Teacher is giving diabetic students candy and principal is disseminating student health information-what should I do?

Dear Nurse Beth Advice Column - The following letter submitted anonymously in search for answers. Join the conversation!

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I am struggling with this incident that has been recurring. I work as a school nurse and have a diabetic student. A few days ago, one of her teachers gave them candy without telling me, even though I gave instruction out to that teacher and all the syudents teachers not to do that. It happened again, but this time, I was unaware that this was one of her teachers and fortunately, the student told me before eating the candy. I sent an email to the principal asking for guidance on how to deal with this without unnecessarily exposing the students health information to staff who don't need to know, but the principal sent the information to everyone who works in the school. I'm unsure of what to do in this situation, or if I need to report anybody for this health information exposure and putting this student at risk. I would really appreciate some advice on what to do.

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Specializes in Tele, ICU, Staff Development.

It sounds like you're in a challenging situation, and understandably, you're feeling uncertain about handling it.

Diabetes Management

Many schools have eliminated treats in the classroom and replaced them with non-food gifts, rewards, or privileges. You may want to advocate for such a policy.

It's good that the student informed you before consuming the candy. It's crucial for them to manage their diabetes and have a diabetes management plan in place. Even if the regular teacher is knowledgeable and follows the plan, there may be instances where a substitute teacher is not aware or compliant, and the student needs to know what to do in that situation.

I don't know how old your diabetic student is or if they are a Type 1 diabetic, but some insulin-dependent diabetics are managed on a carb-counting basis and are allowed occasional additional carbs as long as they are covered with sufficient insulin.

  • Request training. Ask for (or provide) additional training or workshops for school staff on supporting students with diabetes and the importance of following medical protocols. This could help prevent similar incidents from happening in the future.
  • It's a team effort. Has the family provided a copy of the diabetes management plan? Schedule a meeting with the family, teacher, and principal to ensure everyone is on the same page. 

Sensitive Health Information

Did the parents consent to the release of information? Here are some steps you could consider:

  • Documentation. Keep detailed records of the incidents that have occurred, including the dates, times, and individuals involved. This will be helpful if you need to escalate the issue.
  • Review school policies. Check existing school policies and procedures regarding the handling of sensitive health information. Make sure to reference them in your discussions with the principal.
  • Communicate with the principal. Schedule a meeting with the principal to express your concerns about disseminating the student's health information. Explain the importance of confidentiality in managing the student's condition and how it impacts their safety.
  • Consider reporting. If you believe disseminating the student's health information has put them at risk or violated any privacy laws, you may need to consider reporting the incident to the appropriate authorities, such as the school board or relevant regulatory bodies, but first, educate yourself. 

Here's an article on Data Sharing Guidance for School Nurses.

Here's an excerpt and link to another article, Data Privacy in School Nursing:

Can a list of students' health issues be distributed to teachers or other staff?

A global transmittal of students' health issues that contains identifiable, personal information is not permissible under privacy laws and does not constitute best practice. (aggregate or de-identified health data may be shared. However, disclosure is permitted to school officials with a legitimate educational interest, as defined by the school or school district. A "legitimate educational interest" generally refers to individuals in the school district who need to know the information in the student's education record to perform their professional responsibilities. If a school accepts no funding at all from the U.S. Department of Education (e.g., a private or religious school) and qualifies as a covered entity under HIPAA, the HIPAA standard would apply instead. T at is, a list of student health issues could be distributed without authorization to other health care providers for treatment purposes or other covered entities to facilitate payment for services.

Advocate for the student. Throughout this process, keep the student's best interests at the forefront. Advocate for their safety and well-being and ensure that any actions taken are in their best interest.

Don't hesitate to seek support from colleagues, mentors, or professional organizations, such as the National Association for School Nurses, who may be able to offer guidance or assistance in navigating this situation. They have resources about data privacy laws.

Remember that you're acting in the student's best interests; addressing these concerns is essential for their safety and well-being.

Best wishes,

Nurse Beth

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