School nurses and Insulin

schooldistrictnurse · Aug 17, 2011

Here's the explaination I have about the med error. If the UAP (unlicensed assistive personnel)

gives the med in accordance with the parameters set down by the professional, then there should not be any errors. Back that up with a phone call in case something doesn't look or feel right or if there is any question. So the way we treat this in my district is with extensive 1:1 training, thorough written guidelines, and phone availability at all times. Then there is quarterly observation of the UAP to be sure procedures are followed.

No, it is not ideal. Yes, some states require an RN to do insulin.

allnurses Guide · Aug 17, 2011

I live in California which is why I linked that particular story.

We have two kindergarten children coming to separate elementary schools. One got a pump this summer. Both have very motivated parents.

The one with the pump was coming in to (walking in) preschool to care for her child and his insulin needs but the elementary school is too far for her to walk. And she has no car. So, we have to figure out something - one of the options is having a bus go pick her up and take her home. I'm only at work the equivalent of three 8 hour days and on my days off I work another job so there is no way to always have phone access. And there are more than 10 campuses in my district. The other child's parents will be able to come to the school and administer the insulin.

Very complicated to manage this issue here in CA. I'm lucky in a way as we are a small district with under 10 diabetics. Larger school districts with part-time nurses have more diabetic students. Not to mention all the other health issues with kids.

schoolnurse09 · Aug 17, 2011

It is no surprise to me that a non-medical group of people are making medical decisions. What else is new? As an elementary school nurse I refused to delegate injecting insulin to unlicensed persons at school. By law in the state of Nebraska, it was up to me whether to delegate that, or not. If I had delegated it, I would have been responsible for the training and supervision of that person. It was my argument that (in my case) it was not in the best interests of the student (nor did I feel it was safe) to delegate this responsibility. Not to mention that the would-be delegate did not want to do it, and they would have to agree. I do realize that there may be cases where this is entirely safe and do-able.

allnurses Guide · Aug 17, 2011

So, how do YOU handle giving insulin? Are you there all the time?

schooldistrictnurse · Aug 17, 2011

I am the only nurse in my district of 2600 students, half time. 3 elementary schools, one middle and one high. A school nurse is not mandated in my state, some districts don't have any. The thing about having the student travel on the bus is that you are taking away from educational time and every child is entitled to free and appropriate education. Does that plan restrict that? Maybe. I guess I'd prefer a trained staff member assisting the child in the back of the classroom in terms of the child's education. Our educational aides can't refuse to do medical tasks--it's written as part of the job description. Tough situation no matter how you handle it.

allnurses Guide · Aug 17, 2011

No, we go pick up the mom in our school bus and bring her to the school and then take the mom home. The student is a boy. :coollook: Sorry that wasn't clear.

NurseLoveJoy88, ASN, RN · Aug 17, 2011

I worked as a UAP in school health, my formal title was school health assistant and yes we did give insulin.

Ofcourse in a perfect world the LPN/RN will give the insulin but its not reality.

I was always sure to use the five rights and call my RN supervisor if I had any questions. I also had to take a med tech course ( which I know isn't very long) and demonstrate proper administration of insulin to my supervisor.

I understand your concerns too, trust me.

schoolnurse09 · Aug 18, 2011

Oh sorry, I forgot that part.... I traveled between schools... Luckily, I had 15 minutes between lunch times for the students, so I could go and take care of them myself. I had back up from another school nurse, or parent coverage when I could not be there. I know this would not work for a lot of schools. California is just California...I am from there, so I know how things can be with budget issues and schools.

HazelLPN, LPN · Sep 4, 2011

Our school nurses are unionized and have the same contract as the teachers. They are strong advocates for students. The only person who gives meds is the school nurse who is always an RN and has a license with the department of education...or an assistant school nurse who is an RN without the license from the department of ed or an LPN. As our unions are now in jeopardy with the current state administration, I can see where nurses could be the first to go if the unions are stripped of their power. The best advocates for student heath are our school nurses, not politicians trying to blame the middle class unionized teachers and school nurses for the financial damage caused by the greed of CEOs and Wallstreet bankers.

Nursingmom25, ADN, RN · Sep 7, 2011

I am a Health Clerk and my students inject their own insulin. I count the carbs, do blood sugar etc...I call the RN with ALL blood sugars and verify how much insulin before the student administers it. That's how it works in our district...:)

Arnu · Sep 29, 2011

For those that are making the parents come to school (which is illegal, the school MUST provide someone to take care of that child while they are at school, making the parent come in is wrong). What happens when there is an emergency? Do non medical people know how to deal with low blood sugar, what about high blood sugar, or a hypo that makes the child pass out, what about glucagon? Not have a TDP in a school where a nurse just simply isn't avaliable is scary.