Diabetic Kids, All Kids, and School Nurses

Much to the relief of many parents whose children have diabetes, the California Supreme Court ruled recently in American Nurses Ass’n v. Torlakson that insulin shots can be administered by school personnel who volunteer and get trained for the job. School nurses, the court ruled, are not required under state law. That’s a good thing for the kids who attend the 95% of California public schools that have no fulltime school nurse. It’s good for their parents as well, since some schools were telling parents to come to school to give their kids their shots, something most employed parents had difficulty doing without upsetting their employers.

But to say, as the American Diabetes Association does, that the decision should make parents of diabetic kids feel confident that their child is in good hands at school is a bit of an overstatement. Whether they can get a routine shot of insulin isn’t the only health issue that kids with diabetes face during the school day. Some will face emergency health issues specific to diabetes, including hypoglycemia and hyperglycemia. Sometimes, it may take someone with medical training to know whether a shot should be administered at all or if it’s time to do something else, such as calling the ambulance. Diabetic kids also face health issues that other kids face. Like other kids, they fall off of climbing equipment and run into each other, and they may need to be assessed for concussions. Like other kids, they may get too hot when their team is practicing in hot weather, and someone with training will know best whether to get emergency medical care.  Like other kids, they may get sick at school and need to be assessed for whether they need an hour on a couch or a call to a parent. Just as important, someone needs to figure out if it’s time to sound the alert about a communicable disease at the school.

The California legislature apparently decided that school nurses aren’t necessary because of the expense. And indeed it may be difficult to justify spending money on nurses when paying for teachers sometimes seems like a luxury. But what the parents of those California kids with diabetes know, as does the American Diabetes Association, is that a nurse is a better and safer alternative for the kids than a volunteer staff member, even one who is trained. Looking carefully at the diabetic kids, further, helps us understand that school nurses are a very good idea for all of the kids, not just those with chronic conditions. This happens a lot when a person has a disability – solving that person’s problem can improve the lives of others. (Think about curb cuts for wheelchairs the next time you’re pushing a stroller or pulling a piece of luggage on wheels.) All parents, not only those with diabetic kids, need to have confidence that someone at the child’s school is capable of paying attention to serious medical issues. It’s a good issue for parents to join together to solve.


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5 Responses

  1. Well, this is a good move led by the schools and the American Association of Diabetes. I don’t see a problem on this, however; it is imperative that extensive training should be conducted to avoid worse problems to surface.

  2. AP says:

    Plus, this will only work if teachers volunteer for the additional training. But, what’s the incentive? I’m sure the additional training looks good on the teacher’s resume, but I doubt it comes with a salary increase. I hope the teachers are granted immunity from liability that may arise from administering the shots.

  3. Kate Shinberg says:

    There are many reasons that every school needs have a full-time Nurse, and this article speaks to just one of the important ones. Anyone can be trained to give a SubQ injection, but there is more to giving insulin than just aiming a needle.

    As the author points out, hyper & hypoglycemia are potentially severe consequences of chronic diabetes. A child could have symptoms ranging from chills, nausea & vomiting to syncope and even something as serious as a seizure. Recognizing the progression of a medical emergency takes more than the training needed to administer an insulin shot- it’s something that’s honed over the years by working medical professionals. I am still learning how to best assess deteriorating patients and I’ve been a Nurse on a critical care oncology/hematology unit for a year.

    School Nurses are a great asset that unfortunately are a limited presence in our educational system. This discouraging reality exists for a variety of reasons and most likely will not be changing any time in the near future. Therefore, due to the fact that School Nurses are a rare resource and funding is virtually unavailable, there needs to be those in the school system that are medically trained in some respect. Whether this a secretary who knows how to administer an inhaler or a teacher who can take a blood glucose and give an insulin shot- additional education is a fundamental necessity.

  4. anon reader says:

    I don’t know which part of “it’s expensive; money is scarce; we need to prioritize our spending” you do not understand. Yes, it’s awesome to have sidewalk curbs for the very rare occasion I need to drag my suitcase, but the costs of this luxury are prohibitive, so I’d happily push and kick my suitcase a few times for the privilege of having lower taxes or having the money spent on other, more valuable to me, projects.

    Same with nurses and diabetic kids. Nurses are very expensive. They are not doing a lot of work, given the schools’ paranoia about liability and the trend to push most medical care to emergency rooms or other, non-school, providers of care. So, the value of having full-time nurses is very limited. Yes, they are valuable to diabetic kids and kids with a few other serious illnesses, but those are few, and they are likely better cared by other professionals outside the school. To the most part, full-time nurses are the luxury that isn’t necessary and cannot be afforded, and therefore the exclamations of the sort “isn’t it really nice to have this and that luxury!” aren’t very helpful.

  5. Danielle Citron says:

    KCz, Thanks so much for your thoughtful, as always, post. School nurses are as fundamental to learning as good nutrition and books, by my lights. Providing these sorts of services are no luxury–they can be life and death for the one million Type 1 diabetics attending schools.