Unlicensed School Personnel Administering Insulin

allnurses Guide · May 30, 2013

Yep. Totally aware. The California branch of the ANA keeps me informed; NASN (National Association of School Nurses) and the California branch also keep me updated. Our county school nurses also meet up once a month and are aware.

Here's the deal - regardless of the outcome, this will go to the Federal Supreme Court so it won't be solved for awhile.

Right now, I work 3 days a week for the entire district. I am available those days for one student in 1st grade with a pump and I give the insulin at lunch. Otherwise a paraprofessional (aide) watches over him throughout the day and the teacher is trained to notice signs and symptoms. The PP can test his BG and respond with water/no recess for highs and give 15 gms of carbs for lows. The mom comes to school 2 days a week to give insulin. We have a nurse who is available the two days I'm not there to give insulin - she comes for 3 hours each day.

We have two diabetic students in junior high. One with a pump handles it on his own. The other with insulin given by syringe does his own but must be supervised by the secretary in the office.

I'm torn because this is so difficult. We are very lucky in our rural area to so far have just 3 diabetic kiddos. Last year we had 4 but one moved. In the less rural part of our county, it is mostly the parents who have to come in and give the insulin. Or their designee. And we work hard to get the kids to be able to do this by themselves with only supervision at first.

allnurses Guide · May 30, 2013

http://nursingworld.org/HomepageCategory/NursingInsider/SchoolNurse-California.html

http://www.mercurynews.com/opinion/ci_23338551/california-supreme-court-should-forbid-unlicensed-school-employees

squidbilly · May 30, 2013

It seems to me that allowing unlicensed personnel to administer insulin would create a big risk of liability on the school's part. Ok, so blood sugar checks and sliding scales and insulin administration might be simple enough, but will non-nursing school staff know how to handle other aspects of diabetes medical management? Will they recognize signs of highs and lows? Know how to handle a dosage error? Know how to intervene in an emergency? There's a lot more to managing a pediatric diabetic than insulin administration. Even my students who self-administer their insulin require RN supervision to so - per MD orders! And in a hospital setting insulin administration requires a second RN to witness proper dosing! They may try to make it look like they are putting our children first, but to me it seems like they would rather not pay an RN to do the job.

Okay, there's my rant, please don't judge me too harshly for it.

I am all for advocating autonomy for my patients, and my ultimate goal is to smoothly and slowly transition my pediatric patients into managing their own care. I provide them with increasing responsibility that is appropriate for their developmental level. I have a sixth grader that is (finally) pretty much completely independent in self-care. The little one's require more help, of course. Will unlicensed staff be patient educators?

And lastly, I often feel as though this law is (sadly) my job security. I, like many other school personnel, fear lay-offs or having my hours cut. But as long as there are students with diabetes at my school then I have a job and all my students have regualr access to a healthcare professional and patient advocate.

allnurses Guide · May 30, 2013

Even health aides/teacher's aides/yard duty/ cost the district money and you can't ask the teachers to take on this responsibility as they have too much on their plates now anyway.

One of the reasons the teacher's union here is against letting unlicensed folks do this.

mc3, ASN, RN · May 30, 2013

I've worked at my elementary school for 3+ years, and have UAP's cover for me if I'm out. It includes giving insulin and it's worked well for me. The UAP's attend a special medication training class. The District nurse reviews the care plans in detail with each UAP. Our students have always used pens, and a 2 person check is done before giving the med. They also have counted carbs for coverage, and have no problems with the FSBS.

It has worked out fine - I've had a range of students from stable diabetics, to unstable all over-the-place diabetics, to students with pumps. Everything has gone OK so far! The principal is the one who determines who is to be trained as a UAP, but if I had concerns I know she would defer to me. I've been lucky, I guess. The UAP's that work with me are smart and understand exactly what needs to be done. I've never heard the teacher's union here is even concerned about it. The teachers have nothing to do with it.

mc3:nurse: