Unstable Diabetic

Jolie, BSN · May 22, 2014

Maybe her mother could chaperone and take some responsibility for her daughter's care on a field trip... to a waterpark...I know nothing about Ca or school nursing, but to have a school nurse become a student's personal nurse for a field trip to a water park sounds a bit ridiculous. And expensive.

Some parents are willing to do this on "special occasions" but federal law prohibits (public, and private under some circumstances) schools from requiring parents to provide care to their children during the school day. It's all part of making a public education accessible to all.

Sending a nurse to be available 1:1 for a student IS expensive and burdensome, especially if a sub must be hired to stay at school with the remainder of the student body. That's why these issues should be considered when field trips are planned.

And at risk of sounding like a fuddy-duddy, a water park field trip? Really? It's even more unpalatable that taxpayers (if this is a public school) are footing the bill for a nurse to escort a student on a field trip with absolutely no educational value and high liability potential.

schooldistrictnurse · May 22, 2014

The legal reference is that a school acts "in loco parentis" or "in the place of the parent." The student should be given the same level of supervision on a field trip as in the school building. Therefore, if the student checks in with the health professional every four hours, then the same should hold away from the school building. If it is believed the environment requires more frequent monitoring, then every two hours. You won't be in line with the student just as you don't sit by her side in the classroom. You can offer the parent the opportunity to chaperone, but it is discriminatory to require it. In my State, a trained paraprofessional can act in this supervisory capacity and that's how we handle this kind of event.

Wave Watcher · May 23, 2014

In my district it is the Nurses responsibility to go. If a nurse can not go and a parent is not available then the field trip has to be cancelled for everyone. A child with disabilities can not be left out due to inability to provide care per our policy.

allnurses Guide · May 23, 2014

I have a diabetic student with a pump and I went on his field trip last week to a local nature reserve. The only other diabetics are in junior high school and take care of their own needs but this young man is in 2nd grade and not quite ready for that.

If I'm too busy we usually have mom go and she's fine with that.

I really think you or some other licensed professional needs to go with this student - or mom/dad/sis/uncle/aunt. Too unstable and could set you up for liability as the other posters are right - the school does act in place of the parent and the parents have the right to expect safe care of their student while in school. No matter what the activities.

Personally, I could see the value in the nature reserve as the children went to different stations by the river and learned about plants and animals.

But a waterpark is different - my own son will be going to a waterpark as well and this is just a fun reward. So I'd get the parent to go if I could. If not, I'd go.

Flare, ASN, BSN · May 23, 2014

it does stand to reason that if you can delegate out glucagon, that you would send that person to cover that student in case of an extreme low during a field trip. However, if those laws are anything like the laws i've seen in other states, they only allow for the administration of the glucagon. No testing to determine what blood sugar actually is... (this is why on some levels i have an issue with this.. but that's another topic for another day)

That being said, i don't think it really matters whether they are at the water park or the Capitol building. The point is that there is a trip and this child needs to have a coverage figured out for her because it's pretty apparent that with dropping as low as 44 that she is not stable enough to be left completely independent. The only thought with the aspect of a waterpark is that with the added running around, it is more likely that she may drop at some point. My perspective is that the district made the decision to allow the field trip, so they have to provide the medical coverage - if the parent is willing to go, then perhaps the district gets off the hook this time, but they need to realize that they can't force the parent. I don't think in a case like this that a delegate or the on site EMS is sufficient enough.

allnurses Guide · May 23, 2014

I agree Flare. The paraprofessional (fancy word for aide) is trained to check blood sugars and also glucagon and is part of the IEP team so to speak. So is the individual teacher, yard duty, bus driver, but they must have a current CPR card. It is a tricky situation here in CA as the legislature ok'd an unlicensed person being able to be trained to give insulin as well. Plus the ever controversial PR med for a seizure. All fought by nurses unions and teachers unions by the way and I can find NO teacher or para who wants to be trained in either.

This kiddo is unstable - and will be at a waterpark - where drowning can happen in an instant.

OldDude · May 23, 2014

I agree Flare. The paraprofessional (fancy word for aide) is trained to check blood sugars and also glucagon and is part of the IEP team so to speak. So is the individual teacher, yard duty, bus driver, but they must have a current CPR card. It is a tricky situation here in CA as the legislature ok'd an unlicensed person being able to be trained to give insulin as well.

I hear ya....we have that law here too....some bright bulbs in the Texas legislature think you can send an office aide to a 1 day class and they instantly morph into having the ability to manage a type 1 diabetic.

allnurses Guide · May 23, 2014

I hear ya....we have that law here too....some bright bulbs in the Texas legislature think you can send an office aide to a 1 day class and they instantly morph into having the ability to manage a type 1 diabetic.

Ha! We school nurses are supposed to train them. So far, most of the nurses I know are not doing that.

It is scary to think it could come back to bite US if THEY make a mistake.

100kids, BSN, RN · May 23, 2014

If this trip was happening at my school I would be going with this child on the trip and the rest of the school with have a sub nurse for the day. Legally I can train someone to administer glucagon but not insulin or even do bg testing. Our school would ask the child's parent to go as a chaperone and hope they would but if they can't either I would be going or no kids would be going. This is not an easy area to deal with at all.

As a side note: When I was in High School we had a field trip to an amusement park. It was part of physics class. We had a sheet of problems we needed to solve at the park and when we were done we were free to do as we wanted. We had to get info from the rides to solve some of the problems. It was a cool trip and showed us physic in the real world not just in a classroom. I don't know the reason for this trip but just saying it can be educational.

JenTheSchoolRN, BSN, RN · May 23, 2014

I'm with 100kids. Even if I did train a teacher to given glucagon, given this student's unstable BG history, I'd want to be on that trip. Plus, training a teacher to use glucagon and having them give it are two very different things - most of the teachers I know would take one look at that student's glucagon kit and freeze, then ask me to come on the trip :).

coughdrop.2.go, BSN, RN · May 23, 2014

I would totally go on this trip to support the student. If the student's parents can't go then, you would have to. Otherwise if the student cannot go the trip is off for everyone.

Also, if you need a non-licensed volunteer to administer the medication (aka not in their job description), in order to obtain volunteers you have to send an email out to everyone in the entire school. Just like with Diastat, you cannot require a volunteer to administer the medication. Again, if no one steps forward, yourself or the School Nurse would have to go.

And why so much un-love for the waterpark? :confused: I think it's an awesome trip for the end of the year and keep in mind that students still have to send money to go on these trips and if the school is like any of the ones I've been to or worked it the field trip funds are usually money from the PTA or other money raising events.

coughdrop.2.go, BSN, RN · May 23, 2014

This is according the New Glucagon Training Standards for School Personnel from the California Diabetes Program website

According to Section 49414.5 of the California Education Code, school districts may train school personnel who volunteer to provide emergency medical assistance including the administration of glucagon, in accordance with a health care provider’s written statement and the standards established pursuant to this statute, to students with diabetes experiencing severe hypoglycemia in the absence of a credentialed school nurse or other licensed nurse.
The school nurse, when available, is the most appropriate person in the school setting to provide care for a student with diabetes. However, many schools do not have full-time nurses. Even for schools that do, the nurse may not always be available during the school day, during extracurricular activities, or on field trips or other school sponsored events to assist with emergency care, so pursuant to Education Code Section 49414.5, trained non-medical school staff members may be trained to provide care to pupils in the event of severe hypoglycemia.
School personnel who do not volunteer or who have not been trained to administer emergency medical assistance may not be required to provide emergency medical assistance.
Training of school personnel for this purpose must be given by a physician, credentialed school nurse, registered nurse or certified public health nurse. The trainer shall document the training and provide periodic review or retraining a
minimum of one time per year.

New Glucagon Training Standards for School Personnel