at 8:41 AM, Flare said:

my state has allowed delegation of glucagon. The rub is that the staff need to be willing to volunteer to be trained delegates. I have had a few staff members over the years who were either diabetics or had diabetic children / family members so they were already comfortable and well versed with the process. Never-the-less, it's not something that I'm as comfortable with as delegating an epipen. Perhaps if the intranasal glucagon becomes the norm, I'll feel better, but as I don't know much about that, I can't say for sure.

We got intranasal glucagon recently. thankfully havent had to use it but feel better having it because it will be easier and faster to administer if we really need it.

Kooky Korky, BSN, RN · Mar 26, 2021

On 3/24/2021 at 6:08 PM, peaceful2100 said:

Yeah, apparently they do not understand the importance of hiring a nurse for after school program especially since I am in a state where tasks can be delegated to unlicensed personnel. I am really at a lost here. It makes me feel incredibly uncomfortable.

What does your Supervisor say?

You can't just take it upon yourself to stay late, especially if unpaid. You might not be covered by insurance if you work for free.

I think you should speak up to the people in charge and let them know your concerns.

I wonder why you would quit without taking this reasonable and vital step.