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Saving Lives and Changing Laws: The Story of One School Nurse and Glucagon

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Specializes in Nurse Case Manager, Professor, Freelance Writer. Has 20 years experience.

What would you do if the law stood between you and the life of your patient?

Two Illinois nurses faced this exact situation last year. Find out what they did and how one has been working to change the law so that this doesn't happen again.

Saving Lives and Changing Laws: The Story of One School Nurse and Glucagon

Have you ever been faced with a situation where you had to make a life or death decision knowing that it could jam up your license or even cause you to lose them? Jennifer Jacobs, a Registered Nurse, working in a public school made a challenging decision last year when a seventh-grade student who had diabetes came to her office during lunch with low blood sugar.

When the student entered the school nurse's office, she was greeted by Heather Wengler, LPN who jumped to action. Jacobs was at lunch at the time, but returned and began assisting within a few minutes. The two nurses gave the student food and glucose tabs only for her blood sugar to continue to drop. At one point, the student fell to the floor and went unconscious. Jacobs told the Tri States Public Radio, "[She] wasn't seizing but was tremoring, and her eyes were rolling back in her head….." Jacobs gave a dose of glucose gel. However, because the student was drooling, it ran right out of her mouth.

This is when the two nurses conferred with one another and decided to make a difficult decision. They knew the student needed a dose of glucagon, but this particular student didn't have the drug in her supplies. However, another student did. And, in the state of Illinois, glucagon isn't a drug that schools keep in stock for nurses to give following a standing protocol.

Glucagon Dose

Jacobs told the news channel that she knew giving the drug might mean losing her license and placing the school district at huge liability risk. She also knew that the other option was to do nothing and risk the student slipping further into the hypoglycemic episode, seizures, breathing difficulty, and ultimately death. She made the split-second decision that was confirmed by Wengler to take the glucagon from the other student's supply and administer it to the student in distress. Paramedics arrived and delivered a second glucagon dose on the way to the hospital. The student made a full recovery, and the school replaced the dose of glucagon to the student for which it was ordered.

You might think this story ends here. However, Jacobs knew that she needed to do something about this law that left her placing herself in jeopardy to do the right thing for the student. She contacted her state representative, Michael Halpin of Rock Island to discuss the possibility of changing the law to add glucagon to a list of other drugs that can be given per a standing protocol. These drugs include an EpiPen for allergic reactions, Narcan for opioid overdoses, and an inhaler for asthmatic episodes. Halpin agreed to help with the legislation which has now cleared the house and will soon be heard in the Senate. So far, the proposed law has been met with unanimous approval.

The most impressive part of this story isn't that Jacobs gave the medication. It's that she recognized a barrier to care, took the risk, and then refused to sit back and allow this to be another Illinois school nurse's dilemma in the future. She acted with quick and just decision making to see what more she could do.

Have you ever been faced with a similar care issue where you had to decide between "right" and "legal"? If so, we would love for you to leave a comment and let us know about the situation, how it turned out, and if you would do it again. If you have never been in a similar situation, share your thoughts on Jacobs' and Wengler's actions.

Would you have done the same or do you think they should have acted in another way?

Melissa is a professor, medical writer, and business owner. She has been a nurse for over 20 years and enjoys combining her nursing knowledge and passion for the written word. She is available for writing, editing, and coaching services. You can see more of her work at www.melissamills.net.

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10 Comment(s)

JBMmom, MSN

Specializes in Long term care; med-surg; critical care. Has 6 years experience.

Thank goodness for the quick thinking of these nurses, I hope there are no negative actions against them for what they did. And to follow it up with working towards making changes that could help other students as well is wonderful! Thanks to Ms. Jacobs for her efforts in improving the life and health of her students, and others that will benefit.

tnbutterfly - Mary, BSN, RN

Specializes in Peds, Med-Surg, Disaster Nsg, Parish Nsg.

Great story, Melissa. I'm glad these school nurses acted in the best interest of the student. Jennifer Jacobs went even further with this paving the way for safety for other diabetic students. Nurses can be and are great change agents.

traumaRUs, MSN, APRN, CNS

Specializes in Nephrology, Cardiology, ER, ICU. Has 27 years experience.

Not as of now. I did look her up and she currently has an active RN license. However, (and a big however) IDPFR can still come after her with a complaint since she did this BEFORE the law was changed.

I say Bravo! Saving a LIFE is more important than letting someone die. If she were to lose her license I believe she could live with herself not being a nurse any longer than living her life knowing that because she did not act someone (in this case a child) died. Bravo that she has worked to get the glucagon on the list for school nurses. Also she should have the support of the parent(s) of this child and the child's doctor since they failed to have a prescription available for this BRITTLE diabetic. IMHO.

traumaRUs, MSN, APRN, CNS

Specializes in Nephrology, Cardiology, ER, ICU. Has 27 years experience.

I’m very familiar with this school. EMS is only a few minutes away

Sneech11, LPN

Has 28 years experience.

If the student had been presented to me with severe hypoglycemia symptoms described I would have first called 911,then grabbed the nearest glucagon injection I could get my hands on,protocol and laws be damned. That just what a nurse does,personal feelings aside. I figure karma will take care of the rest.

LPNinGH

Specializes in Urology, med/surg, 1:1 school nurse. Has 10 years experience.

Way to go, Jennifer and Heather! And extra kudos for pursuing changing the law.

I am a nurse in a school district. There is no reason for schools not to stock Epi-pens, glucagon, Narcan, and rescue inhalers, and lack of funding is included as an insufficient reason. On the same note, however, parents need to be held equally accountable when events like this occur unless a child was undiagnosed until a scary event occurred. Parents need to step up to the plate and provide these medications BEFORE the first day of school, along with hard copy orders for these medications signed by their child's provider. This is the biggest bugaboo at the beginning of the school year. Parents repeatedly get upset that their kids can't go to school without these emergency medications properly supplied in the school's health room. The same with any students who are allowed to self-carry. There has to be a parent's note that Polly Pupil can carry Advil. In my school district, older students are allowed to carry only enough of the medication for one day and it has to be in the original packaging. We have our students put the container and a copy of the parent's note in a ziplock bag in the event a teacher or other administrator unfamiliar with the student asks for proof it is allowed.

Our district nurses send out letters at the end of the school year notifying/reminding parents to take care of immunizations and doctor's appointments over the summer in order to obtain current med supplies and orders in anticipation of the next school year. Another letter goes out midsummer and another letter a few weeks before school starts. These same notices are posted on the parent portal at the district website and on all registration materials, both online and on paper. How this remains such a problem is beyond comprehension. Whoops...off on a bit of a tangent...

These nurses should be winning awards for heroism. I'm so proud of them for having the cojones to do the right thing!

traumaRUs, MSN, APRN, CNS

Specializes in Nephrology, Cardiology, ER, ICU. Has 27 years experience.

Just an update:

EAST MOLINE — In the spring of 2018, a 7th grader with diabetes at Glenview Middle School went to the nurse’s office with dangerously low blood sugar levels. The student had collapsed onto the ground and was on the verge of seizing.

For school nurse Jennifer Jacobs, the situation posed a life-or-death dilemma.

The student needed glucagon, a rescue medication for students with diabetes. But the student didn’t have a prescription at the school. And the school didn't have an undesignated kit for general use. That's because it was illegal for a school to carry it.

https://qconline.com/news/local/this-east-moline-school-nurse-helped-pass-a-state-law/article_acdb6445-eb96-5276-a687-bdf14a770aba.html

Straight No Chaser, ASN, LPN

Specializes in Sub-Acute & Long-Term Care Nursing. Has 4 years experience.

I think (hope?) you'd be hard pressed to find a nurse who wouldn't have done exactly as this nurse did. My licence isn't worth a fraction of the life of a child.