National Nurses United

NewsBriefs:Dec 2 12/18/08 10:54 PM Page 4 NewsBriefs Unlicensed Staff Cannot Give Insulin Injections to Students CALIFORNIA n a critical ru l ing protecting the safety of California schoolchildren and the registered nurse scope of practice, a superior court judge decided Nov. 14 that unlicensed public school employees cannot administer insulin injections to diabetic children. The decision reversed an agreement settling a lawsuit between the California Department of Education and the American Diabetes Association in which the association argued that schools were not meeting I their duty under the Americans with Disabilities Act to provide care for disabled diabetic students. Under the agreement, any school staff volunteer who received training could administer insulin shots to students. After the state adopted the new rule, the California Nurses Association/National Nurses Organizing Committee, along with the California School Nurses Organization and the American Nurses Association, all sued to block it, arguing that letting unlicensed personnel give insulin to students denied them the proper medical care they deserved at school, and also circumvented state laws which clearly state that only licensed nurses or physicians can administer medication injections such as insulin. Moreover, CNA/NNOC argued that it's against the law for RNs to train unlicensed personnel to 4 REGISTERED NURSE violate their own scope of practice. The court sided with the nurses groups. "If that student was a patient in a clinic, or hospital, or even a prison, the law says that a licensed nurse would need to give the insulin," pointed out Deborah Burger, RN and member of the CNA/NNOC Council of Presidents. Burger is a diabetes case manager for Kaiser Permanente in Santa Rosa. "So why is it okay for any random person with some training to adjust and administer insulin just because the setting is a public school? You're really setting up two levels of care, basically a lower level for kids at school." Burger added that insulin is just one drug; the ruling underscores the importance of having enough trained medical providers at schools to administer the various kinds of medications children take these days and to care for their overall health. Nancy Spradling, executive director of the California School Nurses Organization, wholeheartedly agreed, saying that her group's members are handling increasingly complex and chronic medical conditions, including asthma, epilepsy and other seizure conditions, severe allergies, adrenal insufficiency, and other genetic disorders. Her group estimates that, on average, about onequarter of any given student body is attending school with a chronic illness. "Our position is that these kids need safe care at school, period," said Spradling. "It is the school district's responsibility to provide that safe care." Across California, about 15,000 schoolage children have Type I diabetes for which they take insulin shots, but somewhere between 1,500 and 2,800 nurses work in the 9,800 public schools across California. According to Spradling, the state does not keep accurate track of numbers of certified, registered school nurses since the figures are self-reported by schools. Older students often learn to test their own blood sugar and take insulin, but younger students and stuW W W. C A L N U R S E S . O R G dents with special needs require help. The state, the diabetes association, and some parents have criticized the ruling as unworkable given the shortage of school nurses and budget crisis in public schools, but Burger replied that their argument was as weak as the hospital industry's argument against implementing minimum RN-to-patient staffing ratios in 2004. "They're saying that just because it's difficult, there should be no standards or lower standards for these kids?" she asked, noting that hospitals figured out a way to hire more nurses when they were required to do so under the ratio law. "Schools will do the same." Insulin is considered a "high alert" medication and an overdose can lead to multiple complications, including death. Many variables influence the amount of insulin needed, from correctly reading current blood sugar levels to understanding what a child is planning to eat. School lunchtimes are chaotic, and Spradling said she is aware of too many documented cases of school secretaries and other staff confusing insulin with glucagon, a medication approved for emergency use only in schools when a student's blood sugar dips so low that the child is in danger of going into a coma. Many school employees do not want to administer medications to students, but are simply told or even bullied by the district to do so, said Spradling. Burger also imagined a scenario where a child received insulin based on a lunch menu of a hamburger, fries, and milk. "But what if the cafeteria ran out of fries, and the child only eats half the hamburger, or eats the patty and throws away the buns? That child could have an insulin overdose," said Burger. The school needs a school nurse on site to handle medical situations that don't go according to plan, both said. "Let's take this a step further," said Spradling. "First we let the unlicensed staff give insulin, then we decide, hey, we don't need nurses at all. We'll just let the school secretaries diagnose a broken bone and set it. Where does it end?" —lucia hwang DECEMBER 2008

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